title: Contrast-enhanced magnetic resonance imaging assessment of scar size in patients with chronic myocardial infarction.
abstract: BACKGROUND
  In the assessment of myocardial infarction (MI) mass, contrast-enhanced magnetic resonance imaging (CE-MRI) is comparable to single-photon emission computed tomography (SPECT). The aim of the present study was to determine whether the MI area, as assessed at CE-MRI and SPECT, is comparable to mass evaluation. We also compared CE-MRI and SPECT estimates of the MI area with functional evaluations made at echocardiography and kinetic MRI (cine-MRI).
  
  
  METHODS
  We used a 1.0 Tesla MRI scanner and an inversion-recovery turboFLASH sequence, a tomographic gamma-camera and second-harmonic ultrasound systems. Two blinded operators assessed the extent of scarring, expressed as a percentage of the whole left ventricle (LV), using a 16-segment model. We studied 55 consecutive patients with a clinically stable healed MI (50 Q wave, 5 non-Q wave).
  
  
  RESULTS
  The scar mass was 19+/-23% of the LV at CE-MRI and 21+/-25% at SPECT; the scar area was 29+/-23% of the LV at CE-MRI, 41+/-28% at SPECT, 29+/-31% at cine-MRI, and 32+/-29% at echocardiography. The Bland-Altman bias between CE-MRI and SPECT mass estimations was -2% of the LV with a+/-23% limit of agreement (LOA), while the bias between the area assessments was -12% with a+/-42% LOA. Bias between CE-MRI and functional evaluation by cine-MRI and echocardiography was 0% with a+/-39% LOA and -3% with a+/-36% LOA respectively. Comparing SPECT with cine-MRI and echocardiography the bias was 12% with a+/-52% LOA and 9% with a+/-56% LOA respectively.
  
  
  CONCLUSIONS
  CE-MRI has proved to be comparable to SPECT in the assessment of the healed MI mass. Conversely, a high systematic error (high bias and LOA) renders CE-MRI and SPECT assessments of the MI area incomparable. Similarly (high bias and/or LOA) CE-MRI and SPECT estimations of the MI area cannot be compared with functional evaluation by echocardiography or cine-MRI.
authors.affiliation: IRCCS S Maugeri Foundation, Pavia, Italy. ocatalano@fsm.it
authors.forename: Oronzo
authors.initials: O
authors.lastname: Catalano
authors.forename: Serena
authors.initials: S
authors.lastname: Antonaci
authors.forename: Guido
authors.initials: G
authors.lastname: Moro
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cannizzaro
authors.forename: Renato
authors.initials: R
authors.lastname: Mingrone
authors.forename: Cristina
authors.initials: C
authors.lastname: Opasich
authors.forename: Mauro
authors.initials: M
authors.lastname: Frascaroli
authors.forename: Felice
authors.initials: F
authors.lastname: Rognone
authors.forename: Maurizia
authors.initials: M
authors.lastname: Baldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Tramarin
mesh_terms: D000368:Aged; D002908:Chronic Disease; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology*; D013673:Technology Assessment, Biomedical; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014463:Ultrasonography; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media