MRI assessment of left ventricle myocardial viability in patients with chronic coronary artery disease in comparison with single photon emission computed tomography | ||
| Sohag Medical Journal | ||
| Article 32, Volume 22, Issue 3, October 2018, Pages 274-283 PDF (259.98 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/smj.2018.34490 | ||
| Authors | ||
| Mohamed Solyman; Osama Ahmed Arafa1; Mohamed Hassan Alam Eldeen2; Sherif Ali | ||
| 1Department of Internal Medicine, Faculty of Medicine, Sohag University | ||
| 2Department of Orthopaedic, Faculty of Medicine, Sohag University | ||
| Abstract | ||
| Background: Coronary artery disease (CAD) is highly prevalent in developed countries and is a leading cause of death. Diagnostic imaging plays an important role in the proper assessment and management of CAD. Myocardial perfusion is evaluated by SPECT in most patients today; however, this technique exposes patients to radiation and its diagnostic accuracy is sometimes limited by relatively low spatial resolution and artifacts from photon scatter and tissue attenuation. Scintigraphy defects may not be apparent until 10 g of tissue is infarcted. Thus, because a sizable threshold of damage is required, SPECT may miss small or subendocardial MI. Advances in rapid magnetic resonance imaging technology and its application to cardiac imaging have shown that MR imaging has tremendous potential for evaluation of cardiac disease. Practical advantages of cardiac MRI include the lack of ionizing radiation, a shortened examination time (25 to 40 min), good safety and tolerability profile, and detection of small subendocardial infarcts. Aim: assessment of myocardial viability in patients with chronic coronary artery disease by magnetic resonance imaging in comparison with single photon emission computed tomography (SPECT). Patients and Methods: This prospective study include examination of 10 adult patients (each patient has 3 coronary arteries, so we examined 30 coronary arteries and their myocardial territories) known to have chronic ischemic heart disease in Cairo university by MRI and SPECT with conventional angiography as a standard reference. MRI done by using 1.5T machine, using SENSE (sensitivity encoding) cardiac coil (6 element phased-array coil, receive only), functional cine images, first pass perfusion images and delayed enhancement images were acquired. SPECT study was done by 2-day exercise/rest gated SPECT imaging with Tc–99m sestamibi. Conventional coronary angiography was done using a trans-femoral approach to selectively inject the left and right coronary systems sequentially. The results of cardiac MRI subdivided into three groups: (a) Myocardial ischemia was defined as: either 1- Cardiac segment with motion abnormality or perfusion deficit at first-pass perfusion MR imaging consistent with no hyper-enhancement at delayed-enhancement MR imaging. Or 2- Cardiac segment of subendocardial enhancement (25 % thickness scar) with motion abnormality. (b) Myocardial scarring is defined as: either 1- Cardiac segment with myocardial delayed enhancement having ≥ 75% thickness scar. Or 2- Myocardial thickness less than 6 mm in diastole. (c) Mixed myocardial ischemia and scarring is defined as: Cardiac segment with myocardial delayed enhancement of near 50 % (>25% and <75%) thickness scarring. The results of SPECT were obtained by comparison between resting and exercise images to detect areas with fixed defects (scar) and those with reversible defects (ischemia). A defect was considered to be fixed (scarred) when there was no change between the stress and rest images, partially reversible (mixed ischemia and scar) when there was an improvement in tracer uptake of at least 1 grade between stress and rest images, totally reversible (ischemic) when there was normalization of uptake at rest images. In coronary angiography a reduction of the luminal diameter 70% or more in a major epicardial coronary artery or the major branches was considered to be a relevant stenosis. The angiographic results were classified as one-, two-, or three-vessel disease. Results:Both CMR and SPECT are accurate in detection of diseased coronary arteries with statistically significant P values. The overall patient based sensitivity, specificity, PPV, NPV and accuracy of cardiac MRI for the detection of diseased coronary artery were 94% (15 of 16 territories), 100% (14 of 14), 100% (15 of 15), 93% (14 of 15) and 97% (29 out of 30) respectively while the overall sensitivity, specificity, PPV, NPV and accuracy of SPECT for the detection of coronary artery stenosis were 88% (14 of 16), 93% (13 of 14), 93% (14 of 15), 87% (13 of 15) and 90% (27 out of 30) respectively. Both modalities CMR and SPECT show no statistically significant difference in detection of ischemic and scarred left ventricle myocardial segments although the sensitivity of MRI was higher than SPECT in detection of transmural scarring. As regard detection of complications CMR detected 1 intraventricular thrombus that was missed by SPECT. Conclusion: CMR is an accurate tool for assessment of coronary artery disease and myocardial viability as regard ischemia, scarring with great capability for detection of transmural extension of scarring and prediction of recovery. MRI can detect complications like ventricular thrombus that was missed by SPECT. Other advantages of MRI are time saving, lack of ionizing radiation and detection of left ventricular volumetrics and wall motion abnormalities. *= radiodiagnosis department, ^=internal medicine department- faculty of medicine-sohag unevirsity. | ||
| Keywords | ||
| myocardial viability; Cardiac magnetic resonance imaging; SPECT; Coronary Artery Disease | ||
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| References | ||
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1- Go As, Mozaffarian D, Roger VL, et al. Heart disease and Stroke statistics-2014 update: a report from the American Heart Association. Circulation 2014; 129 (3) : e28-292.
2- Reeder B. Scott, MD, PhD, Yiping P. Du, PhD, Joao A. C. Lima, MD and David A. Bluemke, MD, PhD. Advanced cardiac MR imaging of ischemic heart disease. Radiographics 2001; 21: 1047-1074.
3- Kramer M. Christopher, Cardiac MRI, Fundamentals of Diagnostic Radiology, Brant E. William, Helms A. Clyde, 3rd edition, Lippincott Williams & Wilkins, 2007, p. 653-668.
4- Lin C. Eugene, MD, Steven R. Klepac, MD, and Evan J. Samett, MD. Cardiac MRI- Technical Aspects Primer: Overview- eMedicine Radiology, 2008.
5- Finn J. Paul, MD, Kambiz Nael, MD, Vibhas Deshpande, PhD, Osman Ratib, MD, PhD and Gerhard Laub, PhD. Cardiac MR imaging: State of the technology. Radiology 2006; 241: 338-354.
6- Chavhan B. Govind, MD, DNB, Paul S. Babyn, MD, Bhavin G. Jankharia, MD, Hai-Ling M. Cheng, PhD, and Manohar M. Shroff, MD. Steady-State MR Imaging Sequences: Physics, Classification, and Clinical applications. Radiographics 2008; 28: 1147-1160.
7- Sakuma H, Suzawa N, Ichikawa Y et al. Diagnostic accuracy of stress first-pass contrast-enhanced myocardial perfusion MRI compared with stress myocardial perfusion scintigraphy. American Journal of Roentgenology 2005, 185:95–102.
8- Ruth PL, Monvadi BS, Vivian SL. Non-Ischemic Causes of Delayed Myocardial Hyperenhancement on MRI. American Journal of Roentgenology 2007; 188:1675–1681.
9- Bettencourt N, Chiribiri A, Schuster A, Nagel E. Assessment of Myocardial Ischemia and Viability using Cardiac Magnetic Resonance. Current Heart Failure Reports 2009; 6(3): 142-153.
10- Kitagawa K, Sakuma H, Nagata M, Takeda K. Diagnostic accuracy of stress myocardial perfusion MRI and late gadolinium-enhanced MRI for detecting flow-limiting coronary artery disease: a multicenter study. Eur Radiol 2008, 18: 2808–2816 DOI 10.1007/s00330-008-1097-4
11- Ishida N, Sakuma H, Motoyasu M et al: Noninfarcted myocardium: correlation between dynamic first-pass contrast-enhanced myocardial MR imaging and quantitative coronary angiography. Radiology. 2003; 229:209-216
12- Gebker R, Jahnke C, Paetsch I, et al. Diagnostic Performance of Myocardial Perfusion MR at 3 T in Patients with Coronary Artery Disease. Radiology 2008, 247:57-63.
13- 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.
14- Kühl HP, Lipke CSA, Krombach GA, et al. Assessment of reversible myocardial dysfunction in chronic ischaemic heart disease: comparison of contrast-enhanced cardiovascular magnetic resonance and a combined positron emission tomography-single photon emission computed tomography imaging protocol. Eur Heart J 2006; 27:846 –53.
15- Syed MA, Paterson DI, Ingkanisorn WP, Rhoads KL, Hill J, Cannon RO. Reproducibility and inter-observer variability of dobutamine stress CMR in patients with severe coronary disease: implications for clinical research. J Cardiovasc Magn reson 2005;7(5):763–768
16- Srichai MB, Junor C, Rodriguez LL, et al. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J 2006; 152:75– 84.
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