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Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art.

Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L, Kraitchman DL - J Cardiovasc Magn Reson (2008)

Bottom Line: In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement.The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols.This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium. bernhard.gerber@clin.ucl.ac.be

ABSTRACT
In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

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Typical protocol for assessing extent of microvascular obstruction with rest first-pass perfusion imaging. An alternate method of imaging microvascular obstruction is single shot late gadolinium enhancement.
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Figure 4: Typical protocol for assessing extent of microvascular obstruction with rest first-pass perfusion imaging. An alternate method of imaging microvascular obstruction is single shot late gadolinium enhancement.

Mentions: In patients with acute MI, the main purpose of myocardial perfusion imaging is the precise estimation of the size of microvascular obstruction (no-reflow area),[53] if present. A typical protocol, which might be used for assessment of microvascular obstruction in patients with acute MI, is illustrated in Figure 4. Resting perfusion imaging is performed during bolus injection (3–4 ml/min) of a low dose (0.05–0.1 mmol/kg) of Gd chelate. Since the purpose of this resting perfusion study is accurate sizing of the area of microvascular obstruction/no-reflow, one must increase the spatial coverage and compromise temporal resolution. Since the perfusion defects due to microvascular obstruction fill in relatively slowly, temporal resolution is less important than for stress perfusion studies. Typically, dynamic imaging with full coverage of the entire heart, e. g., 8–10 short axis slices, is performed with a repetition rate every 2 or 3 heart beats. After the completion of the rest perfusion study, additional contrast can be infused for a total dose of 0.15–0.2 mmol/kg for subsequent LGE CMR images for infarct sizing. These LGE images are acquired 10–20 minutes after the contrast injection, with inversion recovery gradient pulse sequences. An alternative approach is to just obtain single shot LGE images to visualize microvascular obstruction. However, the time between first-pass perfusion sequence and LGE images can be used to acquire functional SSFP cine images. Since image contrast in SSFP is determined by the T2/T1 ratio of the tissue, SSFP image quality is often not significantly impaired.


Myocardial first-pass perfusion cardiovascular magnetic resonance: history, theory, and current state of the art.

Gerber BL, Raman SV, Nayak K, Epstein FH, Ferreira P, Axel L, Kraitchman DL - J Cardiovasc Magn Reson (2008)

Typical protocol for assessing extent of microvascular obstruction with rest first-pass perfusion imaging. An alternate method of imaging microvascular obstruction is single shot late gadolinium enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2387155&req=5

Figure 4: Typical protocol for assessing extent of microvascular obstruction with rest first-pass perfusion imaging. An alternate method of imaging microvascular obstruction is single shot late gadolinium enhancement.
Mentions: In patients with acute MI, the main purpose of myocardial perfusion imaging is the precise estimation of the size of microvascular obstruction (no-reflow area),[53] if present. A typical protocol, which might be used for assessment of microvascular obstruction in patients with acute MI, is illustrated in Figure 4. Resting perfusion imaging is performed during bolus injection (3–4 ml/min) of a low dose (0.05–0.1 mmol/kg) of Gd chelate. Since the purpose of this resting perfusion study is accurate sizing of the area of microvascular obstruction/no-reflow, one must increase the spatial coverage and compromise temporal resolution. Since the perfusion defects due to microvascular obstruction fill in relatively slowly, temporal resolution is less important than for stress perfusion studies. Typically, dynamic imaging with full coverage of the entire heart, e. g., 8–10 short axis slices, is performed with a repetition rate every 2 or 3 heart beats. After the completion of the rest perfusion study, additional contrast can be infused for a total dose of 0.15–0.2 mmol/kg for subsequent LGE CMR images for infarct sizing. These LGE images are acquired 10–20 minutes after the contrast injection, with inversion recovery gradient pulse sequences. An alternative approach is to just obtain single shot LGE images to visualize microvascular obstruction. However, the time between first-pass perfusion sequence and LGE images can be used to acquire functional SSFP cine images. Since image contrast in SSFP is determined by the T2/T1 ratio of the tissue, SSFP image quality is often not significantly impaired.

Bottom Line: In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement.The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols.This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium. bernhard.gerber@clin.ucl.ac.be

ABSTRACT
In less than two decades, first-pass perfusion cardiovascular magnetic resonance (CMR) has undergone a wide range of changes with the development and availability of improved hardware, software, and contrast agents, in concert with a better understanding of the mechanisms of contrast enhancement. The following review provides a perspective of the historical development of first-pass CMR, the developments in pulse sequence design and contrast agents, the relevant animal models used in early preclinical studies, the mechanism of artifacts, the differences between 1.5T and 3T scanning, and the relevant clinical applications and protocols. This comprehensive overview includes a summary of the past clinical performance of first-pass perfusion CMR and current clinical applications using state-of-the-art methodologies.

Show MeSH
Related in: MedlinePlus