SCMR expert consensus statement on quantitative myocardial perfusion CMR imaging: core recommendations

Why Myocardial Perfusion CMR Matters?

Quantitative myocardial perfusion cardiovascular magnetic resonance (CMR) is emerging as a game-changer in cardiovascular imaging for patients with known or suspected coronary artery disease (CAD), as well as those with ischemia without obstructive coronary arteries (INOCA), anomalous coronary origins, and Kawasaki disease. International guidelines now grant several Class 1 indications for stress perfusion CMR, underlining its excellent diagnostic accuracy and independent prognostic value—a hallmark for clinical confidence. 

Quantitative vs. Visual Analysis: Accuracy and Utility 

Traditionally, clinicians rely on visual interpretation of stress perfusion CMR images. The consensus highlights that quantitative perfusion CMR is at least as accurate for detecting significant obstructive CAD and is even more precise in estimating the total ischemic burden for CAD patients. This distinction provides deeper, more reproducible data for risk stratification and management.

Unique Insights for Challenging Cases 

Quantitative perfusion CMR stands out by uncovering pathophysiological mechanisms of myocardial ischemia, notably in microvascular dysfunction—a common culprit in INOCA. This capability brings clarity to ambiguous cases where angiograms appear normal but symptoms persist, guiding therapy and research into conditions often overlooked in routine practice.
 

Automation, Standardization, and Scalability 

A major advancement is that quantitative analysis of myocardial perfusion can be fully automated and user-independent, paving the way for broader implementation in clinical routines beyond specialist centers. The consensus aims to standardize acquisition and analysis methods, which is fundamental for reliability, validity, and multi-center research collaboration. 

 Research & Clinical Development Priorities 

The statement emphasizes the following development goals: 

• Addressing current limitations in technology and protocols; 

• Ensuring data reliability and validity; 

• Enabling multi-vendor, multi-center studies for universal adoption; 

• Broadening the role of quantitative perfusion CMR in daily clinical decision-making. 

 Core Recommendations

1. Standardized Acquisition

• Use contrast-enhanced stress perfusion CMR with validated vasodilator stress agents. 

• Maintain consistent imaging parameters to allow precise pixel-wise quantification. 

• Acquire both stress and rest perfusion to enable myocardial perfusion reserve (MPR) calculation. 

• Ensure adequate patient preparation and monitoring for safety during stress administration. 

2. Quantitative Analysis

• Prefer fully automated or semi-automated software validated against clinical and research standards. 

• Employ absolute perfusion values (ml/min/g) rather than only relative or visual assessments. 

• Report both segmental and global perfusion, including MPR, to characterize ischemic burden. 

3. Reporting Standards

• Include: 

• Stress and rest perfusion values; 

• Myocardial perfusion reserve; 

• Ischemic burden expressed as total ischemic myocardium (% of LV mass); 

• Any artefacts or limitations. 

• Use clear terminology consistent with SCMR Lexicon and international reporting guidelines. 

4. Applications & Interpretation

• Recognize Class I indications for stress perfusion CMR in CAD, INOCA, anomalous coronary origins, Kawasaki disease, and other structural/vascular anomalies. 

• In INOCA or suspected microvascular dysfunction, emphasize perfusion reserve and regional/global reduction patterns. 

• Integrate perfusion results with coronary anatomy and other imaging/lab data for complete patient assessment. 

5. Quality Control

• Implement routine calibration for scanners and analysis software. 

• Participate in multicenter quality-assurance programs when available. 

• Ensure operator training and certification for acquisition and review. 

6. Multi-Center and Multi-Vendor Compatibility

• Protocols should be implementable across different scanner platforms and post-processing systems. 

• Use methods validated in multi-vendor contexts to support scalability and research. 

7. Future Development Goals

• Improve signal-to-noise ratio and temporal resolution without increasing scan time. 

• Develop AI-enhanced tools for automated perfusion mapping. 
• Expand data on prognostic value in diverse patient populations and disease phenotypes.

The SCMR Expert Consensus Statement underscores the expanding value of quantitative myocardial perfusion CMR for clinical decision-making in coronary artery disease (CAD), ischemia with non-obstructive coronaries (INOCA), anomalous coronary origins, and Kawasaki disease. Stress perfusion CMR is now recognized in international guidelines with several Class 1 indications testament to its excellent diagnostic accuracy and independent prognostic power. 

Publication Details 

• Report Title: SCMR Expert Consensus Statement on Quantitative Myocardial Perfusion Cardiovascular Magnetic Resonance Imaging 

• Abstract: SCMR Expert Consensus Statement on Quantitative Myocardial Perfusion Cardiovascular Magnetic Resonance Imaging – PubMed 

• Where Published: Journal of Cardiovascular Magnetic Resonance (J Cardiovasc Magn Reson), published by Elsevier on ScienceDirect 

• Date of Publication: August 8, 2025