Quantitative First-Pass Perfusion CMR: from technical principles to clinical practice

Myocardial perfusion cardiovascular magnetic resonance (pCMR) using first-pass contrast-enhanced imaging could play an important role in the detection of epicardial and microvascular coronary artery disease. Recently, the emergence of quantitative pCMR has provided a more reliable and observer-independent analysis compared to visual interpretation of dynamic images. This review aims to cover the basics of quantitative pCMR, from acquisition protocols, its use in preclinical and clinical studies, image reconstruction and motion handling, to automated quantitative pCMR pipelines. It also offers an overview of emerging tools in the field, including artificial intelligence-based methods.