Multimodality MR imaging assessment of myocardial viability: Combination of first-pass and late contrast enhancement to wall motion dynamics and comparison with FDG PET - Initial experience

PURPOSE: To combine three magnetic resonance (MR) imaging modalities-dobuta mine stress cine, first pass, and late contrast material-enhanced T1-weight ed imaging-and to compare the results with 2-[fluorine 18]fluoro-2-deoxy-D- glucose (FDC) positron emission tomography (PET) in the assessment of unvia ble myocardium in coronary artery disease. MATERIALS AND METHODS: Ten patients with multivessel coronary artery diseas e underwent MR imaging before and 6 months after bypass surgery. Left ventr icular cine MR imaging was performed at rest and during dobutamine infusion . Inversion-recovery gradient-echo images were obtained to study myocardial contrast enhancement at first pass and 5 minutes later. FDC PET was perfor med with orally administered acipimox before surgery. RESULTS: With dobutamine cine MR imaging, unviable myocardium was detected with a sensitivity of 79% and a specificity of 93%; postoperative wall thic kening was the standard. First-pass analysis increased these values to 97% and 96%; analysis of late enhancement with T1-weighted imaging, to 62% and 98%. FDC PET had a sensitivity of 81% and a specificity of 86%. CONCLUSION: The combination of first-pass enhancement analysis and wall mot ion assessment with stress significantly increases the specificity of MR im aging in the detection of unviable sectors.