Key result
SPECT perfusion defect size was larger than the hyperenhanced volume by DE-MRI by 8 ± 8 ml in acute, 10 ± 18 ml in chronic, and 26 ± 30 ml in clinical populations.
Why the study?
Does SPECT perfusion imaging accurately estimate infarct size compared to DE-MRI in patients with acute or chronic myocardial infarction?
Cross-Sectional (n=30)
Single-blind
No
Does SPECT perfusion imaging accurately estimate infarct size compared to DE-MRI in patients with acute or chronic myocardial infarction?
Effect estimate: 8 ml difference
p-value: p=0.002
SPECT perfusion defect size overestimates infarct size compared to DE-MRI, likely due to the inclusion of hypoperfused but viable myocardium or wall thinning.
SPECT overestimation warrants caution in infarct sizing; leaves open need for prospective DE-MRI validation in MI.
BACKGROUND: Single photon emission computed tomography (SPECT) perfusion imaging has been considered a reference method for non-invasive estimation of infarct size in man. Recently, delayed gadolinium-enhanced magnetic resonance imaging (DE-MRI) has evolved as an accurate tool to quantify infarct size. Therefore, the present study was designed to compare perfusion defect size by SPECT to hyperenhanced volume by DE-MRI. METHODS: DE-MRI was performed in 30 patients. Fourteen were patients with revascularized first-time acute infarctions, eight revascularized chronic infarctions, and eight clinically referred non-revascularized patients. SPECT was performed in the same patients and analysed by a commercial package. RESULTS: The hypoperfused volume by SPECT was larger than the hyperenhanced volume by DE-MRI by 8 +/- 8 ml (6% +/- 5 percentage points), 10 +/- 18 ml (6% +/- 11 percentage points), and 26 +/- 30 ml (12% +/- 10 percentage points) in the acute, chronic and clinical populations, respectively. Left ventricle wall volume was smaller by SPECT in all settings. CONCLUSION: The SPECT perfusion defect size was comparable with but generally slightly larger than the hyperenhanced volume by DE-MRI in both absolute and relative terms in patients with acute and chronic infarction. The results may be related to systematic differences between modalities but could also be influenced by biological phenomena such as wall thinning or hypoperfused but viable myocardium.
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Hedström et al. (2004) conducted a cross-sectional in Myocardial infarction (n=30). Single photon emission computed tomography (SPECT) vs. Delayed gadolinium-enhanced magnetic resonance imaging (DE-MRI) was evaluated on Difference between hypoperfused volume by SPECT and hyperenhanced volume by DE-MRI in acute infarction (8 ml difference, p=0.002). SPECT perfusion defect size was larger than the hyperenhanced volume by DE-MRI by 8 ± 8 ml in acute, 10 ± 18 ml in chronic, and 26 ± 30 ml in clinical populations.
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