Advanced Cardiovascular Magnetic Resonance Myocardial Perfusion Imaging

Myocardial perfusion imaging with cardiovascular magnetic resonance (CMR) has been established as an accurate method for the detection of coronary artery disease (CAD) in single- and multicenter studies.1–4 In most previous studies, myocardial perfusion CMR data have been acquired in 3 left ventricular short-axis slices with an in-plane spatial resolution of 2.5 to 3 mm.1–4 In recent years, an array of techniques that can achieve faster scan speed by using spatial, temporal, or spatiotemporal redundancy of the data have been proposed.5–7 Applied to myocardial perfusion CMR, the faster data acquisition afforded by these methods has been used in different ways. Some authors have invested the speed-up to improve the in-plane spatial resolution of myocardial perfusion CMR to below 2 mm.8–12 The main benefits of such high-resolution acquisition include a reduction in dark-rim artifact and better detection of subendocardial ischemia leading to improved diagnostic performance.8,12,13 Other authors have used faster data acquisition to develop 3-dimensional (3D) myocardial perfusion CMR methods that provide whole-heart coverage.14–17 The main motivation for these developments is to overcome the limited cardiac coverage of standard perfusion CMR and to allow more accurate quantification of total myocardial ischemic burden.16 Furthermore, 3D perfusion CMR allows the acquisition of all slices at the same, optimized time point in the cardiac cycle, for example, the mid-diastolic or end-systolic phase, so that motion artifacts can be reduced and registration between slices improved.18However, both high-resolution and 3D whole-heart perfusion CMR have specific limitations, mostly related to the high-temporal undersampling that is used, and their potential clinical role remains undefined. This article gives a brief overview of the principles of advanced acceleration and compares the current evidence for both high-spatial resolution and 3D whole-heart acquisition in myocardial perfusion CMR.Accelerating data …