SCMR Mid-Year Meeting: Myocardial Perfusion CMR-Introduction to Quantification of Myocardial Blood Flow and Perfusion Reserve

Video Transcription

Video Summary

The transcript captures the opening of a stress CMR workshop focused on myocardial blood flow, perfusion reserve, and wall-motion stress testing. Organizers emphasize that the lectures are recorded, CME credit is available, and participant feedback will shape future meetings. They also stress the importance of society membership and advocacy for reimbursement and growth of CMR programs.<br /><br />Greg Hundley begins by reviewing dobutamine and exercise stress CMR. He explains practical requirements such as real-time imaging, safety protocols, staff training, rhythm monitoring, and dedicated workflow. He describes standard dobutamine protocols, the need to assess wall motion in multiple planes, and the role of gadolinium when resting wall-motion abnormalities are present. He also discusses treadmill stress CMR as a practical alternative in selected patients.<br /><br />Michael Salerno then presents the rationale for quantitative perfusion, linking it to the 2021 chest pain guidelines. He highlights how myocardial blood flow and flow reserve improve detection of multivessel disease, risk stratification, and evaluation of microvascular dysfunction, including ANOCA. He shows examples where visual interpretation underestimates ischemic burden and explains how quantitative perfusion can reveal more extensive disease.<br /><br />Peter Kellman provides a technical overview of first-pass perfusion mapping. He explains the signal-processing pipeline, motion correction, dual-echo acquisition, and physiologic modeling used to generate pixel-wise quantitative blood flow maps. He also notes related applications such as pulmonary transit time assessment.<br /><br />A panel discussion follows, addressing accuracy, reproducibility, normal ranges, artifact recognition, and how quantitative perfusion may be used clinically.<br /><br />The session closes with Michael Salerno and Greg Hundley presenting case-based examples of vasodilator and dobutamine stress CMR, illustrating infarction, ischemia, artifacts, viability assessment, and the importance of integrating stress images, LGE, function, and clinical context.

Keywords

stress CMR

myocardial blood flow

perfusion reserve

wall-motion stress testing

dobutamine stress

exercise stress CMR

quantitative perfusion

2021 chest pain guidelines

microvascular dysfunction

ANOCA

first-pass perfusion mapping

motion correction

gadolinium

late gadolinium enhancement

vasodilator stress