Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice
Comparison with wall motion and Technetium-99m sestamibi single-photon emission computed tomography
Thomas H. Marwick, MD, PhDa,
Richard Brunken, MDa,
Nils Meland, MSa,
Eric Brochet, MDa,
Frank M. Baer, MDa,
Thomas Binder, MDa,
Frank Flachskampf, MDa,
Otto Kamp, MDa,
Christoph Nienaber, MDa,
Petros Nihoyannopoulos, MDa,
Luc Pierard, MDa,
Jean-Louis Vanoverschelde, MDa,
Poll van der Wouw, MDa,
Kaj Lindvall, MDa the Nycomed NC100100 Iinvestigators
a Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Normal myocardial perfusion by MCE. The initial noncontrast image (A) is of good quality with fairly uniform gain settings. After injection of contrast agent (B), myocardial opacification is seen in the septum, apex and apical lateral wall (small arrows), with an attenuation artifact (large arrow) in the basal lateral wall. The accompanying SPECT image (C) shows normal perfusion by nuclear imaging.
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Figure 2 Apparent perfusion defect due to artifact. The noncontrast image (A) shows lower levels of backscatter from the lateral wall, probably due to interposed lung. After injection of contrast agent (B), an apparent defect involves the basal half of the lateral wall (arrows). The accompanying SPECT image (C) shows normal myocardial perfusion. This pattern is the most common source of false positive findings (i.e. reduced MCE when there should be normal perfusion).
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Figure 3 Sensitivity and specificity of intermediate and high dose myocardial contrast agent injection with continuous and triggered harmonic imaging for detection of SPECT defects. Accuracy data reflect segments where interpretation was feasible (proportion of total shown as feasibility).
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Figure 4 Relation of SPECT perfusion defect severity with probability of MCE perfusion defect (A) and probability of abnormal wall motion (B). WMA = wall motion abnormality.
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