title: Myocardial viability by contrast-enhanced cardiovascular magnetic resonance in patients with coronary artery disease: comparison with gated single-photon emission tomography and FDG position emission tomography.
abstract: BACKGROUND
  The aim of this study was to assess the value of contrast-enhanced cardiovascular magnetic resonance (CMR) in viability for patients with coronary artery disease and left ventricular (LV) dysfunction (ejection fraction [EF] </=50%), comparing to gated thallium-201 ((201)Tl) single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET).
  
  
  RESULTS
  One hundred sixteen patients (EF 37.8 +/- 16.2%) underwent stress-reinjection or rest-redistribution gated-SPECT and CMR (46 FDG-PET) within 1 month. All images were analyzed in a 17-segment and 0-4 scales system. Of 1972 segments, delayed enhancement (DE) on CMR correlated well with (201)Tl reduction (r = 0.90, p < 0.0001). The agreement of SPECT (>/=50% maximal (201)Tl activity) and CMR (</=50% DE) was 96.8% (kappa = 0.62). CMR detected more subendocardial scars in 18 subjects (60 segments). Reduced (201)Tl activity but none DE were observed in 19 subjects (76 segments; more inferior) who had lower EF and larger end-systolic volume (p < 0.05). Of 411 dysfunctional segments from 46 patients, FDG-PET (>/=50% of maximal FDG uptake) detected more viability (9%).
  
  
  CONCLUSIONS
  The extent of DE correlated (201)Tl activity well. CMR could detect more small infarcts, while FDG-PET could detect more viability. CMR could distinguish between artifacts or infarction on SPECT, especially in poor LV function.
authors.affiliation: Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
authors.forename: Eiji
authors.initials: E
authors.lastname: Tadamura
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kanao
authors.forename: Masaki
authors.initials: M
authors.lastname: Yamamuro
authors.forename: Akira
authors.initials: A
authors.lastname: Marui
authors.forename: Masashi
authors.initials: M
authors.lastname: Komeda
authors.forename: Masanao
authors.initials: M
authors.lastname: Toma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Kaori
authors.initials: K
authors.lastname: Togashi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003287:Contrast Media; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D019788:Fluorodeoxyglucose F18