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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

¹ Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan; ² Department of Nuclear Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan; and ³ Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

Correspondence: For correspondence contact: Eiji Tadamura, MD, PhD, Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara, Sakyo-ku, Kyoto, 606-8507, Japan. E-mail: et{at}kuhp.kyoto-u.ac.jp

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 bypass 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 (5%) 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.

Key Words: cardiovascular magnetic resonance • ¹⁸F-FDG • myocardial viability • surgical revascularization • cardiac function

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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