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Assessment of resting perfusion defects in patients with acute myocardial infarction: comparison of myocardial contrast echocardiography, combined first-pass/delayed contrast-enhanced magnetic resonance imaging and 99mTC-sestamibi SPECT

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Abstract

Background

Information on the accuracy of both magnetic resonance imaging (MRI) and myocardial contrast echocardiography (MCE) for the identification of perfusion defects in patients with acute myocardial infarction is limited. We evaluated the accuracy of MRI and MCE, using Single Photon Emission Computed Tomography (SPECT) imaging as reference technique.

Methods

Fourteen consecutive patients underwent MCE, MRI and 99mTc-MIBI SPECT after acute myocardial infarction to assess myocardial perfusion. MCE was performed by Harmonic Power Angio Mode, with end-systolic triggering 1:4, using i.v. injection of Levovist®. First-pass and delayed enhancement MRI was obtained after i.v administration of Gadolinium-DTPA. At MCE, homogeneous perfusion was considered as normal and absent or “patchy” perfusion as abnormal. At MRI, homogenous contrast enhancement was defined as normal whereas hypoenhancement at first-pass followed by hyperenhancement or persisting hypoenhancement in delayed images was defined as abnormal.

Results

At MCE 153 (68%) of segments were suitable for analysis compared to 220 (98%) segments at MRI (p<0.001). Sensitivity, specificity and accuracy of MCE for segmental perfusion defects in these 153 segments were 83, 73 and 77%, respectively. Sensitivity, specificity and accuracy of MRI were 63, 82, and 77%, respectively. MCE and MRI showed a moderate agreement with SPECT (k: 0.52 and 0.46, respectively). The agreement between MCE and MRI was better (k: 0.67) that the one of each technique with SPECT.

Conclusion

MCE and MRI may be clinically useful in the assessment of perfusion defects in patients with acute myocardial infarction, even thought MCE imaging may be difficult to obtain in a considerable proportion of segments when the Intermittent Harmonic Angio Mode is used.

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Authors and Affiliations

  1. Department of Cardiology, Catholic University, Roma, Italy

    Antonella Lombardo, Vittoria Rizzello, Leonarda Galiuto, Antonio Rebuzzi, Francesco Loperfido & Filippo Crea

  2. Department of Radiology, Catholic University, Roma, Italy

    Luigi Natale

  3. Department of Nuclear Medicine, Catholic University, Roma, Italy

    Alessandro Giordano

  4. San Raffaele Hospital, University Vita-Salute, Milano, Italy

    Attilio Maseri

  5. Istituto di Cardiologia, Università Cattolica, L.go A. Gemelli, 8, 00168, Roma, Italy

    Antonella Lombardo

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  1. Antonella Lombardo
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  2. Vittoria Rizzello
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  3. Leonarda Galiuto
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Correspondence to Antonella Lombardo.

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Lombardo, A., Rizzello, V., Galiuto, L. et al. Assessment of resting perfusion defects in patients with acute myocardial infarction: comparison of myocardial contrast echocardiography, combined first-pass/delayed contrast-enhanced magnetic resonance imaging and 99mTC-sestamibi SPECT. Int J Cardiovasc Imaging 22, 417–428 (2006). https://doi.org/10.1007/s10554-005-9045-8

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