Dynamic contrast-enhanced perfusion CMR

Dynamic contrast-enhanced perfusion cardiovascular magnetic resonance (CMR) visualizes the first passage of a peripherally injected contrast agent bolus through the left ventricle and myocardium. The presence and extent of myocardial ischaemia is assessed during vasodilation using adenosine or regadenoson and, in most cases, is repeated at rest. Contrast-enhanced perfusion CMR methods use electrocardiogram-gated fast T1-sensitive imaging to capture the signal changes during contrast agent passage with high temporal (every or every other heartbeat) and spatial (below 3 × 3 mm in-plane, up to submillimetre) resolution, allowing the detection of subendocardial ischaemia and microvascular disease. In clinical routine, perfusion CMR data are mostly visually interpreted but can also be analysed semi-quantitatively by describing or quantitatively. Perfusion CMR is highly accurate in detecting significant coronary artery stenoses. Combined with cine and late gadolinium enhancement imaging, it provides comprehensive assessment and risk stratification of patients with known or suspected coronary artery disease and is gaining an increasing role in international practice guidelines.