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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

View larger version (7K): [in this window] [in a new window]   FIGURE 1.  Segmental extent of DE by MRI categorized according to 18F-FDG PET/201Tl SPECT in dysfunctional myocardium (n = 394).

View larger version (11K): [in this window] [in a new window]   FIGURE 2.  Relation between segmental viability status by MRI categorization (A) and 18F-FDG PET/201Tl SPECT (B) and early functional outcome after surgical revascularization (n = 252).

View larger version (129K): [in this window] [in a new window]   FIGURE 3.  A 70-y-old man with history of anterior wall MI. (A) Steady-state, free-precession cine MR images in short-axis (top panel) and long-axis (bottom panel) planes show apical aneurysm and anterior wall hypokinesis (left column); the myocardial wall motion and systolic wall thickening improves in these segments after CABG (right column; arrows). ED = end-diastole; ES = end-systole. (B) Transmural DE in apex and >50% DE in anterior wall are evident. (C) Severe hypoperfusion on redistribution 201Tl SPECT (C) and preserved 18F-FDG uptake on PET (D) are observed in the corresponding segments.

View larger version (107K): [in this window] [in a new window]   FIGURE 4.  A 56-y-old man with history of inferior wall MI. (A) Cine MR images in short-axis plane show inferior wall akinesis (top panel) and regional wall motion that do not change after CABG (bottom panel; arrows). ED = end-diastole; ES = end-systole. (B) Transmural DE in inferior wall is evident. Hypoperfusion on redistribution 201Tl SPECT (C) and enhanced 18F-FDG uptake on PET (D) are observed (mismatch pattern).

View larger version (106K): [in this window] [in a new window]   FIGURE 5.  A 64-y-old man with history of inferior wall MI. (A) Cine MR images in short-axis plane show akinesis with wall thinning in inferior wall (top panel), without significant improvement after bypass surgery (bottom panel; arrows). ED = end-diastole; ES = end-systole. (B) More than 75% DE is noted in these segments. (C) Severe hypoperfusion in inferior wall on redistribution 201Tl SPECT (C) and decreased 18F-FDG uptake on PET (with smaller extent than SPECT) (D) are observed.