Clinical study: cardiac imaging
Myocardial viability inchronic ischemic heart disease: Comparison of contrast-enhanced magnetic resonance imaging with 18F-fluorodeoxyglucose positron emission tomography

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Abstract

Objectives

We sought to compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease and left ventricular (LV) dysfunction.

Background

Contrast-enhanced MRI has been shown to identify scar tissue in ischemically damaged myocardium.

Methods

Twenty-six patients with chronic coronary artery disease and LV dysfunction (mean ejection fraction 31 ± 11%) underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), technetium-99m tetrofosmin single-photon emission computed tomography (SPECT), and ceMRI. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI, defined as the relative amount of contrast-enhanced tissue per myocardial segment, was compared with segmental FDG and tetrofosmin uptake by PET and SPECT.

Results

In severely dysfunctional segments (n = 165), SEH was 9 ± 14%, 33 ± 25% (p < 0.05), and 80 ± 23% (p < 0.05) in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively. Segmental glucose uptake by PET was inversely correlated to SEH (r = −0.86, p < 0.001). By receiver operator characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At a cutoff value of 37%, SEH optimally differentiated viable from non-viable segments defined by PET. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by PET were 96% and 84%, respectively.

Conclusions

Contrast-enhanced MRI allows assessment of myocardial viability with a high accuracy, compared with FDG-PET, in patients with chronic ischemic heart disease and LV dysfunction.

Keywords

AUC
area under the curve
ceMRI
contrast-enhanced magnetic resonance imaging
EDWT
end-diastolic wall thickness
FDG
18F-fluorodeoxyglucose
LV
left ventricle or ventricular
PET
positron emission tomography
ROC
receiver operator characteristic
ROI
region of interest
SHE
segmental extent of hyperenhancement
SPECT
single-photon emission computed tomography

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This work was supported by grant no. 2001.158 from the Netherlands Heart Foundation. Dr. H. P. Kühl was supported in part by grants from the Faculty of Medicine of the Rheinisch-Westfälische Technische Hochschule, Aachen, and by the Grimmke-Stiftung, Düsseldorf, Germany.