Quantitative Assessment of Myocardial Perfusion

Noninvasive imaging is the cornerstone in the diagnosis and management of coronary artery disease, which continues to be a leading cause of morbidity and mortality worldwide. Of the modalities available, positron emission tomography/computed tomography and cardiac magnetic resonance have shown the highest accuracy for detecting flow-limiting coronary stenoses. Each modality additionally offers the ability to quantify the myocardial blood flow and myocardial perfusion reserve on a pixel-wise, segmental, and global level. Quantitative perfusion has shown additive diagnostic value over traditional perfusion imaging, particularly in difficult cases such as multivessel disease, and will likely be increasingly found in clinical workflows. This State-of-the-Art Review compares the principles, performance, limitations, and future directions of quantitative myocardial blood flow assessment using positron emission tomography/computed tomography and cardiac magnetic resonance and provides physicians with practical guidance on when to choose which test.