Evaluation of quantitative CMR perfusion imaging by comparison with simultaneous (15)O-water-PET

BACKGROUND: We assessed the quantitative accuracy of cardiac perfusion measurements using dynamic contrast-enhanced MRI with simultaneous (15)O-water PET as reference with a fully integrated PET-MR scanner. METHODS: 15 patients underwent simultaneous DCE MRI and (15)O-water PET scans at rest and adenosine-stress on an integrated PET-MR scanner. Correlation and agreement between MRI- and PET-based global and regional MBF values were assessed using correlation and Bland–Altman analysis. RESULTS: Three subjects were excluded due to technical problems. Global mean (± SD) MBF values at rest and stress were 0.97 ± 0.27 and 3.19 ± 0.70 mL/g/min for MRI and 1.02 ± 0.28 and 3.13 ± 1.16 mL/g/min for PET (P = 0.66 and P = 0.81). The correlations between global and regional MRI- and PET-based MBF values were strong (r = 0.86 and r = 0.75). The biases were negligible for both global and regional MBF comparisons (0.01 and 0.00 mL/min/g for both), but the limits of agreement were wide for both global and regional MBF, with larger variability for high MBF-values. CONCLUSION: The correlation between simultaneous MBF measurements with DCE MRI and (15)O-water PET measured in an integrated PET-MRI was strong but the agreement was only moderate indicating that MRI-based quantitative MBF measurements is not ready for clinical introduction. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-019-01810-z) contains supplementary material, which is available to authorized users.