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Updated: Dec 6, 2025

In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Non-invasive imaging techniques to assess myocardial perfusion
Olivier Villemain1,2,3, Jérôme Baranger2, Zakaria Jalal4,5
1Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto , Toronto, ON, Canada.
Insights
Noninvasive imaging techniques are advancing for assessing coronary artery disease and myocardial perfusion, offering crucial insights beyond traditional methods. New ultrasound and hybrid approaches show promise for future diagnostics.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Physiology
Background:
- Coronary artery disease remains a leading global cause of death.
- Invasive methods like coronary angiography are the gold standard for assessing myocardial perfusion.
- Noninvasive imaging is increasingly vital for therapeutic decisions and prognostication.
Purpose of the Study:
- To review recent advancements in noninvasive imaging for myocardial perfusion assessment.
- To discuss the diagnostic capabilities and limitations of various imaging modalities.
- To highlight emerging technologies in the field.
Main Methods:
- Utilizes various noninvasive imaging modalities: echocardiography, coronary CT angiography, MRI, and nuclear imaging.
- Enables assessment of coronary artery anatomy and microcirculation.
- Quantifies myocardial perfusion at rest and during stress.
Main Results:
- Noninvasive techniques provide valuable data on coronary artery anatomy and microcirculation.
- Quantitative assessment of myocardial perfusion is achievable with current technologies.
- Technological evolution is enhancing the role of noninvasive imaging.
Conclusions:
- New ultrasound technologies and hybrid imaging approaches represent the future of myocardial perfusion assessment.
- Noninvasive imaging plays a critical role in guiding patient management and prognosis.
- Continued innovation is crucial for improving cardiovascular disease diagnosis.
Introduction:
Coronary artery disease affecting myocardial perfusion continues to be the leading cause of cardiovascular morbidity and mortality worldwide. While invasive evaluation based on coronary angiography and flow measurements still is considered the reference technique for assessing myocardial perfusion, technological evolutions in noninvasive imaging techniques resulted in them playing a more important role in assessing myocardial perfusion influencing therapeutic decision-making and prognostication.
Areas Covered:
Different imaging modalities are used to evaluate coronary perfusion, including echocardiography, coronary computerized tomography scan, magnetic resonance imaging, and nuclear myocardial perfusion imaging. Through a combination of different techniques, it is possible to describe coronary artery anatomy and the diameter of the epicardial vessels but more recently also of the coronary microcirculation. Quantification of myocardial perfusion is feasible both at baseline and during pharmacological or physiological stress.
Expert Opinion:
The objective of this state-of-the-art paper is to review the recent evolutions in imaging methods to estimate myocardial perfusion and to discuss the diagnostic strengths and limitations of the different techniques. The new ultrasound technologies and the hybrid approaches seem to be the future is these fields.
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