Skip to main content

Quantitative myocardial perfusion imaging by cardiovascular magnetic resonance and positron emission tomography

Journal of Nuclear Cardiology volume 20, pages 860–870 (2013)Cite this article

Abstract

Recent studies have demonstrated that a detailed knowledge of the extent of angiographic coronary artery disease (CAD) is not a prerequisite for clinical decision making, and the clinical management of patients with CAD is more and more focused towards the identification of myocardial ischemia and the quantification of ischemic burden. In this view, non-invasive assessment of ischemia and in particular stress imaging techniques are emerging as preferred and non-invasive options. A quantitative assessment of regional myocardial perfusion can provide an objective estimate of the severity of myocardial injury and may help clinicians to discriminate regions of the heart that are at increased risk for myocardial infarction. Positron emission tomography (PET) has established itself as the reference standard for myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) quantification. Cardiac magnetic resonance (CMR) is increasingly used to measure MBF and MPR by means of first-pass signals, with a well-defined diagnostic performance and prognostic value. The aim of this article is to review the currently available evidence on the use of both PET and CMR for quantification of MPR, with particular attention to the studies that directly compared these two diagnostic methods.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2
Figure 3

References

  1. Piek JJ, Boersma E, di Mario C, Schroeder E, Vrints C, Probst P, et al. Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography. DEBATE study group. Doppler Endpoints Balloon Angioplasty Trial Europe. Eur Heart J 2000;21:466-74.

    PubMed  Article  CAS  Google Scholar 

  2. Gould KL, Kirkeeide RL, Buchi M. Coronary flow reserve as a physiologic measure of stenosis severity. J Am Coll Cardiol 1990;15:459-74.

    PubMed  Article  CAS  Google Scholar 

  3. Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 1994;330:1782-8.

    PubMed  Article  CAS  Google Scholar 

  4. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial nuclear substudy. Circulation 2008;117:1283-91.

    PubMed  Article  Google Scholar 

  5. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 2003;107:2900-7.

    PubMed  Article  Google Scholar 

  6. Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-24.

    PubMed  Article  CAS  Google Scholar 

  7. De Bruyne B, Pijls NH, Kalesan B, Barbato E, Tonino PA, Piroth Z, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med 2012;367:991-1001.

    PubMed  Article  Google Scholar 

  8. Christian TF, Rettmann DW, Aletras AH, Liao SL, Taylor JL, Balaban RS, et al. Absolute myocardial perfusion in canines measured by using dual-bolus first-pass MR imaging. Radiology 2004;232:677-84.

    PubMed  Article  Google Scholar 

  9. Berman DS, Kang X, Gransar H, Gerlach J, Friedman JD, Hayes SW, et al. Quantitative assessment of myocardial perfusion abnormality on SPECT myocardial perfusion imaging is more reproducible than expert visual analysis. J Nucl Cardiol 2009;16:45-53.

    PubMed  Article  Google Scholar 

  10. Zaacks SM, Ali A, Parrillo JE, Barron JT. How well does radionuclide dipyridamole stress testing detect three-vessel coronary artery disease and ischemia in the region supplied by the most stenotic vessel? Clin Nucl Med 1999;24:35-41.

    PubMed  Article  CAS  Google Scholar 

  11. Berman DS, Kang X, Slomka PJ, Gerlach J, de Yang L, Hayes SW, et al. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. J Nucl Cardiol 2007;14:521-8.

    PubMed  Article  Google Scholar 

  12. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830-40.

    PubMed  Article  CAS  Google Scholar 

  13. Patel AR, Epstein FH, Kramer CM. Evaluation of the microcirculation: Advances in cardiac magnetic resonance perfusion imaging. J Nucl Cardiol 2008;15:698-708.

    PubMed  Article  Google Scholar 

  14. Al-Saadi N, Nagel E, Gross M, Bornstedt A, Schnackenburg B, Klein C, et al. Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation 2000;101:1379-83.

    PubMed  Article  CAS  Google Scholar 

  15. Hsu LY, Groves DW, Aletras AH, Kellman P, Arai AE. A quantitative pixel-wise measurement of myocardial blood flow by contrast-enhanced first-pass CMR perfusion imaging: microsphere validation in dogs and feasibility study in humans. JACC Cardiovasc Imaging 2012;5:154-66.

    PubMed  Article  Google Scholar 

  16. Muzik O, Duvernoy C, Beanlands RS, Sawada S, Dayanikli F, Wolfe ER Jr, et al. Assessment of diagnostic performance of quantitative flow measurements in normal subjects and patients with angiographically documented coronary artery disease by means of nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol 1998;31:534-40.

    PubMed  Article  CAS  Google Scholar 

  17. Camici PG, Rimoldi OE. The clinical value of myocardial blood flow measurement. J Nucl Med 2009;50:1076-87.

    PubMed  Article  Google Scholar 

  18. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215-24.

    PubMed  Article  Google Scholar 

  19. Manning WJ, Atkinson DJ, Grossman W, Paulin S, Edelman RR. First-pass nuclear magnetic resonance imaging studies using gadolinium-DTPA in patients with coronary artery disease. J Am Coll Cardiol 1991;18:959-65.

    PubMed  Article  CAS  Google Scholar 

  20. Wilke N, Jerosch-Herold M, Wang Y, Huang Y, Christensen BV, Stillman AE, et al. Myocardial perfusion reserve: Assessment with multisection, quantitative, first-pass MR imaging. Radiology 1997;204:373-84.

    PubMed  CAS  Google Scholar 

  21. Jerosch-Herold M, Kwong RY. Optimal imaging strategies to assess coronary blood flow and risk for patients with coronary artery disease. Curr Opin Cardiol 2008;23:599-606.

    PubMed  Article  Google Scholar 

  22. Nagel E, al-Saadi N, Fleck E. Cardiovascular magnetic resonance: Myocardial perfusion. Herz 2000;25:409-16.

    PubMed  Article  CAS  Google Scholar 

  23. Cullen JH, Horsfield MA, Reek CR, Cherryman GR, Barnett DB, Samani NJ. A myocardial perfusion reserve index in humans using first-pass contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol 1999;33:1386-94.

    PubMed  Article  CAS  Google Scholar 

  24. Gebker R, Schwitter J, Fleck E, Nagel E. How we perform myocardial perfusion with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2007;9:539-47.

    PubMed  Article  Google Scholar 

  25. Nagel E, Klein C, Paetsch I, Hettwer S, Schnackenburg B, Wegscheider K, et al. Magnetic resonance perfusion measurements for the noninvasive detection of coronary artery disease. Circulation 2003;108:432-7.

    PubMed  Article  Google Scholar 

  26. al-Saadi N, Gross M, Bornstedt A, Schnackenburg B, Klein C, Fleck E, et al. Comparison of various parameters for determining an index of myocardial perfusion reserve in detecting coronary stenosis with cardiovascular magnetic resonance tomography. Z Kardiol 2001;90:824-34.

    PubMed  Article  CAS  Google Scholar 

  27. Ishida M, Ichihara T, Nagata M, Ishida N, Takase S, Kurita T, et al. Quantification of myocardial blood flow using model based analysis of first-pass perfusion MRI: Extraction fraction of Gd-DTPA varies with myocardial blood flow in human myocardium. Magn Reson Med 2011;66:1391-9.

    PubMed  Article  Google Scholar 

  28. Patel AR, Antkowiak PF, Nandalur KR, West AM, Salerno M, Arora V, et al. Assessment of advanced coronary artery disease: Advantages of quantitative cardiac magnetic resonance perfusion analysis. J Am Coll Cardiol 2010;56:561-9.

    PubMed  Article  Google Scholar 

  29. Jerosch-Herold M, Wilke N, Stillman AE. Magnetic resonance quantification of the myocardial perfusion reserve with a Fermi function model for constrained deconvolution. Med Phys 1998;25:73-84.

    PubMed  Article  CAS  Google Scholar 

  30. Zun Z, Wong EC, Nayak KS. Assessment of myocardial blood flow (MBF) in humans using arterial spin labeling (ASL): Feasibility and noise analysis. Magn Reson Med 2009;62:975-83.

    PubMed  Article  Google Scholar 

  31. Arnold JR, Karamitsos TD, Pegg TJ, Francis JM, Olszewski R, Searle N, et al. Adenosine stress myocardial contrast echocardiography for the detection of coronary artery disease: A comparison with coronary angiography and cardiac magnetic resonance. JACC Cardiovasc Imaging 2010;3:934-43.

    PubMed  Article  Google Scholar 

  32. Schwitter J, Wacker CM, van Rossum AC, Lombardi M, Al-Saadi N, Ahlstrom H, et al. MR-IMPACT: Comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J 2008;29:480-9.

    PubMed  Article  Google Scholar 

  33. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): A prospective trial. Lancet 2012;379:453-60.

    PubMed  Article  Google Scholar 

  34. Schwitter J, Nanz D, Kneifel S, Bertschinger K, Buchi M, Knusel PR, et al. Assessment of myocardial perfusion in coronary artery disease by magnetic resonance: A comparison with positron emission tomography and coronary angiography. Circulation 2001;103:2230-5.

    PubMed  Article  CAS  Google Scholar 

  35. Ibrahim T, Nekolla SG, Schreiber K, Odaka K, Volz S, Mehilli J, et al. Assessment of coronary flow reserve: Comparison between contrast-enhanced magnetic resonance imaging and positron emission tomography. J Am Coll Cardiol 2002;39:864-70.

    PubMed  Article  Google Scholar 

  36. Parkka JP, Niemi P, Saraste A, Koskenvuo JW, Komu M, Oikonen V, et al. Comparison of MRI and positron emission tomography for measuring myocardial perfusion reserve in healthy humans. Magn Reson Med 2006;55:772-9.

    PubMed  Article  Google Scholar 

  37. Morton G, Chiribiri A, Ishida M, Hussain ST, Schuster A, Indermuehle A, et al. Quantification of absolute myocardial perfusion in patients with coronary artery disease: Comparison between cardiovascular magnetic resonance and positron emission tomography. J Am Coll Cardiol 2012;60:1546-55.

    PubMed  Article  Google Scholar 

  38. Fritz-Hansen T, Hove JD, Kofoed KF, Kelbaek H, Larsson HB. Quantification of MRI measured myocardial perfusion reserve in healthy humans: A comparison with positron emission tomography. J Magn Reson Imaging 2008;27:818-24.

    PubMed  Article  Google Scholar 

  39. Costa MA, Shoemaker S, Futamatsu H, Klassen C, Angiolillo DJ, Nguyen M, et al. Quantitative magnetic resonance perfusion imaging detects anatomic and physiologic coronary artery disease as measured by coronary angiography and fractional flow reserve. J Am Coll Cardiol 2007;50:514-22.

    PubMed  Article  Google Scholar 

  40. Lockie T, Ishida M, Perera D, Chiribiri A, De Silva K, Kozerke S, et al. High-resolution magnetic resonance myocardial perfusion imaging at 3.0-Tesla to detect hemodynamically significant coronary stenoses as determined by fractional flow reserve. J Am Coll Cardiol 2011;57:70-5.

    PubMed  Article  Google Scholar 

  41. Jahnke C, Nagel E, Gebker R, Kokocinski T, Kelle S, Manka R, et al. Prognostic value of cardiac magnetic resonance stress tests: Adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation 2007;115:1769-76.

    PubMed  Article  Google Scholar 

  42. Ingkanisorn WP, Kwong RY, Bohme NS, Geller NL, Rhoads KL, Dyke CK, et al. Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol 2006;47:1427-32.

    PubMed  Article  Google Scholar 

  43. Klem I, Heitner JF, Shah DJ, Sketch MH Jr, Behar V, Weinsaft J, et al. Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging. J Am Coll Cardiol 2006;47:1630-8.

    PubMed  Article  Google Scholar 

  44. Bodi V, Sanchis J, Lopez-Lereu MP, Nunez J, Mainar L, Monmeneu JV, et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol 2007;50:1174-9.

    PubMed  Article  Google Scholar 

  45. Saraste A, Kajander S, Han C, Nesterov SV, Knuuti J. PET: Is myocardial flow quantification a clinical reality? J Nucl Cardiol 2012;19:1044-59.

    PubMed  Article  Google Scholar 

  46. Schwaiger M, Hutchins G. Quantification of regional myocardial perfusion by PET: Rationale and first clinical results. Eur Heart J 1995;16:84-91.

    PubMed  Article  Google Scholar 

  47. Beanlands RS, Muzik O, Melon P, Sutor R, Sawada S, Muller D, et al. Noninvasive quantification of regional myocardial flow reserve in patients with coronary atherosclerosis using nitrogen-13 ammonia positron emission tomography. Determination of extent of altered vascular reactivity. J Am Coll Cardiol 1995;26:1465-75.

    PubMed  Article  CAS  Google Scholar 

  48. Dayanikli F, Grambow D, Muzik O, Mosca L, Rubenfire M, Schwaiger M. Early detection of abnormal coronary flow reserve in asymptomatic men at high risk for coronary artery disease using positron emission tomography. Circulation 1994;90:808-17.

    PubMed  Article  CAS  Google Scholar 

  49. Keereman V, Holen RV, Mollet P, Vandenberghe S. The effect of errors in segmented attenuation maps on PET quantification. Med Phys 2011;38:6010-9.

    PubMed  Article  Google Scholar 

  50. Herzog BA, Husmann L, Valenta I, Gaemperli O, Siegrist PT, Tay FM, et al. Long-term prognostic value of 13N-ammonia myocardial perfusion positron emission tomography added value of coronary flow reserve. J Am Coll Cardiol 2009;54:150-6.

    PubMed  Article  Google Scholar 

  51. Tio RA, Dabeshlim A, Siebelink HM, de Sutter J, Hillege HL, Zeebregts CJ, et al. Comparison between the prognostic value of left ventricular function and myocardial perfusion reserve in patients with ischemic heart disease. J Nucl Med 2009;50:214-9.

    PubMed  Article  Google Scholar 

  52. Murthy VL, Naya M, Foster CR, Gaber M, Hainer J, Klein J, et al. Association between coronary vascular dysfunction and cardiac mortality in patients with and without diabetes mellitus. Circulation 2012;126:1858-68.

    PubMed  Article  CAS  Google Scholar 

  53. Czernin J, Muller P, Chan S, Brunken RC, Porenta G, Krivokapich J, et al. Influence of age and hemodynamics on myocardial blood flow and flow reserve. Circulation 1993;88:62-9.

    PubMed  Article  CAS  Google Scholar 

  54. Uren NG, Camici PG, Melin JA, Bol A, de Bruyne B, Radvan J, et al. Effect of aging on myocardial perfusion reserve. J Nucl Med 1995;36:2032-6.

    PubMed  CAS  Google Scholar 

  55. Kaufmann PA, Gnecchi-Ruscone T, di Terlizzi M, Schafers KP, Luscher TF, Camici PG. Coronary heart disease in smokers: Vitamin C restores coronary microcirculatory function. Circulation 2000;102:1233-8.

    PubMed  Article  CAS  Google Scholar 

  56. Kaufmann PA, Gnecchi-Ruscone T, Schafers KP, Luscher TF, Camici PG. Low density lipoprotein cholesterol and coronary microvascular dysfunction in hypercholesterolemia. J Am Coll Cardiol 2000;36:103-9.

    PubMed  Article  CAS  Google Scholar 

  57. Sambuceti G, Parodi O, Marzullo P, Giorgetti A, Fusani L, Puccini G, et al. Regional myocardial blood flow in stable angina pectoris associated with isolated significant narrowing of either the left anterior descending or left circumflex coronary artery. Am J Cardiol 1993;72:990-4.

    PubMed  Article  CAS  Google Scholar 

  58. Dorbala S, Di Carli MF, Beanlands RS, Merhige ME, Williams BA, Veledar E, et al. Prognostic value of stress myocardial perfusion positron emission tomography: Results from a multicenter observational registry. J Am Coll Cardiol 2013;61:176-84.

    PubMed  Article  Google Scholar 

  59. Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol 1993;21:612-21.

    PubMed  Article  CAS  Google Scholar 

  60. Schwarz ER, Speakman MT, vom Dahl J, Kloner RA. Hibernating myocardium: Is there evidence for chronic flow reduction? Heart Dis 1999;1:155-62.

    PubMed  CAS  Google Scholar 

  61. Camici P, Chiriatti G, Lorenzoni R, Bellina RC, Gistri R, Italiani G, et al. Coronary vasodilation is impaired in both hypertrophied and nonhypertrophied myocardium of patients with hypertrophic cardiomyopathy: A study with nitrogen-13 ammonia and positron emission tomography. J Am Coll Cardiol 1991;17:879-86.

    PubMed  Article  CAS  Google Scholar 

  62. Choudhury L, Elliott P, Rimoldi O, Ryan M, Lammertsma AA, Boyd H, et al. Transmural myocardial blood flow distribution in hypertrophic cardiomyopathy and effect of treatment. Basic Res Cardiol 1999;94:49-59.

    PubMed  Article  CAS  Google Scholar 

  63. Gistri R, Cecchi F, Choudhury L, Montereggi A, Sorace O, Salvadori PA, et al. Effect of verapamil on absolute myocardial blood flow in hypertrophic cardiomyopathy. Am J Cardiol 1994;74:363-8.

    PubMed  Article  CAS  Google Scholar 

  64. Jorg-Ciopor M, Namdar M, Turina J, Jenni R, Schwitter J, Turina M, et al. Regional myocardial ischemia in hypertrophic cardiomyopathy: Impact of myectomy. J Thorac Cardiovasc Surg 2004;128:163-9.

    PubMed  Article  Google Scholar 

  65. Cecchi F, Olivotto I, Gistri R, Lorenzoni R, Chiriatti G, Camici PG. Coronary microvascular dysfunction and prognosis in hypertrophic cardiomyopathy. N Engl J Med 2003;349:1027-35.

    PubMed  Article  CAS  Google Scholar 

  66. Opherk D, Schwarz F, Mall G, Manthey J, Baller D, Kubler W. Coronary dilatory capacity in idiopathic dilated cardiomyopathy: Analysis of 16 patients. Am J Cardiol 1983;51:1657-62.

    PubMed  Article  CAS  Google Scholar 

  67. Stolen KQ, Kemppainen J, Kalliokoski KK, Karanko H, Toikka J, Janatuinen T, et al. Myocardial perfusion reserve and peripheral endothelial function in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2004;93:64-8.

    PubMed  Article  Google Scholar 

  68. Canetti M, Akhter MW, Lerman A, Karaalp IS, Zell JA, Singh H, et al. Evaluation of myocardial blood flow reserve in patients with chronic congestive heart failure due to idiopathic dilated cardiomyopathy. Am J Cardiol 2003;92:1246-9.

    PubMed  Article  Google Scholar 

  69. Neglia D, Michelassi C, Trivieri MG, Sambuceti G, Giorgetti A, Pratali L, et al. Prognostic role of myocardial blood flow impairment in idiopathic left ventricular dysfunction. Circulation 2002;105:186-93.

    PubMed  Article  Google Scholar 

  70. Jaarsma C, Leiner T, Bekkers SC, Crijns HJ, Wildberger JE, Nagel E, et al. Diagnostic performance of noninvasive myocardial perfusion imaging using single-photon emission computed tomography, cardiac magnetic resonance, and positron emission tomography imaging for the detection of obstructive coronary artery disease: A meta-analysis. J Am Coll Cardiol 2012;59:1719-28.

    PubMed  Article  Google Scholar 

  71. Nielsen G, Fritz-Hansen T, Dirks CG, Jensen GB, Larsson HB. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging. J Magn Reson Imaging 2004;20:403-10.

    PubMed  Article  Google Scholar 

  72. Pack NA, DiBella EV, Rust TC, Kadrmas DJ, McGann CJ, Butterfield R, et al. Estimating myocardial perfusion from dynamic contrast-enhanced CMR with a model-independent deconvolution method. J Cardiovasc Magn Reson 2008;10:52.

    PubMed  Article  Google Scholar 

  73. Plein S, Kozerke S, Suerder D, Luescher TF, Greenwood JP, Boesiger P, et al. High spatial resolution myocardial perfusion cardiac magnetic resonance for the detection of coronary artery disease. Eur Heart J 2008;29:2148-55.

    PubMed  Article  Google Scholar 

  74. Araoz PA, Glockner JF, McGee KP, Potter DD Jr, Valeti VU, Stanley DW, et al. 3 Tesla MR imaging provides improved contrast in first-pass myocardial perfusion imaging over a range of gadolinium doses. J Cardiovasc Magn Reson 2005;7:559-64.

    PubMed  Article  Google Scholar 

  75. Shin T, Hu HH, Pohost GM, Nayak KS. Three dimensional first-pass myocardial perfusion imaging at 3 T: Feasibility study. J Cardiovasc Magn Reson 2008;10:57.

    PubMed  Article  Google Scholar 

  76. Machac J. Cardiac positron emission tomography imaging. Semin Nucl Med 2005;35:17-36.

    PubMed  Article  Google Scholar 

  77. Salerno M, Beller GA. Noninvasive assessment of myocardial perfusion. Circ Cardiovasc Imaging 2009;2:412-24.

    PubMed  Article  Google Scholar 

  78. Garcia EV. Physical attributes, limitations, and future potential for PET and SPECT. J Nucl Cardiol 2012;19:S19-29.

    PubMed  Article  Google Scholar 

  79. Algranati D, Kassab GS, Lanir Y. Why is the subendocardium more vulnerable to ischemia? A new paradigm. Am J Physiol Heart Circ Physiol 2011;300:H1090-100.

    PubMed  Article  CAS  Google Scholar 

  80. Panting JR, Gatehouse PD, Yang GZ, Grothues F, Firmin DN, Collins P, et al. Abnormal subendocardial perfusion in cardiac syndrome X detected by cardiovascular magnetic resonance imaging. N Engl J Med 2002;346:1948-53.

    PubMed  Article  Google Scholar 

  81. Muehling OM, Jerosch-Herold M, Panse P, Zenovich A, Wilson BV, Wilson RF, et al. Regional heterogeneity of myocardial perfusion in healthy human myocardium: Assessment with magnetic resonance perfusion imaging. J Cardiovasc Magn Reson 2004;6:499-507.

    PubMed  Article  Google Scholar 

  82. Muehling OM, Wilke NM, Panse P, Jerosch-Herold M, Wilson BV, Wilson RF, et al. Reduced myocardial perfusion reserve and transmural perfusion gradient in heart transplant arteriopathy assessed by magnetic resonance imaging. J Am Coll Cardiol 2003;42:1054-60.

    PubMed  Article  Google Scholar 

  83. Vermeltfoort IAC, Raijmakers PGHM, et al. Is subendocardial ischaemia present in patients with chest pain and normal coronary angiograms? A cardiovascular MR study. Eur Heart J 2007;28:1554-8.

    PubMed  Article  Google Scholar 

  84. Miyai N, Kawasaki T, Taniguchi T, Kamitani T, Kawasaki S, Sugihara H. Exercise-induced ST-segment depression and myocardial ischemia in patients with hypertrophic cardiomyopathy: myocardial scintigraphic study. J Cardiol 2005;46:141-7.

    PubMed  Google Scholar 

  85. Kawasaki T, Akakabe Y, Yamano M, Miki S, Kamitani T, Kuribayashi T, et al. Gated single-photon emission computed tomography detects subendocardial ischemia in hypertrophic cardiomyopathy. Circ J 2007;71:256-60.

    PubMed  Article  Google Scholar 

  86. Rajappan K, Rimoldi OE, Dutka DP, Ariff B, Pennell DJ, Sheridan DJ, et al. Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 2002;105:470-6.

    PubMed  Article  Google Scholar 

  87. Vermeltfoort IA, Raijmakers PG, Lubberink M, Germans T, van Rossum AC, Lammertsma AA, et al. Feasibility of subendocardial and subepicardial myocardial perfusion measurements in healthy normals with (15)O-labeled water and positron emission tomography. J Nucl Cardiol 2011;18:650-6.

    PubMed  Article  Google Scholar 

  88. Kaufmann PA, Gnecchi-Ruscone T, Yap JT, Rimoldi O, Camici PG. Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with 15O-labeled water and PET. J Nucl Med 1999;40:1848-56.

    PubMed  CAS  Google Scholar 

  89. Nagamachi S, Czernin J, Kim AS, Sun KT, Bottcher M, Phelps ME, et al. Reproducibility of measurements of regional resting and hyperemic myocardial blood flow assessed with PET. J Nucl Med 1996;37:1626-31.

    PubMed  CAS  Google Scholar 

  90. Jerosch-Herold M, Vazquez G, Wang L, Jacobs DR Jr, Folsom AR. Variability of myocardial blood flow measurements by magnetic resonance imaging in the multi-ethnic study of atherosclerosis. Invest Radiol 2008;43:155-61.

    PubMed  Article  Google Scholar 

  91. Ziadi MC, Dekemp RA, Williams K, Guo A, Renaud JM, Chow BJ, et al. Does quantification of myocardial flow reserve using rubidium-82 positron emission tomography facilitate detection of multivessel coronary artery disease? J Nucl Cardiol 2012;19:670-80.

    PubMed  Article  Google Scholar 

  92. Jogiya R, Kozerke S, Morton G, De Silva K, Redwood S, Perera D, et al. Validation of dynamic 3-dimensional whole heart magnetic resonance myocardial perfusion imaging against fractional flow reserve for the detection of significant coronary artery disease. J Am Coll Cardiol 2012;60:756-65.

    PubMed  Article  Google Scholar 

  93. Morton G, Ishida M, Schuster A, Hussain S, Schaeffter T, Chiribiri A, et al. Perfusion cardiovascular magnetic resonance: Comparison of an advanced, high-resolution and a standard sequence. J Cardiovasc Magn Reson 2012;14:34.

    PubMed  Article  Google Scholar 

  94. Schroeder MA, Clarke K, Neubauer S, Tyler DJ. Hyperpolarized magnetic resonance: A novel technique for the in vivo assessment of cardiovascular disease. Circulation 2011;124:1580-94.

    PubMed  Article  Google Scholar 

  95. Small GR, Wells RG, Schindler T, Chow BJ, Ruddy TD. Advances in cardiac SPECT and PET imaging: Overcoming the challenges to reduce radiation exposure and improve accuracy. Can J Cardiol 2013;29:275-84.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St. Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. The Division of Imaging Sciences receives also support as the Centre of Excellence in Medical Engineering (funded by the Welcome Trust and EPSRC; Grant Number WT 088641/Z/09/Z) as well as the BHF Centre of Excellence (British Heart Foundation Award RE/08/03). Dr Bratis acknowledges receiving training grant by the Hellenic Society of Cardiology. Dr Mahmoud acknowledges receiving training grant by the Egyptian Ministry of Higher Education. Dr Chiribiri receives grant support from Philips Healthcare. Dr Nagel received significant grant support from Bayer Schering Pharma and Philips Healthcare.

Author information

Affiliations

  1. Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom

    K. Bratis MD, I. Mahmoud MD, A. Chiribiri MD, PhD & E. Nagel MD, PhD, FACC, FESC, MRCR

  2. British Heart Foundation Centre of Excellence, National Institute for Health Research Biomedical Research Centre, London, United Kingdom

    K. Bratis MD, I. Mahmoud MD, A. Chiribiri MD, PhD & E. Nagel MD, PhD, FACC, FESC, MRCR

  3. Wellcome Trust and Engineering and Physical Sciences Research Council Medical Engineering Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom

    K. Bratis MD, I. Mahmoud MD, A. Chiribiri MD, PhD & E. Nagel MD, PhD, FACC, FESC, MRCR

Authors
  1. K. Bratis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Mahmoud MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Chiribiri MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Nagel MD, PhD, FACC, FESC, MRCR
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Bratis MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bratis, K., Mahmoud, I., Chiribiri, A. et al. Quantitative myocardial perfusion imaging by cardiovascular magnetic resonance and positron emission tomography. J. Nucl. Cardiol. 20, 860–870 (2013). https://doi.org/10.1007/s12350-013-9762-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-013-9762-7

Keywords

  • Cardiac magnetic resonance (CMR)
  • positron emission tomography (PET)
  • quantitative perfusion imaging