Synopsis

First-pass MRI utilizes ECG-gated saturation-recovery gradient-echo or SSFP imaging applied immediately upon intravenous injection of gadolinium, enabling the visual or quantitative assessment of myocardial perfusion. For multislice coverage with high spatiotemporal resolution, acceleration is required. While parallel imaging is standard, compressed sensing, multiband, and/or non-Cartesian trajectories provide improvements, and deep learning may facilitate rapid reconstruction. Perfusion quantification is important in three-vessel and microvascular disease, and recent deep-learning-based pipelines promise to make quantification routine. Clinically, while superiority compared to SPECT was demonstrated in 2012, recently noninferiority compared to fractional flow reserve for guiding coronary revascularization was shown, representing another major advance.