Quantitative Myocardial Perfusion Imaging with MRI and CT: Clinical Applications and Future Directions

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Accurate evaluation of myocardial ischemia is crucial for managing coronary artery disease (CAD).
• Quantitative perfusion cardiovascular magnetic resonance (QP-CMR) and quantitative computed tomography perfusion (CTP) are advanced imaging techniques.
• These methods assess myocardial blood flow (MBF) and integrate anatomical and functional data.

Purpose of the Study:

• To review quantitative myocardial perfusion imaging techniques using CMR and cardiac CT.
• To discuss their fundamental principles, diagnostic performance, and clinical applications.
• To explore their use in evaluating coronary microvascular dysfunction and non-ischaemic cardiomyopathies.

Main Methods:

• Overview of quantitative perfusion cardiovascular magnetic resonance (QP-CMR).
• Overview of quantitative computed tomography perfusion (CTP).
• Discussion of diagnostic performance and clinical applications.

Main Results:

• QP-CMR provides high-resolution assessment of absolute myocardial blood flow (MBF) without ionizing radiation.
• QP-CMR demonstrates excellent diagnostic performance for detecting significant CAD, often outperforming visual analysis.
• CTP integrates coronary anatomy with functional data, improving diagnostic accuracy and specificity over coronary CT angiography alone.

Conclusions:

• Quantitative perfusion imaging with CMR and CT are valuable tools for evaluating CAD.
• These techniques show promise beyond epicardial CAD, including microvascular dysfunction and cardiomyopathies.
• The review discusses advantages, limitations, and future directions for these quantitative imaging modalities.