Technical advances and clinical applications of quantitative myocardial blood flow imaging with cardiac MRI.
The recent FAME 2 study highlights the importance of myocardial ischemia assessment, particularly in the post-COURAGE trial era of managing patients with stable coronary artery disease. Qualitative assessment of myocardial ischemia by stress cardiovascular magnetic resonance imaging (CMR) has gained widespread clinical acceptance and utility. Despite the high diagnostic and prognostic performance of qualitative stress CMR, the ability to quantitatively assess myocardial perfusion reserve and absolute myocardial blood flow remains an important and ambitious goal for non-invasive imagers. Quantitative perfusion by stress CMR remains a research technique that has yielded progressively more encouraging results in more recent years. The ability to safely, rapidly, and precisely procure quantitative myocardial perfusion data would provide clinicians with a powerful tool that may substantially alter clinical practice and improve downstream patient outcomes and the cost effectiveness of healthcare delivery. This may also provide a surrogate endpoint for clinical trials, reducing study population sizes and costs through increased power. This review will cover emerging quantitative CMR techniques for myocardial perfusion assessment by CMR, including novel methods, such as 3-dimensional quantitative myocardial perfusion, and some of the challenges that remain before more widespread clinical adoption of these techniques may take place.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115.
Bobak
B
Heydari
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115.
Raymond Y
RY
Kwong
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115. Electronic address: mjerosch-herold@partners.org.
Michael
M
Jerosch-Herold
D003326:Coronary Circulation; D053805:Fractional Flow Reserve, Myocardial; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000639:trends; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis
Cardiac magnetic resonance imaging; Coronary artery disease; Coronary flow reserve; Fractional flow reserve; Ischemia; Myocardial flow reserve; Myocardial infarction; Perfusion; Quantitative myocardial perfusion