Stress perfusion magnetic resonance imaging of the heart

Extensive research has documented that rapid imaging during the first pass of a magnetic resonance imaging (MRI) contrast agent provides good sensitivity to detect myocardial blood flow deficits caused by coronary disease, cardiomyopathies, or microvascular dysfunction in patients without obstructive lesions in the coronary arteries. The autoregulatory mechanisms of the coronary circulation serve the purpose of maintaining sufficient blood flow at baseline in the presence of flow-obstructing coronary lesions. Stress testing is most commonly used in this setting to determine the hemodynamic effect of coronary lesions in the epicardial arteries when the small-vessel resistance has been minimized by vasodilation. The protocols for perfusion MRI combined with vasodilation have been successfully tested in large patient studies. Besides the absence of any ionizing radiation, MRI offers the advantages of relatively high spatial resolution to detect perfusion defects limited to the inner layer of the heart muscle. Furthermore, MRI can be used for noninvasive quantitative measurements of myocardial blood flow that compare well with invasive measurements with labeled microspheres. Additional useful markers, such as the dynamic distribution volume, the delay in the arrival of the contrast agent in a myocardial region relative to the enhancement in the arterial input, and the capillary permeability-surface area product, may, in the future, further enhance the capabilities to characterize with MRI coronary atherosclerosis, coronary vascular dysfunction, and adaptive mechanisms in the coronary circulation, such as arteriogenesis, that reduce ischemia.