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—dobutamine stress cine, first pass, and late contrast material–enhanced T1-weighted imaging—and to compare the results with 2-fluorine 18fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the assessment of unviable myocardium in coronary artery disease. MATERIALS AND METHODS: Ten patients with multivessel coronary artery disease underwent MR imaging before and 6 months after bypass surgery. Left ventricular 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. FDG PET was performed 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 thickening 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%. FDG PET had a sensitivity of 81% and a specificity of 86%. CONCLUSION: The combination of first-pass enhancement analysis and wall motion assessment with stress significantly increases the specificity of MR imaging in the detection of unviable sectors.