Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging: comparison with positron emission tomography.
BACKGROUND
Recent studies indicate that MRI, after administration of gadolinium-diethylenetriamine pentaacetic acid, can identify nonviable areas in dysfunctional myocardium. We compared MRI hyperenhancement with PET as a gold standard for detection and quantification of myocardial scar tissue.


RESULTS
Thirty-one patients with ischemic heart failure (ejection fraction, 28+/-9%) were imaged with PET and MRI. Scar was defined as regionally increased MRI signal intensity 20 minutes after injection of 0.2 mmol/kg gadolinium-diethylenetriamine pentaacetic acid and as concordantly reduced perfusion and glucose metabolism as defined by PET. Sensitivity and specificity of MRI in identifying patients and segments (n=1023) with matched flow/metabolism defects was 0.96 of 1.0 and 0.86 of 0.94, respectively. Eleven percent of segments defined as viable by PET showed some degree of MRI hyperenhancement. Defect severity score based on visual analysis was 44.3+/-9.1 for PET and 47.6+/-11.1 for MRI (r=0.91, P<0.0001). Quantitatively assessed relative MRI infarct mass correlated well with PET infarct size (r=0.81, P<0.0001). Furthermore, MRI hyperenhancement was a better predictor of scar tissue than end-diastolic and end-systolic wall thickness or thickening.


CONCLUSIONS
In severe ischemic heart failure, MRI hyperenhancement as a marker of myocardial scar closely agrees with PET data. Although hyperenhancement correlated with areas of decreased flow and metabolism, it seems to identify scar tissue more frequently than PET, reflecting the higher spatial resolution. Additional functional studies after revascularization are required to define the significance of small islands of scar detected by MRI.
Klein
Christoph
C
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Germany.
Nekolla
Stephan G
SG
Bengel
Frank M
FM
Momose
Mitsuru
M
Sammer
Andrea
A
Haas
Felix
F
Schnackenburg
Bernhard
B
Delius
Wolfram
W
Mudra
Harald
H
Wolfram
Dieter
D
Schwaiger
Markus
M
D002470:Cell Survival; D003287:Contrast Media; D003327:Coronary Disease / Q000175:diagnosis; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009206:Myocardium / Q000166:cytology; D012372:ROC Curve; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014055:Tomography, Emission-Computed / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis
D003287:Contrast Media; D019786:Gadolinium DTPA