Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Regional 99mTc-methoxyisobutyl-isonitrile-uptake at rest in patients with myocardial infarcts: comparison with morphological and functional parameters obtained from gradient-echo magnetic resonance imaging
Klinik III für Innere Medizin und Klinik und Poliklinik für Nuklearmedizin
*Klinik III für Innere Medizin und Klinik und Poliklinik für Nuklearmedizin der Universität zu Köln
Received 26 April 1993; revised 21 July 1993; .
Correspondence: Udo Sechtem, MD, Klinik III f
r Innere Medizin, Universität zu Köln, Joseph-Stelzmannstr. 9, D-50924 Köhn, Germany
Abstract
It is not yet clear whether 99mTc-methoxyisobutyl-isonitrile (MIBI)-uptake is a reliable indicator of myocardial viability, and a threshold value, differentiating viable from scarred myocardium, in comparison to a morphological and functional standard of reference has not been defined.
MIBI-uptake was quant in 800 segments from 55 patients with angiographically proven coronary artery disease with and without a history of myocardial infarction. Viable myocardium was defined from gradient-echo magnetic resonance images (MRI) as regions with systolic wall thickening or an end-diastolic wall thickness above the mean value – 2·5 SD of a healthy control group (n=21). Scar was defined as end-diastolic wall thickness >2·5 SD below the normal mean value and absent systolic wall thickening or wall thinning.
Mean MIBI-uptake of viable (n=676; 79 ± 14%) and scar segments by MRJ (n = 124, 31 ± 16%) was significantly different (P<0·001). Segmental MIBI-uptake vs end-diastolic wall thickness (r=0·7) and systolic wall thickening (r = 0·71) yielded a fair correlation. The highest values as regards sensitivity and specificity of MIBI-uptake in predicting the presence of scar were 89% and 96% respectively for MIBI-uptake 
50%, However, of the 136 segments with MIBI-uptake 50%, 26 (19%) were viable by MRI, resulting in a positive predictive accuracy for scar tissue of 81%. Of the 26 segments diagnosed as scarred by MIBI-SPECT but viable by MRI, 25 (96%) were located in the inferoseptal region.
MIBI-SPECT seems useful in the detection of viable myocardium after anterior myocardial infarcts, but over-estimates scar in the inferoseptal regions. Perfusion defects in these regions could be confirmed or denied by additional evaluation of myocardial morphology and function by MRI or tissue metabolism by positron emission tomography (PET).
Key Words: Technetium-99m-hexakis-2-methoxyisobutyl-isonitrile (MIBI) • single photon emission computed tomography (SPECT) • gradient-echo magnetic resonance imaging (MRI) • viability • Q-wave myocardial infarction • non-Q-wave myocardial infarction
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H.-M. J. Siebelink, P. K. Blanksma, H. J. G. M. Crijns, J. J. Bax, A. J. van Boven, T. Kingma, D. A. Piers, J. Pruim, P. L. Jager, W. Vaalburg, et al. No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management: A prospective, randomized comparison of patients with suspicion of jeopardized myocardium J. Am. Coll. Cardiol., January 1, 2001; 37(1): 81 - 88. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. van der Wall, H. W. Vliegen, A. de Roos, and A. V.G. Bruschke Magnetic Resonance Imaging in Coronary Artery Disease Circulation, November 1, 1995; 92(9): 2723 - 2739. [Abstract] [Full Text]
|
|
|
|
|
|
F. M. Baer, E. Voth, C. A. Schneider, P. Theissen, H. Schicha, and U. Sechtem Comparison of Low-Dose Dobutamine–Gradient-Echo Magnetic Resonance Imaging and Positron Emission Tomography With [18F]Fluorodeoxyglucose in Patients With Chronic Coronary Artery Disease : A Functional and Morphological Approach to the Detection of Residual Myocardial Viability Circulation, February 15, 1995; 91(4): 1006 - 1015. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. N. Oshinski, H.-C. Han, D. N. Ku, and R. I. Pettigrew Quantitative Prediction of Improvement in Cardiac Function after Revascularization with MR Imaging and Modeling: Initial Results Radiology, November 1, 2001; 221(2): 515 - 522. [Abstract] [Full Text] [PDF]
|
|