Quantitative 3D myocardial perfusion with an efficient arterial input function

• Published in: Magnetic resonance in medicine 2020-06, Vol.83 (6), p.1949-1963
• Main Authors: Mendes, Jason Kraig, Adluru, Ganesh, Likhite, Devavrat, Fair, Merlin J., Gatehouse, Peter D., Tian, Ye, Pedgaonkar, Apoorva, Wilson, Brent, DiBella, Edward V. R.
• Format: Article
• Language: English
• Subjects: 3D cardiac perfusion; Algorithms; arterial input function; Coronary Circulation; Gadolinium; Heart diseases; Heart rate; Humans; Ischemia; Magnetic Resonance Imaging; Myocardial Perfusion Imaging; Perfusion; Phantoms, Imaging; quantitative cardiac perfusion; Rest; Stress
• ISSN: 0740-3194; 1522-2594
• DOI: 10.1002/mrm.28050

Purpose The purpose of this study was to further develop and combine several innovative sequence designs to achieve quantitative 3D myocardial perfusion. These developments include an optimized 3D stack‐of‐stars readout (150 ms per beat), efficient acquisition of a 2D arterial input function, tailored saturation pulse design, and potential whole heart coverage during quantitative stress perfusion. Theory and Methods All studies were performed free‐breathing on a Prisma 3T MRI scanner. Phantom validation was used to verify sequence accuracy. A total of 21 subjects (3 patients with known disease) were scanned, 12 with a rest only protocol and 9 with both stress (regadenoson) and rest protocols. First pass quantitative perfusion was performed with gadoteridol (0.075 mmol/kg). Results Implementation and quantitative perfusion results are shown for healthy subjects and subjects with known coronary disease. Average rest perfusion for the 15 included healthy subjects was 0.79 ± 0.19 mL/g/min, the average stress perfusion for 6 healthy subject studies was 2.44 ± 0.61 mL/g/min, and the average global myocardial perfusion reserve ratio for 6 healthy subjects was 3.10 ± 0.24. Perfusion deficits for 3 patients with ischemia are shown. Average resting heart rate was 59 ± 7 bpm and the average stress heart rate was 81 ± 10 bpm. Conclusion This work demonstrates that a quantitative 3D myocardial perfusion sequence with the acquisition of a 2D arterial input function is feasible at high stress heart rates such as during stress. T1 values and gadolinium concentrations of the sequence match the reference standard well in a phantom, and myocardial rest and stress perfusion and myocardial perfusion reserve values are consistent with those published in literature.