Comparative Study of Stress Myocardial Blood Flow by Cardiac MRI and Cardiac PET in the Absence of Obstructive Coronary Artery Disease

Friday, February 6, 2026

3:52 PM - 3:59 PM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

Stephanie Everest, DO

Resident Physician
University of Connecticut
West Hartford, Connecticut, United States

Primary Author(s)

Stephanie Everest, DO

Resident Physician
University of Connecticut
West Hartford, Connecticut, United States

Co-Author(s)

WD

William L. Duvall, MD

Cardiologist
Hartford Hospital, United States
SS

Stephanie Saucier, MD

Director of Women's Heart & Wellness Program
Hartford Hospital, United States
SJ

Saurabh Joshi, MD

Interventional Cardiologist
Hartford Hospital, United States
EM

Eugene Milshteyn, PhD

MR Clinical Scientist
GE HealthCare
Boston, Massachusetts, United States
HW

Haonan Wang, PhD

Lead Cardiac MR Scientist
GE HealthCare
Waukesha, Wisconsin, United States
SW

Shuo Wang, MD, PhD

Research Associate
University of Virginia Health System
Charlottesville, Virginia, United States
Vidya Nadig, MD

Director, cardiac MRI
Hartford Hospital
Hartford, Connecticut, United States

Background: Angina with nonobstructive coronary arteries (ANOCA) can be caused by microvascular, endothelial or epicardial dysfunction. For the non-invasive evaluation, quantitative perfusion using cardiac positron emission tomography (PET) has been traditionally used to assess myocardial blood flow (MBF) to diagnose the condition. Stress cardiac magnetic resonance (CMR) is increasingly being utilized to evaluate this population. There is currently no data comparing quantitative perfusion results of PET and stress CMR.

Methods: In a single center study, we sought to compare Rb-82 PET and CMR with regadenoson stress for the diagnosis of ANOCA. Consecutive patients were included who were evaluated for ANOCA from 10/01/2024 to 07/10/2025 and had both MBF and myocardial perfusion reserve (MPR) assessed by PET (GE Discovery MI) and CMR (GE 1.5T SIGNA Artist), respectively. Myocardial blood flow metrics were compared between PET and CMR using paired t-tests.

Results: Nine patients underwent both vasodilator PET and CMR within a mean of 5 months of each other. We found no significant difference in global MBF at rest (p=0.26) and stress (p=0.96), nor any difference in global MPR (p=0.72) between vasodilator PET and CMR. The mean percent difference in global rest flow was 8.1%, 0.4% for stress flow, and 2.1% for MPR. Similar findings were seen when comparing PET and CMR MPR by coronary artery distribution. Eight of the nine patients had concordant, normal myocardial flow reserve by CMR and PET. One of the 9 patients had abnormal myocardial flow reserve by CMR, but not by PET, which was confirmed by invasive testing.

Conclusion: In this small cohort of patients, there was no significant difference between myocardial flow and myocardial flow reserve as measures by vasodilator stress CMR and PET. There was concordance in the results of the test in 89% of the patients included in this study.

CMR-PET Differences

CMR-PET Difference Results	Rest Global	Stress Global	Reserve Global
Mean Diff +/- SD	*0.13 ± 0.31	^§0.01 ± 0.77	^†0.19 ± 1.49
Mean % Diff	8.1 ± 25.3%	0.4 ± 26.2%	-2.1 ± 41.3%
Median Diff (IQR)	0.06 (-0.02, 0.14)	-0.14 (-0.51, 0.72)	-0.13 (-1.14, 0.60)
Min Diff	-0.26	-1.20	-1.28
Max Diff	0.89	1.11	3.26

*Rest: p = 0.26, ^§Stress: p = 0.96, Global: p = 0.72

CMR-PET Differences by Coronary Territory

CMR-PET Difference Results	Reserve LAD	Reserve LCx	Reserve RCA
Mean +/- SD	0.24 ± 1.32	0.27 ± 1.65	0.02 ± 1.77
Mean % Diff	0.65 ± 39.6%	-0.87 ± 41.8%	-5.1 ± 48.4%
Median (IQR)	-0.01 (-0.46, 1.00)	-0.06 (-1.05, 0.62)	-0.07 (-1.13, 0.70)
Min	-1.37	-1.46	-2.96
Max	2.73	3.93	3.29

PET vs MRI Blood Flow Comparison