Optimization of the arterial input function for myocardial perfusion cardiovascular magnetic resonance

PURPOSE: To determine how injection rate, cardiac function, and breathhold influence the arterial input function (AIF), in order to optimize the AIF in the clinical setting for quantitative myocardial perfusion cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS: Gd (0.1 mmol/kg) bolus was injected at 3, 5, or 7 mL/second in 35 patients. In each cardiac cycle during the first-pass, a series of saturation recovery (SR) fast low-angle shot (FLASH) low resolution images with exponentially increasing SR delay times were acquired. Signal intensity (SI) time measurements were made from a region of interest (ROI) drawn in the ascending aorta (AA). The calculation of short T1s and thus peak Gd concentration [Gd] was performed by fitting the mean ROI SI against SR delay times. RESULTS: The mean peak [Gd] in the AA increased as injection rate increased from 3 mL/second (5.0 mM), to 5 mL/second (7.1 mM), to 7 mL/second (4 mM) (P < 0.0001). The peak [Gd] increased as the left ventricular stroke volume (LV SV) increased (P = 0.01). Breath holding was not found to influence peak [Gd]. CONCLUSION: In this study, we found that a high injection rate has advantages over lower injection speeds, although the duration of the AIF was apparently not significantly shortened by faster injection. The choice of expiration or inspiration as breathhold did not have a significant influence upon the AIF. Poor cardiac function was associated with a lower peak [Gd], indicating that first pass perfusion measurements in these patients will be suboptimal.