Accurate assessment of the arterial input function during high-dose myocardial perfusion cardiovascular magnetic resonance

Purpose: To develop a method for accurate measurement of the arterial input function (AIF) during high-dose, single-injection, quantitative T1-weighted myocardial perfusion cardiovascular magnetic resonance (CMR). Materials and Methods: Fast injection of high-dose gadolinium with highly T1 sensitive myocardial perfusion imaging is normally incompatible with quantitative perfusion modeling because of distortion of the peak of the AIF caused by full recovery of the blood magnetization. We describe a new method that for each cardiac cycle uses a low-resolution short-axis (SA) image with a short saturation-recovery time immediately after the R-wave in order to measure the left ventricular (LV) blood pool signal, which is followed by a single SA high-resolution image with a long saturation-recovery time in order to measure the myocardial signal with high sensitivity. Fifteen subjects were studied. Using the new method, we compared the myocardial perfusion reserve (MPR) with that obtained from the dual-bolus technique (a low-dose bolus to measure the blood pool signal and a high-dose bolus to measure the myocardial signal). Results: A small significant difference was found between MPRs calculated using the new method and the MPRs calculated using the dual-bolus method. Conclusion: This new method for measuring the AIF introduced no major error, while removing the practical difficulties of the dual-bolus approach. This suggests that quantification of the MPR can be achieved using the simple high-dose single-bolus technique, which could also image multiple myocardial slices.