Circulation. 2002;105:162-167
doi: 10.1161/hc0202.102123
doi: 10.1161/hc0202.102123
(Circulation. 2002;105:162.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Assessment of Myocardial Viability With Contrast-Enhanced Magnetic Resonance Imaging
Comparison With Positron Emission Tomography
From Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München (C.K., S.G.N., F.M.B., M.M., A.S., M.S.); Herzchirurgische Klinik, Deutsches Herzzentrum München and Technische Universität München (F.H.); Philips Medical Systems, Hamburg (B.S.); Krankenhaus München-Bogenhausen (W.D.); Krankenhaus München-Neuperlach (H.M.); and Medical Park/St Hubertus Klinik (D.W.), Germany.
Correspondence to Markus Schwaiger, MD, Nuklearmedizinische Klinik und Poliklinik, Technische Universität München, Ismaningerstr.22, D-81675 München, Germany. E-mail m.schwaiger{at}lrz.tu-muenchen.de
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.
Methods and 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.
Key Words: magnetic resonance • coronary disease • heart failure • hibernation
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
V. Fuster and R. J. Kim Frontiers in Cardiovascular Magnetic Resonance Circulation, July 5, 2005; 112(1): 135 - 144. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 P. Hunold, T. Schlosser, F. M. Vogt, H. Eggebrecht, A. Schmermund, O. Bruder, W. O. Schuler, and J. Barkhausen Myocardial Late Enhancement in Contrast-Enhanced Cardiac MRI: Distinction Between Infarction Scar and Non-Infarction-Related Disease Am. J. Roentgenol., May 1, 2005; 184(5): 1420 - 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
A. F L Schinkel, J. J Bax, and D. Poldermans Clinical assessment of myocardial hibernation Heart, January 1, 2005; 91(1): 111 - 117. [Full Text] [PDF]
|
|
|
|
 |
|
 S. K Prasad, R. G Assomull, and D. J Pennell Recent developments in non-invasive cardiology BMJ, December 11, 2004; 329(7479): 1386 - 1389. [Full Text] [PDF]
|
|
|
|
|
|
A. Gupta, V. S. Lee, Y.-C. Chung, J. S. Babb, and O. P. Simonetti Myocardial Infarction: Optimization of Inversion Times at Delayed Contrast-enhanced MR Imaging Radiology, December 1, 2004; 233(3): 921 - 926. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Pennell, U. P. Sechtem, C. B. Higgins, W. J. Manning, G. M. Pohost, F. E. Rademakers, A. C. van Rossum, L. J. Shaw, and E. K. Yucel Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report Eur. Heart J., November 1, 2004; 25(21): 1940 - 1965. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons, U. S. Valeti, P. A. Araoz, and A. S. Jaffe The quantification of infarct size J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1533 - 1542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. Edelman Contrast-enhanced MR Imaging of the Heart: Overview of the Literature Radiology, September 1, 2004; 232(3): 653 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. C. Moon, D. Perez De Arenaza, A. G. Elkington, A. K. Taneja, A. S. John, D. Wang, R. Janardhanan, R. Senior, A. Lahiri, P. A. Poole-Wilson, et al. The pathologic basis of Q-wave and non-Q-wave myocardial infarction: A cardiovascular magnetic resonance study J. Am. Coll. Cardiol., August 4, 2004; 44(3): 554 - 560. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Arai and G. A. Hirsch Q-wave and non-q-wave myocardial infarctions through the eyes of cardiac magnetic resonance imaging J. Am. Coll. Cardiol., August 4, 2004; 44(3): 561 - 563. [Full Text] [PDF]
|
|
|
|
|
|
G. K. Lund, A. Stork, M. Saeed, M. P. Bansmann, J. H. Gerken, V. Muller, J. Mester, C. B. Higgins, G. Adam, and T. Meinertz Acute Myocardial Infarction: Evaluation with First-Pass Enhancement and Delayed Enhancement MR Imaging Compared with 201Tl SPECT Imaging Radiology, July 1, 2004; 232(1): 49 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Kim and W. J. Manning Viability Assessment by Delayed Enhancement Cardiovascular Magnetic Resonance: Will Low-Dose Dobutamine Dull the Shine? Circulation, June 1, 2004; 109(21): 2476 - 2479. [Full Text] [PDF]
|
|
|
|
|
|
E. Wellnhofer, A. Olariu, C. Klein, M. Grafe, A. Wahl, E. Fleck, and E. Nagel Magnetic Resonance Low-Dose Dobutamine Test Is Superior to Scar Quantification for the Prediction of Functional Recovery Circulation, May 11, 2004; 109(18): 2172 - 2174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Shan, G. Constantine, M. Sivananthan, and S. D. Flamm Role of Cardiac Magnetic Resonance Imaging in the Assessment of Myocardial Viability Circulation, March 23, 2004; 109(11): 1328 - 1334. [Full Text] [PDF]
|
|
|
|
|
|
R J Kim and D J Shah Fundamental concepts in myocardial viability assessment revisited: when knowing how much is "alive" is not enough Heart, February 1, 2004; 90(2): 137 - 140. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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 K. C. Wu and J. A.C. Lima Noninvasive Imaging of Myocardial Viability: Current Techniques and Future Developments Circ. Res., December 12, 2003; 93(12): 1146 - 1158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|