Comparison of contrast-enhanced MRI with 18F-FDG PET/ 201Tl SPECT in dysfunctional myocardium: Relation to early functional outcome after surgical revascularization in chronic ischemic heart disease
Journal
Journal of Nuclear Medicine
Journal Volume
48
Journal Issue
7
Pages
1096-1103
Date Issued
2007
Author(s)
Abstract
Revascularization of viable myocardial segments has been shown to improve left ventricular (LV) function and long-term prognosis; however, the surgical risk is comparatively higher in patients with a low ejection fraction (EF). We compared contrast-enhanced MRI with 18F-FDG PET/201Tl SPECT for myocardial viability and prediction of early functional outcome in patients with chronic coronary artery disease (CAD). Methods: Forty-one patients with chronic CAD and LV dysfunction (mean age ± SD, 66 ± 10 y; 32 men; mean EF ± SD, 38% ± 13%) referred for 18F-FDG PET, 201Tl-SPECT and MRI within 2 wk were included. Twenty-nine subjects underwent coronary artery by-pass grafting (CABG), and LV function was reassessed by MRI before discharge (17 ± 7 d after surgery). Two were excluded from outcome analysis (1 death due to sepsis; 1 perioperative myocardial infarction). The extent of viable myocardium by 18F-FDG PET/201Tl SPECT was defined by the metabolism-perfusion mismatch or ischemia, in comparison with the extent of delayed enhancement (DE) on MRI in a 17-segment model. Segmental functional recovery was defined as improvement in the wall motion score of ?1 on a 4-point scale. EF and LV volume change were used as global functional outcome. Results: Three hundred ninety-four dysfunctional segments were compared, and the extent of DE on MRI correlated negatively with the viability on 18F-FDG PET. Of 252 dysfunctional segments that were successfully revascularized, the sensitivity, specificity, positive predictive value, and negative predictive value of PET/SPECT were 60.2%, 98.7%, 76.6%, and 96.7% and of MRI were 92.2%, 44.9%, 72.4%, and 78.6% using the cutoff value of 50% DE on MRI, without significant differences in overall accuracies. In 18 subjects who underwent isolated CABG, improvement of EF (25%) and reverse LV remodeling (?10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on 18F-FDG/SPECT predicted a poor early functional outcome (all P < 0.001). Conclusion: Accurate prediction of early functional outcome by PET/SPECT and contrast-enhanced MRI is possible. Copyright ? 2007 by the Society of Nuclear Medicine, Inc.
SDGs
Other Subjects
fluorodeoxyglucose f 18; gadodiamide; thallium 201; accuracy; adult; aged; apparatus; article; clinical article; contrast enhancement; convalescence; coronary artery bypass graft; coronary artery disease; female; functional assessment; heart ejection fraction; heart left ventricle failure; heart muscle ischemia; heart muscle metabolism; heart perfusion; heart ventricle wall motion; human; image analysis; image enhancement; intermethod comparison; male; nuclear magnetic resonance imaging; outcome assessment; positron emission tomography; prediction; priority journal; prognosis; sensitivity and specificity; single photon emission computer tomography; Aged; Chronic Disease; Contrast Media; Coronary Arteriosclerosis; Coronary Artery Bypass; Female; Fluorodeoxyglucose F18; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Revascularization; Positron-Emission Tomography; Radiopharmaceuticals; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Dysfunction, Left
Type
journal article