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Adenosine perfusion MRI

The MRI perfusion diagnostics is one of the few clinically relevant examination procedures by which blood supply to the heart muscle can be displayed and measured. The blood itself not shown, but rather the permeation rate of a quick injection (bolus dose) of an MR contrast agent. A paramagnetic substance is used, which the magnetic fields of MR scanners then detect and reproduce in very detailed images. In healthy individuals, the contrast agent is distributed evenly in the heart muscle, so that all sections are represented with an equal amount of contrast intensity. If there is a circulatory disorder (at rest; non-active; e.g. after a heart attack) the affected portions of the heart muscle tissue remain dark, in other words, lacking contrast. On the other hand, if a bottleneck (narrowing) in a coronary artery is present, a resting, non-active MRI examination is usually not sufficient. A stress test with vasodilation (a widening of the blood vessel) has proven to be effective with an endogenous preparation (adenosine). With vasodilation, the amount of blood flow in the healthy sections increases up to 5 times (see coronary flow reserve (CFR)). The areas that are under stress with less perfusion fill up more slowly. This creates a visible and measurable contrast difference. As with many established examination procedures, MR contrast agents were not initially developed for the adenosine perfusion MRI.  This means it is formally a so-called “off-label” application of the contrast agent. Scientific studies have demonstrated the safety and also the excellent suitability of this method for the measurement of blood circulation, so that the MRI perfusion imaging is now considered by many clinics and centers to be the "gold standard" of perfusion measurement.