In this issue of the Journal, Arnold et al. (13) evaluate clinical application of BOLD imaging for detection of CAD. To optimize BOLD image quality, the investigators utilized high field strength (3-T) CMR and applied a recently developed approach, whereby data was acquired using a T2-prepared, steady-state free precession pulse sequence sampled across multiple RR intervals. Both BOLD and perfusion CMR imaging were performed at baseline and during adenosine stress, with results analyzed quantitatively. Diagnostic performance of BOLD imaging for obstructive CAD was compared with perfusion CMR among patients who underwent invasive angiography. Myocardial oxygen consumption, as manifest on BOLD, was also examined in relation to clinical indexes as well as conventional CMR findings (i.e., perfusion, hyperenhancement) to assess whether oxygen consumption varies in relation to physiological substrate. Regarding diagnostic performance, results demonstrated that BOLD yielded slightly lower accuracy (86%) than did perfusion CMR (91%), with differences between the 2 techniques attributable to lower specificity for BOLD (72%) compared with perfusion (89%). Additionally, whereas this study found that the likelihood of an abnormal BOLD response generally declined as perfusion-evidenced hyperemic blood flow increased, the 2 indexes correlated weakly (r = 0.26), as evidenced by the fact that half of hypoperfused segments demonstrated no evidence of deoxygenation.