SCMR Mid-Year Meeting: Myocardial Perfusion CMR-Implementing Quantitative Myocardial Blood Flow and Perfusion Reserve into your Stress CMR Exam

Video Transcription

Video Summary

The session focused on how to make quantitative myocardial blood flow (MBF) and perfusion reserve reliable and clinically useful in stress CMR. Speakers emphasized that trustworthy numbers depend on careful quality control: checking respiratory motion correction, ECG triggering, arterial input function (AIF) quality, adequate contrast bolus capture, patient stress response, and correct segmentation, including RV attachment and sector orientation. Common problems included heavy breathing, PVCs, atrial fibrillation, adenosine heart block, poor coils/shimming, implantable devices, and misplacement of the AIF or segmentation errors. Poor function can cause slow bolus transit and noisy maps, though mean values may still be usable if the first pass is captured well.<br /><br />The discussion also showed how to interpret discordant visual and quantitative findings. Quantification can reveal diffuse ischemia, multivessel disease, or microvascular dysfunction when visual images look normal, but artifacts must be excluded first. The panel addressed practical issues such as injection rates, scanner speed, re-stressing patients when problems are correctable, and what clinical context should appear in reports.<br /><br />Case-based talks illustrated the value of stress CMR in INOCA, MINOCA, SCAD, lupus-related myocardial disease, and hypertrophic cardiomyopathy. Stress CMR helped identify microvascular dysfunction in women with angina and normal coronaries, detect small infarcts after SCAD, and characterize atypical or early HCM phenotypes. A recurring theme was that perfusion maps, when combined with source images and clinical context, can improve diagnosis, guide treatment, and uncover diseases missed by standard testing.

Keywords

stress CMR

myocardial blood flow

perfusion reserve

quantitative perfusion

quality control

respiratory motion correction

ECG triggering

arterial input function

contrast bolus

microvascular dysfunction

INOCA

MINOCA

SCAD

hypertrophic cardiomyopathy

diffuse ischemia