Document Detail


Comparison of contrast-enhanced MRI with (18)F-FDG PET/201Tl SPECT in dysfunctional myocardium: relation to early functional outcome after surgical revascularization in chronic ischemic heart disease.
MedLine Citation:
PMID:  17607039     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (18)F-FDG PET/(201)Tl 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 (18)F-FDG PET, (201)Tl-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 (18)F-FDG PET/(201)Tl 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 > or =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 (18)F-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 (> or =5%) and reverse LV remodeling (> or =10% LV size reduction) was best predicted by the no DE on MRI, and patients with substantial nonviable myocardium on (18)F-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.
Authors:
Yen-Wen Wu; Eiji Tadamura; Masaki Yamamuro; Shotaro Kanao; Akira Marui; Keiichi Tanabara; Masashi Komeda; Kaori Togashi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  48     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-07-03     Completed Date:  2007-08-27     Revised Date:  2007-11-26    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1096-103     Citation Subset:  IM    
Affiliation:
Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chronic Disease
Contrast Media
Coronary Artery Bypass
Coronary Artery Disease / radionuclide imaging*,  surgery
Female
Fluorodeoxyglucose F18 / diagnostic use*
Humans
Image Enhancement / methods
Magnetic Resonance Imaging / methods
Male
Middle Aged
Myocardial Revascularization*
Positron-Emission Tomography / methods
Radiopharmaceuticals / diagnostic use
Thallium Radioisotopes / diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods
Treatment Outcome
Ventricular Dysfunction, Left / radionuclide imaging*,  surgery
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Radiopharmaceuticals; 0/Thallium Radioisotopes; 63503-12-8/Fluorodeoxyglucose F18
Comments/Corrections
Erratum In:
J Nucl Med. 2007 Nov;48(11):1789

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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