SCMR Mid-Year Meeting: Myocardial Perfusion CMR-Stress CMR and Alternative Approaches

Video Transcription

Video Summary

The transcript covers a cardiac MRI session focused on first-pass perfusion and quantitative myocardial blood flow. Dr. Jennifer Jordan explained the basics of perfusion pulse sequences, emphasizing the key technical needs: strong T1 contrast, good temporal and spatial resolution, adequate myocardial coverage, linearity for gadolinium quantification, and artifact-free image quality. She reviewed historical and current sequence options, noting that saturation-recovery preparations are now standard, with readout choices such as SSFP, GRE/FLASH, and hybrid GRE-EPI depending on field strength, heart rate, image quality, and artifact tradeoffs. She then introduced quantitative perfusion, highlighting the need to measure the arterial input function and convert signal to blood-flow values. Two major quantitative approaches were described: dual-bolus and dual-sequence methods. Dual-sequence was presented as especially practical because it provides both visual perfusion images and pixel-wise quantitative blood flow maps.<br /><br />Dr. Saeed and Dr. Bandettini expanded on the clinical value of quantitation and coronary sinus flow reserve. They discussed how quantitative perfusion can improve confidence when visual reads are uncertain, help distinguish artifact from true ischemia, and detect diffuse disease, microvascular dysfunction, and multivessel ischemia. Dr. Bandettini showed that coronary sinus phase-contrast imaging is feasible in routine CMR and can add prognostic information beyond ischemia and late gadolinium enhancement.<br /><br />The panel and case reviews illustrated practical issues such as regadenoson timing, breath-hold versus free-breathing strategies, heart-rate considerations, sequence selection, and the importance of careful ROI placement and quality control. Multiple cases showed how quantitative perfusion clarified diagnosis in coronary disease, microvascular dysfunction, apical hypertrophic cardiomyopathy, and sarcoidosis. Overall, the speakers emphasized that quantitative perfusion is becoming more accessible and may significantly improve cardiac MRI practice.

Keywords

cardiac MRI

first-pass perfusion

quantitative myocardial blood flow

perfusion pulse sequences

saturation-recovery

SSFP

GRE/FLASH

hybrid GRE-EPI

dual-bolus

dual-sequence

arterial input function

coronary sinus flow reserve

microvascular dysfunction

regadenoson

late gadolinium enhancement