How to do quantitative myocardial perfusion cardiovascular magnetic resonance

Myocardial perfusion cardiovascular magnetic resonance (CMR) using first-pass contrast-enhanced imaging is an established non-invasive test for the detection of myocardial ischaemia. Current practice involves visual interpretation of a series of dynamic images and relies on experienced reporters to identify perfusion defects. The acquired data can be used to derive quantitative maps of myocardial blood flow (MBF). Potential advantages over visual reading include removal of operator dependence, simpler and faster analysis, and the ability to detect disease with global rather than regional reduction of MBF. Recent developments allow semi-automated or fully automated in-line calculation of MBF. Although these methods remain mostly in the research domain, they are on the threshold of becoming integrated into routine clinical care. This ‘How to’ article gives a brief practical overview of the steps involved in generating quantitative MBF maps and suggests how these may be used in clinical practice. This article is not intended as an exhaustive review of the principles or clinical evidence, which have been summarised elsewhere.