Fermi function constrained deconvolution underestimates myocardial blood flow and myocardial perfusion reserve regardless of saturation correction of arterial input curve

Background Myocardial blood flow (MBF) can be quantified from arterial input function (AIF) and myocardial output function in perfusion MRI by using tracer kinetic modeling. Fermi function constrained deconvolution has been widely used to determine MBF and myocardial perfusion reserve (MPR). However, stress MBF and MPR in healthy subjects quantified by the Fermi deconvolution approach were reported to be 2 to 3 mL/min/g and 2 to 3, respectively, which are substantially smaller than those quantified by O-water PET (3 to 5 mL/min/g and 3 to 5, respectively). Tissue compartment model analysis with Patlak plot is an alternative approach to estimate MBF and MPR. In a recent study employing corrections for AIF saturation and extraction fraction of gadolinium contrast medium, MBF and MPR by model-based Patlak plot method showed an excellent agreement with those quantified by O-water PET. In the current study, we compare MBF and MPR calculated by Fermi function constrained deconvolution with those by model-based Patlak plot method.