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CLINICAL RESEARCH: CARDIAC IMAGING

Diagnostic Value of Contrast-Enhanced Magnetic Resonance Imaging and Single-Photon Emission Computed Tomography for Detection of Myocardial Necrosis Early After Acute Myocardial Infarction

Tareq Ibrahim, MD^_*,_*, Hubertus P. Bülow, MD, Thomas Hackl, MD, Mira Hörnke, MD, Stephan G. Nekolla, PhD, Martin Breuer, MD^_*, Albert Schömig, MD^_* and Markus Schwaiger, MD, FACC

^_* Deutsches Herzzentrum and 1. Medizinische Klinik Rechts der Isar, Technische Universität München, München, Germany
Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, München, Germany.

Manuscript received March 17, 2006; revised manuscript received August 21, 2006, accepted August 22, 2006.

^_* Reprint requests and correspondence: Dr. Tareq Ibrahim, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 München, Germany. (Email: T.Ibrahim{at}lrz.tu-muenchen.de).

OBJECTIVES: This study sought to evaluate the diagnostic value of contrast-enhanced magnetic resonance imaging (CMR) and single-photon emission computed tomography (SPECT) for detection of myocardial necrosis after acute myocardial infarction (AMI).

BACKGROUND: Single-photon emission computed tomography is widely accepted in the clinical setting for detection and estimation of myocardial infarction. Contrast-enhanced magnetic resonance imaging offers technical advantages and is therefore a promising new method for identification of infarcted tissue.

METHODS: Seventy-eight patients with AMI were examined by CMR and SPECT 7 days after percutaneous coronary intervention. Contrast-enhanced magnetic resonance imaging and SPECT images were scored for presence and location of infarction using a 17-segment model. Results were compared with the peak troponin T level, electrocardiographic, and angiographic findings.

RESULTS: Acute myocardial infarction was detected significantly more often by CMR than SPECT (overall sensitivity: 97% vs. 87%; p = 0.008). Sensitivity of CMR was superior to SPECT in detecting small infarction as assessed by the peak troponin T level <3.0 ng/ml (92 vs. 69%; p = 0.03), and infarction in non-anterior location (98% vs. 84%; p = 0.03). Non–Q-wave infarctions were more likely to be detected by CMR (sensitivity 85% vs. 46%; p = 0.06). While CMR offered high sensitivity for detection of AMI irrespective of the infarct-related artery, SPECT was less sensitive, particularly within the left circumflex artery territory.

CONCLUSIONS: Contrast-enhanced magnetic resonance imaging is superior to SPECT in detecting myocardial necrosis after reperfused AMI because CMR detects small infarcts that were missed by SPECT independent of the infarct location. Thus, CMR is attractive for accurate detection and assessment of the myocardial infarct region in patients early after AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CE = contrast enhancement   CMR = contrast-enhanced magnetic resonance imaging   LAD = left anterior descending artery   LCX = left circumflex artery   LV = left ventricle   MI = myocardial infarction   RCA = right coronary artery   SPECT = single-photon emission computed tomography

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