2025 Stress MR III In DC: A Hands-On Workshop-Day 2 - Part VI: Clinical Applications of Stress CMR MBF

Video Transcription

Video Summary

The session focused on quality control, interpretation pitfalls, and clinical applications of quantitative myocardial blood flow and stress MRI/PET.<br /><br />Dr. Peter Kelman reviewed how to judge whether myocardial blood flow numbers are trustworthy. He emphasized checking image quality, ECG triggering, arterial input function shape, motion correction, segmentation accuracy, and whether adequate stress was achieved. He noted that errors during the bolus upslope and myocardial enhancement phase are especially harmful, while baseline or late-phase errors are often less important.<br /><br />Dr. Amadeo Cheriberi expanded on common failure points in quantitative perfusion, including inadequate stress, motion compensation problems, atrial fibrillation, arterial input function mis-segmentation, poor image fitting, and incomplete ventricular coverage. He stressed that automated pipelines improve reproducibility but still require careful quality review.<br /><br />Dr. Jonathan Lindner broadened the discussion beyond epicardial coronary disease, describing how abnormal rheology, thrombotic microangiopathy, and compressive processes can all reduce hyperemic flow. He illustrated this with examples including sickle cell disease, transfusion effects, TTP-like processes, aortic regurgitation, left bundle branch block, and hypertrophic cardiomyopathy.<br /><br />Dr. Mouaz Al-Mallat discussed lessons from nuclear cardiology, especially access, reader competency, scan efficiency, standardization, and the importance of adding atherosclerotic burden and body composition to flow assessment. He argued for short, high-throughput protocols and better clinical adoption of quantitative flow.<br /><br />Finally, Dr. Raymond Kwong presented several cases showing how MRI perfusion, LGE, and flow quantification can clarify complex disease, distinguish scar from ischemia, and reveal when low flow reflects inadequate stress, microvascular dysfunction, or true obstructive CAD.

Keywords

myocardial blood flow

quality control

stress MRI

PET imaging

perfusion quantification

arterial input function

motion correction

ECG triggering

hyperemic flow

microvascular dysfunction

coronary artery disease

late gadolinium enhancement

nuclear cardiology

image segmentation

clinical applications