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The Paradox Image: A Noninvasive Index of Regional Left-Ventricular Dyskinesis

Harvard Medical School and Peter Bent Brigham Hospital, Boston, Massachusetts

Correspondence: For reprints contact: B. Leonard Holman, Dept. of Radiology, Harvard Medical School, 25 Shattuck St., Boston, MA 02115.

ABSTRACT

The paradox image, a functional image of regional dyskinesis derived from the equilibrium (gated) radionuclide ventriculogram, was constructed by subtracting the background-corrected end-diastolic frame from the background-corrected end-systolic frame. In 11 patients showing dyskinesis by contrast ventriculography, the percentage of left-ventricular picture elements containing paradox ranged from 3.6 to 55.6% (21.44% ± 4.45 s.e.m.). In 11 patients with normokinesis and in eight patients with hypokinesis by contrast ventriculography, the left-ventricular picture elements demonstrating paradox were less than 1.1% in all cases. In nine patients with akinesis, the percentage of left-ventricular picture elements containing paradox was 2.05 % ± 0.96 s.e.m. and was less than 2% in seven patients. There was also an excellent agreement between the location of dyskinesis on the paradox image and that by contrast ventriculography. The paradox image is a sensitive indicator of left-ventricular dyskinesis and should be useful in the evaluation of patients with suspected left-ventricular asynergy.