Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging and comparison with single-photon emission computed tomography.
OBJECTIVE
To compare contrast-enhanced magnetic resonance imaging (ceMRI) with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease.


METHODS
Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography (SPECT). Patients with positive SPECT results also underwent 18F-fluorodeoxyglucose (FDG) SPECT. In a 17-segment model, the segmental extent of hyperenhancement (SEH) by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed.


RESULTS
Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent 18F-FDG SPECT. In 221 segments of 13 patients, SEH was (2.1 +/- 8.2)%, (25.0 +/- 13.7)%, and (57.7 +/- 23.6)% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them (all P < 0.05). By receiver operating characteristic curve analysis, the area under the curve was 0.95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction (r = - 0.90, P < 0.01) and positively with left ventricular volumes (r = 0.62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P < 0.05).


CONCLUSIONS
CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.
Wang
Yi-Ning
YN
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730.
Jin
Zheng-Yu
ZY
Zhang
Zhu-Hua
ZH
Kong
Ling-Yan
LY
Chen
Li-Bo
LB
Zhou
Lu
L
Sun
Hong-Yi
HY
Zhang
Heng
H
Miao
Qi
Q
D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D019788:Fluorodeoxyglucose F18