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CLINICAL STUDY: CARDIAC IMAGING

Myocardial viability inchronic ischemic heart disease

Comparison of contrast-enhanced magnetic resonance imaging with ¹⁸F-fluorodeoxyglucose positron emission tomography

Harald P. Kühl, MD^*, Aernout M. Beek, MD, Arno P. van der Weerdt, MD, Mark B. M. Hofman, PhD, Cees A. Visser, MD, PhD, Adriaan A. Lammertsma, PhD^||, Nicole Heussen, MSc, Frans C. Visser, MD, PhD and Albert C. van Rossum, MD, PhD^*,*

^* Medical Clinic I, Aachen, Germany
Department of Medical Statistics, University Hospital, Aachen, Germany
Department of Cardiology, Amsterdam, The Netherlands
Department of Clinical Physics and Informatics, Amsterdam, The Netherlands
^|| PET Center, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

Manuscript received October 9, 2002; revised manuscript received November 30, 2002, accepted December 18, 2002.

^* Reprint requests and correspondence: Prof. Dr. Albert C. van Rossum, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, Amsterdam HV 1081, The Netherlands.
ac.vrossum{at}vumc.nl

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.

Abbreviations and Acronyms   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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