Semiquantitative Analysis of Ischemic Dysfunctional Myocardial Tissue: Comparison of Contrast Enhanced MRI and Myocardial PET (original) (raw)
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Delineation of myocardial viability with PET
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1995
Relative flow and metabolic imaging (the "mismatch pattern") with PET have been proposed to identify the presence of viable myocardium in patients with ischemic left ventricular dysfunction. Yet, optimal criteria to identify dysfunctional but viable myocardium and predict significant functional improvement have not been fully defined. Dynamic PET imaging with 13N-ammonia and 18F-deoxyglucose to assess absolute myocardial perfusion and glucose uptake was performed in 25 patients (20 men, 5 women; mean age 57 +/- 12 yr, range 30-72 yr) scheduled for coronary revascularization because of coronary artery disease, anterior wall dysfunction and mildly depressed left ventricular ejection fraction (49% +/- 11%). Global and regional left ventricular function was evaluated by contrast left ventriculography at baseline and after revascularization. As judged from the changes in end-systolic volume and resting anterior wall motion before and after revascularization, 17 patients with im...
World Journal of Cardiology
AIM To compare myocardial viability assessment accuracy of cardiac magnetic resonance imaging (CMR) compared to [ 18 F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) depending on left ventricular (LV) function. METHODS One-hundred-five patients with known obstructive coronary artery disease (CAD) and anticipated coronary revascularization were included in the study and examined by CMR on a 1.5T scanner. The CMR protocol consisted of cine-sequences for function analysis and late gadolinium enhancement (LGE) imaging for viability
Hypodense regions in unenhanced CT identify nonviable myocardium: validation versus 18F-FDG PET
European Journal of Nuclear Medicine and Molecular Imaging, 2012
The aim of the present study was to evaluate the accuracy of hypodense regions in non-contrast-enhanced cardiac computed tomography (unenhanced CT) to identify nonviable myocardial scar tissue. METHODS: Hypodense areas were visually identified in unenhanced CT of 80 patients in the left ventricular anterior, apical, septal, lateral and inferior myocardium and CT density was measured in Hounsfield units (HU). Findings were compared to (18)F-fluorodeoxyglucose uptake by positron emission tomography (FDG PET), which served as the standard of reference to distinguish scar (<50 % FDG uptake) from viable tissue (50 % uptake). RESULTS: Visually detected hypodense regions demonstrated a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 74, 97, 84 and 94 %, respectively. A receiver-operating characteristic (ROC) curve analysis revealed a cutoff value of mean HU at <28.8 for predicting scar tissue with an area under the curve of 0.93 yielding a sensitivity, specificity, PPV and NPV of 94, 90, 67 and 99 %, respectively. CONCLUSION: Hypodense regions in unenhanced cardiac CT scans allow accurate identification of nonviable myocardial scar tissue.
PET vs MRI for Myocardial Viability
Indian Journal of Clinical Cardiology
Myocardial viability is an important concept that though conceptualy inituitive however has eluded any positive benefit in a randomised trial situation . The two techniques that are cutting edge and also the most accurate are the PET and CMR . In this review we will try to address the fundamentals and the pros and cons of each technique to enable clinical cardiologists to have an understanding on which technique will be the most optimum in a given clinical situation.
Assessment of Myocardial Scar; Comparison Between 18 F-FDG PET, CMR and 99 Tc-Sestamibi
Clinical Medicine Insights Cardiology, 2009
Objective: Patients with heart failure and ischaemic heart disease may obtain benefit from revascularisation if viable dysfunctional myocardium is present. Such patients have an increased operative risk, so it is important to ensure that viability is correctly identified. In this study, we have compared the utility of 3 imaging modalities to detect myocardial scar.
Assessment of myocardial scar; comparison between F-FDG PET, CMR and Tc-sestamibi
Clinical Medicine: Cardiology
Patients with heart failure and ischaemic heart disease may obtain benefit from revascularisation if viable dysfunctional myocardium is present. Such patients have an increased operative risk, so it is important to ensure that viability is correctly identified. In this study, we have compared the utility of 3 imaging modalities to detect myocardial scar. Prospective, descriptive study. Tertiary cardiac centre. 35 patients (29 male, average age 70 years) with coronary artery disease and symptoms of heart failure (>NYHA class II). Assessment of myocardial scar by (99)Tc-Sestamibi (MIBI), (18)F-flurodeoxyglucose (FDG) and cardiac magnetic resonance (CMR). The presence or absence of scar using a 20-segment model. More segments were identified as nonviable scar using MIBI than with FDG or CMR. FDG identified the least number of scar segments per patient (7.4 +/- 4.8 with MIBI vs. 4.9 +/- 4.2 with FDG vs. 5.8 +/- 5.0 with CMR, p = 0.0001 by ANOVA). The strongest agreement between modal...
Imaging Techniques in Nuclear Cardiology for the Assessment of Myocardial Viability
The International Journal of Cardiovascular Imaging, 2006
The assessment of myocardial viability has become an important aspect of the diagnostic and prognostic work-up of patients with ischemic cardiomyopathy. Although revascularization may be considered in patients with sufficient viable myocardium, patients with predominantly scar tissue should be treated medically. Patients with left ventricular dysfunction who have viable myocardium are the patients at highest risk because of the potential for ischemia but at the same time benefit most from revascularization. It is important to identify viable myocardium in these patients, and radionuclide myocardial scintigraphy is an excellent tool for this. Single-photon emission computed tomography perfusion scintigraphy (SPECT), whether using 201 thallium, 99m Tc-sestamibi, or 99m Tc-tetrofosmin, in stress and/or rest protocols, has consistently been shown to be an effective modality for identifying myocardial viability and guiding appropriate management. Metabolic and perfusion imaging with positron emission tomography (PET) radiotracers frequently adds additional information and is a powerful tool for predicting which patients will have an improved outcome from revascularization. New techniques in the nuclear cardiology field, like attenuation corrected SPECT, dual isotope simultaneous acquisition (DISA) SPECT and gated FDG PET are promising and will further improve the detection of myocardial viability. Also the combination of multislice computed tomography scanners with PET opens possibilities of adding coronary calcium scoring and non-invasive coronary angiography to myocardial perfusion imaging and quantification. Evaluation of the clinical role of these creative new possibilities warrants investigation.
Magnetic Resonance Imaging for the Assessment of Myocardial Viability
The identification of myocardial viability in the setting of left ventricular (LV) dysfunction is crucial for the prediction of functional recovery following revascularization. Although echocardiography, positron emission tomography (PET), and nuclear imaging have validated roles, recent advances in cardiac magnetic resonance (CMR) technology and availability have led to increased experience in CMR for identification of myocardial viability. CMR has unique advantages in the ability of magnetic resonance spectroscopy (MRS) to measure subcellular components of myocardium, and in the image resolution of magnetic resonance proton imaging. As a result of excellent image resolution and advances in pulse sequences and coil technology, magnetic resonance imaging (MRI) can be used to identify the transmural extent of myocardial infarction (MI) in vivo for the first time. This review of the role of CMR in myocardial viability imaging describes the acute and chronic settings of ventricular dysfunction and concepts regarding the underlying pathophysiology. Recent advances in MRS and MRI are discussed, including the potential for dobutamine MRI to identify viable myocardium and a detailed review of the technique of delayed gadolinium (Gd) contrast hyperenhancement for visualization of viable and nonviable myocardium.
Archivos de cardiologia de Mexico, 2006
BACKGROUND In patients with myocardial infarction and left ventricular dysfunction, the evidence of myocardial viability is primordial. There are some methods to detect the presence of myocardial viability, 201 thallium reinjection SPECT protocol represents the most common radioisotopic technique to evaluate it. Positron emission tomography (PET) using FDG is considered the gold standard. The aim of this study was to compare globally and by segments the value of both techniques in the detection of viable myocardium. METHODS Twenty-three consecutive patients with previous myocardial infarction and left ventricular dysfunction were studied. All of them underwent into a SPECT perfusion scan and a FDG PET study to asses myocardial viability. Each study was performed in less than one week between the other. For the analysis, the myocardium was divided into 17 segments. A visual semi-quantitative analysis was carried out according to the following score indicating radiotracer uptake: O = ...