DOI: 10.1148/radiol.2392051310
(Radiology 2006;239:613.)
© RSNA, 2006
Imaging Quantification of Infarct Size
Joseph B. Selvanayagam, MBBS, FRACP, DPhil
University of Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Oxford, Oxon OX3 9DU, United Kingdom
e-mail: Joseph.selvanayagam{at}cardiov.ox.ac.uk
Editor:
I read with much interest the article by Dr Paul and colleagues (1) in the August 2005 issue of Radiology. The authors used single photon emission computed tomography (SPECT) as the reference standard in assessing the accuracy of multi–detector row computed tomography (CT) in the prediction of infarct size after reperfused acute myocardial infarction. They state that, on the basis of current evidence, SPECT is the best available technique for the quantification of infarct size. On the contrary, I believe that cardiovascular magnetic resonance (MR) imaging is the modality of choice for infarct quantification in current clinical practice (regardless of infarct size), and the lack of corroborating cardiovascular MR information in their study cohort substantially limits the findings.
Delayed-enhancement MR imaging, validated in animal and human studies, has been shown to be superior to SPECT for the identification of subendocardial myocardial infarction (2) and permits quantification and localization of microinfarction. Multiple clinical studies have confirmed the utility of delayed-enhancement MR imaging in predicting viability after revascularization in chronic ischemic heart disease (3,4). Furthermore, given its unique ability to depict the transmural extent of infarction, cardiovascular MR provides new insights into the traditional electrocardiography (ECG)-based classification of myocardial infarction, challenging the concept that ECG Q waves always indicate full-thickness infarction (5). While long-term prognostic studies based on cardiovascular MR are needed, when assessing new techniques for infarct detection and quantification I would suggest that delayed-enhancement cardiovascular MR be used as the reference standard measurement.
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References
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- Paul JF, Wartski M, Caussin C, et al. Late defect on delayed contrast-enhanced multi–detector row CT scans in the prediction of SPECT infarct size after reperfused acute myocardial infarction: initial experience. Radiology 2005;236:485–489.[Abstract/Free Full Text]
- Wagner A, Mahrholdt H, Holly TA, et al. Contrast-enhanced MRI and routine single photon emission computed tomography (SPECT) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet 2003;361:374–379.[CrossRef][Medline]
- Selvanayagam JB, Kardos A, Francis JM, et al. Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation 2004;110:1535–1541.[Abstract/Free Full Text]
- Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 2000;343:1445–1453.[Abstract/Free Full Text]
- Moon JC, Perez De Arenaza D, Elkington AG, et al. The pathologic basis of Q-wave and non-Q-wave myocardial infarction: a cardiovascular magnetic resonance study. J Am Coll Cardiol 2004;44:554–560.[Abstract/Free Full Text]
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