Assessment of myocardial viability with contrast-enhanced magnetic resonance imaging - Comparison with positron emission tomography

被引:422
作者
Klein, C
Nekolla, SG
Bengel, FM
Momose, M
Sammer, A
Haas, F
Schnackenburg, B
Delius, W
Mudra, H
Wolfram, D
Schwaiger, M
机构
[1] Tech Univ Munich, Nukl Med Klin & Poliklin, D-81675 Munich, Germany
[2] Deutsch Herzzentrum Munich, Herzgefasschirurg Klin, Munich, Germany
[3] Philips Med Syst, Hamburg, Germany
[4] Stadt Krankenhaus Munchen Bogenhausen, D-8000 Munich, Germany
[5] Krankenhaus Munchen Neuperlach, Munich, Germany
关键词
magnetic resonance; coronary disease; heart failure; hibernation;
D O I
10.1161/hc0202.102123
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 MR1 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, MR1 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.
引用
收藏
页码:162 / 167
页数:6
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