| 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. | |
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MedLine Citation:
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PMID: 17607039 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Yen-Wen Wu; Eiji Tadamura; Masaki Yamamuro; Shotaro Kanao; Akira Marui; Keiichi Tanabara; Masashi Komeda; Kaori Togashi |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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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:
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Created Date: 2007-07-03 Completed Date: 2007-08-27 Revised Date: 2007-11-26 |
Medline Journal Info:
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Nlm Unique ID: 0217410 Medline TA: J Nucl Med Country: United States |
Other Details:
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Languages: eng Pagination: 1096-103 Citation Subset: IM |
Affiliation:
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Department of Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Contrast Media; 0/Radiopharmaceuticals; 0/Thallium Radioisotopes; 63503-12-8/Fluorodeoxyglucose F18 |
| Comments/Corrections | |
Erratum In:
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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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