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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

View larger version (104K): [in a new window]   Figure 1 Analysis of contrast-enhanced images. (Large panel) The posterior insertion of the right ventricular wall into the left ventricle served as a landmark for the definition of sectors in the short-axis slices. (Small panel) Total myocardial area per sector (outer white line, arrows) and contrast-enhanced area per sector (inner white line, arrowheads) were traced manually, and the amount of hyperenhancement was expressed as the percentage relative to total myocardial area.

View larger version (22K): [in a new window]   Figure 2 Bar graph showing mean segmental extent of hyperenhancement by contrast-enhanced magnetic resonance imaging categorized according to 18F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET).

View larger version (36K): [in a new window]   Figure 3 The receiver operator characteristic analysis of the differentiation between viable and non-viable segments by contrast-enhanced magnetic resonance imaging using 18F-fluorodeoxyglucose-positron emission tomography as a reference standard.

View larger version (72K): [in a new window]   Figure 4 (Top row) Representative tetrofosmin SPECT (left panel), FDG-PET (middle panel), and contrast-enhanced magnetic resonance imaging (ceMRI) (right panel) images of the basal myocardial segments of the same patient. The SPECT image shows a perfusion defect extending from the septum to the inferior wall (white arrowheads). FDG-PET demonstrates preserved glucose metabolism in the same region (white arrowheads). On the ceMRI image, a subtle subendocardial area of hyperenhancement is seen extending from the inferoseptal to posterolateral myocardium (black arrowheads). (Bottom row) End-diastolic (left panel) and end-systolic (right panel) frames of the corresponding cine images. An area of akinesia extends along the same region as the hyperenhancement area. This area corresponds to non-contracting but viable myocardium. SPECT = single photon emission computed tomography. Other definitions are defined in Figure 2.

View larger version (113K): [in a new window]   Figure 5 Example of a patient with a 36-month-old posterolateral myocardial infarction. The 18F-fluorodeoxyglucose-positron emission tomography images (A through G, base to apex) reveal a defect in the posterolateral wall extending to the inferior wall at the midventricular level. Contrast-enhanced magnetic resonance imaging (1 through 8, base to apex) shows transmural enhancement of a similar size in the same location.