Impact of baseline calibration on semiquantitative assessment of myocardial perfusion reserve by adenosine stress MRI

  • Andreas SeitzEmail author
  • Giancarlo Pirozzolo
  • Udo Sechtem
  • Raffi Bekeredjian
  • Peter Ong
  • Heiko Mahrholdt
Original Article


In this study, we sought to investigate the impact of baseline calibration, which is used in quantitative cardiac MRI perfusion analysis to correct for surface coil inhomogeneity and noise, on myocardial perfusion reserve index (MPRI) and its contribution to previously reported paradoxical low MPRI < 1.0 in patients with unobstructed coronary arteries. Semiquantitative perfusion analysis was performed in 20 patients with unobstructed coronary arteries undergoing stress/rest perfusion CMR and in ten patients undergoing paired rest perfusion CMR. The following baseline calibration settings were compared: (1) baseline division, (2) baseline subtraction and (3) no baseline calibration. In uncalibrated analysis, we observed ~ 20% segmental dispersion of signal intensity (SI)-over-time curves. Both baseline subtraction and baseline division reduced relative dispersion of t0-SI (p < 0.001), but only baseline division corrected for dispersion of peak-SI and maximum upslope also (p < 0.001). In the assessment of perfusion indices, however, baseline division resulted in paradoxical low MPRI (1.01 ± 0.23 vs. 1.63 ± 0.38, p < 0.001) and rest perfusion index (RPI 0.54 ± 0.07 vs. 0.94 ± 0.12, p < 0.001), respectively. This was due to a reversed ratio of blood-pool and myocardial baseline-SI before the second perfusion study caused by circulating contrast agent from the first injection. In conclusion, baseline division reliably corrects for inhomogeneity of the surface coil sensitivity profile facilitating comparisons of regional myocardial perfusion during hyperemia or at rest. However, in the assessment of MPRI, baseline division can lead to paradoxical low results (even MPRI < 1.0 in patients with unobstructed coronary arteries) potentially mimicking severely impaired perfusion reserve. Thus, in the assessment of MPRI we propose to waive baseline calibration.


Adenosine stress perfusion CMR Myocardial perfusion reserve MPRI Baseline calibration Baseline correction Surface coil sensitivity profile 



Coronary artery disease


Confidence interval


Coronary microvascular disease


Cardiac MRI


Coefficient of variation




End-diastolic volume


Intra-class correlation coefficient


LV ejection fraction


End-systolic volume


Late gadolinium enhancement


Left ventricular


Myocardial perfusion reserve index


Magnetic resonance imaging


Proton density


Rest perfusion index


Relative upslope


Signal intensity


Standard deviation



This study was funded by the Robert Bosch Stiftung and the Berthold Leibinger Stiftung.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval from the local ethics committee was obtained and all data acquired in this study were handled anonymously.

Informed consent

Informed consent was waived for retrospective review of existing patient data (Group 1). Prospectively enrolled study participants (Group 2) gave written informed consent to research participation.

Supplementary material

10554_2019_1729_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 48 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Andreas Seitz
    • 1
    Email author
  • Giancarlo Pirozzolo
    • 1
  • Udo Sechtem
    • 1
  • Raffi Bekeredjian
    • 1
  • Peter Ong
    • 1
  • Heiko Mahrholdt
    • 1
  1. 1.Department of CardiologyRobert-Bosch-KrankenhausStuttgartGermany

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