Quantitative Stress Myocardial Perfusion CMR-Quantitative Stress Myocardial Perfusion CMR

Video Transcription

Video Summary

This webinar on quantitative stress myocardial perfusion CMR was a case-based discussion led by experts from multiple centers. It highlighted how quantitative perfusion imaging can be used alongside cine imaging and late gadolinium enhancement (LGE) to evaluate ischemia, microvascular dysfunction, and alternative causes of chest symptoms.<br /><br />Four cases were presented. The first was a 56-year-old woman with atypical chest pain and coronary calcification with a moderate mid-LAD lesion on CTA, but normal CT-FFR, normal stress CMR perfusion, normal LGE, and normal myocardial perfusion reserve. The case emphasized quality control checks, including heart rate response, arterial input function, and segmentation accuracy before trusting the numbers.<br /><br />The second case involved a 78-year-old man with prior LAD and RCA stents and recurrent chest pain. Stress CMR showed apical aneurysm with LGE and clear inducible ischemia in the anterior territory. Quantitative analysis showed reduced stress myocardial blood flow, although the myocardial perfusion reserve appeared less informative because rest flow was low.<br /><br />The third case demonstrated a male patient with severe CAD and multi-territory ischemia on both visual and quantitative perfusion imaging, including a discussion of scanner vendors, dual-sequence versus dual-bolus acquisition, and the importance of checking for artifacts and mis-triggering.<br /><br />The fourth case was a 77-year-old woman with exertional dyspnea, patent coronary stent, and no obstructive disease on angiography. Her stress CMR showed circumferential subendocardial perfusion reduction consistent with microvascular disease.<br /><br />Across the session, speakers stressed that quantitative perfusion is becoming more practical, vendor support is expanding, and interpretation should combine raw images, maps, and flow values rather than relying on numbers alone.

Keywords

quantitative stress myocardial perfusion CMR

stress CMR

myocardial perfusion reserve

late gadolinium enhancement

ischemia

microvascular dysfunction

coronary artery disease

CT-FFR

apical aneurysm

quantitative perfusion imaging