Figure 4.

High-resolution perfusion CMR. A 48-year-old lady with suspected angina underwent stress perfusion CMR at 1.5 T using a high-resolution (1.4 mm in-plane) technique facilitated by 5-fold k-t-BLAST. Stress-induced perfusion defects were seen in all three coronary territories (arrows, A), some of which are clearly subendocardial. Subsequent X-ray angiography revealed significant three-vessel disease (arrows, C and D). This case highlights the ability of high-resolution acquisition to overcome the potential effects of balanced ischemia in multi-vessel disease by detecting transmural perfusion gradients and subendocardial ischemia. (Reprinted with permission from: Motwani et al. Circ Cardiovasc Imaging 2013;6:339-48) (29). CMR, cardiovascular magnetic resonance; BLAST, broad linear speed-up technique.