Related Experiment Video
Updated: Jul 20, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Focal and diffuse myocardial fibrosis both contribute to regional hypoperfusion assessed by post-processing
Jeremy Weiner1, Corinna Heinisch1, Salome Oeri2
1Cardiology, Hospital Centre of Biel, Biel, Switzerland.
Introduction:
Indications for stress-cardiovascular magnetic resonance imaging (CMR) to assess myocardial ischemia and viability are growing. First pass perfusion and late gadolinium enhancement (LGE) have limited value in balanced ischemia and diffuse fibrosis. Quantitative perfusion (QP) to assess absolute pixelwise myocardial blood flow (MBF) and extracellular volume (ECV) as a measure of diffuse fibrosis can overcome these limitations. We investigated the use of post-processing techniques for quantifying both pixelwise MBF and diffuse fibrosis in patients with clinically indicated CMR stress exams. We then assessed if focal and diffuse myocardial fibrosis and other features quantified during the CMR exam explain individual MBF findings.
Methods:
This prospective observational study enrolled 125 patients undergoing a clinically indicated stress-CMR scan. In addition to the clinical report, MBF during regadenoson-stress was quantified using a post-processing QP method and T1 maps were used to calculate ECV. Factors that were associated with poor MBF were investigated.
Results:
Of the 109 patients included (66 ± 11 years, 32% female), global and regional perfusion was quantified by QP analysis in both the presence and absence of visual first pass perfusion deficits. Similarly, ECV analysis identified diffuse fibrosis in myocardium beyond segments with LGE. Multivariable analysis showed both LGE (β = -0.191, p = 0.001) and ECV (β = -0.011, p < 0.001) were independent predictors of reduced MBF. In patients without clinically defined first pass perfusion deficits, the microvascular risk-factors of age and wall thickness further contributed to poor MBF (p < 0.001).
Discussion:
Quantitative analysis of MBF and diffuse fibrosis detected regional tissue abnormalities not identified by traditional visual assessment. Multi-parametric quantitative analysis may refine the work-up of the etiology of myocardial ischemia in patients referred for clinical CMR stress testing in the future and provide a deeper insight into ischemic heart disease.
Insights
Quantitative perfusion and ECV in cardiovascular magnetic resonance imaging (CMR) improve assessment of myocardial ischemia. These methods detect abnormalities missed by traditional visual assessment, offering deeper insights into ischemic heart disease.
Area of Science:
- Cardiovascular Imaging
- Myocardial Perfusion Imaging
- Cardiac MRI
Background:
- Cardiovascular magnetic resonance imaging (CMR) is increasingly used to evaluate myocardial ischemia and viability.
- Traditional methods like first-pass perfusion and late gadolinium enhancement (LGE) have limitations in detecting balanced ischemia and diffuse fibrosis.
- Quantitative perfusion (QP) and extracellular volume (ECV) offer potential solutions by measuring absolute myocardial blood flow (MBF) and diffuse fibrosis.
Purpose of the Study:
- To investigate the utility of post-processing techniques for quantifying pixelwise MBF and diffuse fibrosis in patients undergoing clinically indicated stress-CMR exams.
- To assess if focal and diffuse myocardial fibrosis, along with other quantified CMR features, explain individual MBF findings.
Main Methods:
- A prospective observational study included 109 patients undergoing clinically indicated stress-CMR.
- Quantitative perfusion (QP) was used to measure MBF during regadenoson stress.
- T1 mapping was employed to calculate extracellular volume (ECV) for diffuse fibrosis assessment.
Main Results:
- QP analysis quantified global and regional perfusion, identifying abnormalities beyond visual assessment.
- ECV analysis detected diffuse fibrosis in areas without LGE.
- Multivariable analysis revealed LGE and ECV as independent predictors of reduced MBF (p<0.001).
- In patients without visual perfusion deficits, age and wall thickness also predicted poor MBF (p<0.001).
Conclusions:
- Quantitative analysis of MBF and ECV identifies regional tissue abnormalities missed by traditional visual assessment in stress-CMR.
- Multi-parametric quantitative analysis holds promise for refining the etiological work-up of myocardial ischemia.
- These advanced techniques may provide deeper insights into ischemic heart disease management.
