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Cardiac Imaging |
1 From the Departments of Cardiology (G.K.L., J.H.G., T.M.), Diagnostic and Interventional Radiology (A.S., M.P.B., J.H.G., G.A.), and Nuclear Medicine (V.M., J.M.), University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; and Department of Radiology, University of California, San Francisco (M.S., C.B.H.). From the 2002 RSNA scientific assembly. Received July 18, 2003; revision requested October 2; revision received October 29; accepted January 5, 2004. Supported in part by Schering, Berlin, Germany, and by the Pinguin Stiftung Düsseldorf, Germany. Address correspondence to G.K.L. (e-mail: glund@uke.uni-hamburg.de).
PURPOSE: To evaluate acute myocardial infarction by using first-pass enhancement (FPE) and delayed enhancement (DE) magnetic resonance (MR) imaging compared with thallium 201 (201Tl) single photon emission computed tomography (SPECT).
MATERIALS AND METHODS: Contrast material–enhanced FPE MR, inversion-recovery DE MR, and rest-redistribution 201Tl SPECT images were obtained in 60 consecutive patients (53 men, seven women; mean age [± SD], 56 years ± 13; range, 30–78 years) at 6 days ± 3 after reperfused first myocardial infarction. Presence of microvascular obstruction was determined on FPE MR images. Infarct size was defined on DE MR images as percentage of left ventricular (LV) area and compared with uptake defect on redistribution 201Tl SPECT images. Differences in continuous data were analyzed with Student t test. Linear regression and Bland-Altman analysis were used to compare measurements of infarct size.
RESULTS: Mean infarct size was not significantly different between DE MR imaging (20.7% ± 11.5% of LV area) and 201Tl SPECT (19.4% ± 14.3% of LV area; P = .26); good correlation (r = 0.73; P < .001) and agreement were found, with a mean difference of +1.3% ± 9.8% of LV area. 201Tl SPECT failed to depict infarct in six (20%) of 30 patients with inferior myocardial infarction (mean size, 6.4% ± 5.7% of LV area on DE MR images), whereas DE MR images showed the infarct in all patients (P < .01). FPE MR images depicted microvascular obstruction in 23 (38%) of 60 patients; these patients had larger infarctions at DE MR imaging than did patients without microvascular obstruction (30.4% ± 9.0% vs 15.1% ± 8.4% of LV area, P < .001). 201Tl SPECT showed larger infarcts in patients with microvascular obstruction (26.7% ± 16.2% vs 15.0% ± 11.2% of LV area, P < .01).
CONCLUSION: Good correlation and agreement with 201Tl SPECT indicate DE MR imaging may be used to estimate infarct size 6 days after reperfused acute myocardial infarction. DE MR imaging is more sensitive for detection of inferior infarction than is 201Tl SPECT. Patients with microvascular obstruction on FPE MR images have larger infarcts.
© RSNA, 2004
Index terms: Coronary vessels, stenosis or obstruction, 54.771 • Myocardium, infarction, 511.771 • Myocardium, MR, 511.121413, 511.12143 • Myocardium, SPECT, 511.12162 • Single photon emission computed tomography (SPECT), comparative studies, 511.121413, 511.12162
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