Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

M. Schmidt; M. Jochims; P. Theissen; F. M. Baer; J. Crnac; E. Voth; C. A. Schneider; E. Erdmann; H. Schicha

doi:10.1055/s-0038-1625282

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2001; 40(06): 198-206
DOI: 10.1055/s-0038-1625282

Editorial

Schattauer GmbH

Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography

Vergleich von Dobutamin-Stress-Magneiresonanztomographie und Dipyridamole-Tl-201-SPECT als alternative Strategien der KHK-Diagnostik bei Patienten mit unzureichendem Schallfenster in der Stress-Echokardio-graphie

M. Schmidt

¹Klinik und Poliklinik für Nuklearmedizin und

,

M. Jochims^*

,

P. Theissen

¹Klinik und Poliklinik für Nuklearmedizin und

,

F. M. Baer^*

,

J. Crnac^*

,

E. Voth

¹Klinik und Poliklinik für Nuklearmedizin und

,

C. A. Schneider^*

,

E. Erdmann^*

,

H. Schicha

¹Klinik und Poliklinik für Nuklearmedizin und

› Institutsangaben

Abstract

Summary

Aim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.

Zusammenfassung

Ziel: Die Stress-Echokardiographie hat zunehmende Verbreitung zur Ischämiediagnostik bei Patienten mit koronarer Herzerkrankung (KHK) gefunden. 10 bis 15% der Patienten, die einer Stress-Echokardiographie zugeführt werden, haben jedoch ein unzureichendes Schallfenster. Deshalb sollten Dobutamin-Stress-Magnetresonanztomogra-phie (Dobutamin« und Dipyridamol-TI-201-SPECT (Dipyridamol-SPECT) als alternative Strategien der Ischämiediagnostik verglichen werden. Patienten und Methoden: Von 296 konsekutiven Patienten, die einer Stress-Echokardiographie zugeführt wurden, waren bei 45 Patienten (15%) mindestens zwei Wandsegmente nach dem 16-Segment-Modell der American Society of Echocardiography nicht beurteilbar. Sie wurden einer Dobutamin-MRT und einer Dipyridamol-SPECT zugeführt und zum Vergleich nach einem 28-Segment-Modell ausgewertet. Die Myokardseg-mente wurden den Versorgungsgebieten der Koronargefäße zugeordnet und die Ergebnisse der Ischämiediagnostik mit denen der Koronarangiographie (Stenose >50%) verglichen. Ergebnisse: Im Vergleich zur Koronarangiographie ergab sich für die Dobutamin-MRT eine Sensilivität von 87%, eine Spezifität von 86%, ein positiver Vorhersagewert von 93%, ein negativer Vorhersagewert von 75% und eine diagnostische Genauigkeit von 86%. Für die Dipyridamol-SPECT betrugen die jeweiligen Werte 90%, 86%, 93%, 80% und 89%. Diese Werte zeigten keinen signifikanten Unterschied. Schlussfolgerungen: Bei Patienten mit schlechten echokardiographischen Schallbedingungen sind Dobutamin-MRT und Dipyridamol-SPECT geeignete Verfahren zur Ischämiediagnostik. Die Auswahl ist vom Patienten, von technischen Faktoren, der örtlichen Logistik und der Erfahrung des Untersuchers abhängig.

Keywords

Coronary artery disease - stress-echocardiography - magnetic resonance imaging - myocardial scintigraphy - T1-201 -SPECT - pharmacological stress testing

Schlüsselwörter

Koronare Herzerkrankung (KHK) - Stress-Echokardio-graphie - Magnetresonanztomographie - Myokardszintigraphie - T1-201-SPECT - pharmakologische Stressuntersuchungen

Volltext

Referenzen

Literatur
1 Baer FM, Smolarz K, Jungehülsing M. et al. Feasibility of high-dose dipyridamole-magnetic resonance imaging for detection of coronary artery disease and comparison with coronary angiography. Am J Cardiol 1992; 69: 51-6.
2 Baer FM, Theissen P, Voth E. et al. Dobutamine versus dipyridamole-magnetic resonance imaging: Safety and sensitivity for the diagnosis of coronary artery stenoses. Z Kardiol 1993; 82: 494-503.
3 Baer FM, Voth E, Theissen P. et al. Gradientecho magnetic resonance imaging during incremental dobutamine infusion for the localization of coronary artery stenoses. Eur Heart J 1994; 15: 218-25.
4 Baer FM, Voth E, Theissen P. et al. Coronary artery disease: Findings with GRE MR Imaging and Tc-99m-methoxyisobutyl-isonitrile SPECT during simultaneous dobutamine stress. Radiology 1994; 193: 203-9.
5 Baer FM, Theissen P, Crnac J. et al. Head to head comparison of dobutamine-transoeso-phageal echocardiography and dobutamine-magnetic resonance imaging for the prediction of left ventricular functional recovery in patients with chronic coronary artery disease. Eur Heart J 2000; 21: 981-91.
6 Busch M, Bornstedt A, Wendt M. et al. Fast “real time” imaging with different k-space update strategies for interventional procedures. J Magn Reson Imaging 1998; 8: 944-54.
7 Ergün EL, Caner B, Atalar E. et al. Paradoxer Blutdruckabfall während der Dobutamin-Belastung bei der Myokardszintigraphie. Nuklearmedizin 1998; 37: 268-71.
8 Geleijnse ML, Fioretti PM, Roelandt JR. Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol 1997; 30: 595-606.
9 Hoffmann R, Lethen H, Marwick T. et al. Analysis of interinstitutional observer agreement in interpretation of dobutamine stress echocardiograms. J Am Coll Cardiol 1996; 27: 330-6.
10 La Canna G, Alfieri O, Giubbini R. et al. Echocardiography during infusion of dobutamine for identification of reversibly dysfunction in patients with chronic coronary arterv disease. J Am Coll Cardiol 1994; 23: 617-26.
11 Leppo JA. Dipyridamole myocardial perfusion imaging. J Nucl Med 1994; 35: 730-3.
12 Machecourt J, Longere P, Fagret D. et al. Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect. Study in 1926 patients with follow-up at 33 months. J Am Coll Cardiol 1994; 23: 1096-106.
13 Marcowitz PA, Armstrong WF. Accuracy of dobutamine stress echocardiography in detecting coronary artery disease. Am J Cardiol 1992; 69: 1269-73.
14 Mazeika PK, Nadazdin A, Oakley CM. Dobutamine stress echocardiography for detection and assessment of coronary artery disease. J Am Coll Cardiol 1990; 19: 1203-11.
15 McNeill AJ, Fioretti PM, el-Said SM. et al. Dobutamine stress echocardiography before and after coronary angioplasty. Am J Cardiol 1992; 69: 740-5.
16 Nagel E, Lehmkul HB, Bocksch W. et al. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: Comparison with dobutamine stress echocardiography. Circulation 1999; 99: 763-70.
17 Nagueh SF, Zoghbi WA. Stress echocardiography for the assessment of myocardial ischemia and viability. Curr Probl Cardiol 1996; 21: 445-520.
18 Pennell DJ, Underwood SR, Ell PJ. et al. Dipyridamole magnetic resonance imaging: a comparison with thallium-201 emission tomography. Br Heart J 1990; 64: 362-9.
19 Pennell DJ, Underwood SR, Manzara CC. et al. Magnetic resonance imaging during dobutamine stress in coronary artery disease. Am J Cardiol 1992; 70: 34-40.
20 Pennell DJ. Review: Pharmacological cardiac stress: when and how. Nucl Med Comm 1994; 15: 578-85.
21 Pflugfelder PW, Sechtem U, White RD. et al. Quantification of regional myocardial function by rapid cine MR imaging. Am J Radiol 1988; 150: 523-9.
22 Pierard LA, Berthe C, Albert A. et al. Haemo-dynamic alterations during ischaemia induced by dobutamine stress testing. Eur Heart J 1989; 10: 783-90.
23 Reichek N. Magnetic resonance imaging for assessment of myocardial function. Magn Reson Q 1991; 7: 255-74.
24 Reuland P, Irmer M, Stiehr T. et al. Einfluss der Patientenlagerung bei der Myokard-SPECT auf die Diagnose einer KHK. Nuklearmedizin 1999; 38: 178-85.
25 Sawada SG, Segar DS, Ryan T. et al. Echocardiography detection of coronary artery disease during dobutamine infusion. Circulation 1991; 83: 1605-14.
26 Schiller NB, Shah PM, Crawford M. et al. Recommendations for quantitation of the left ventricle by 2-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of 2-dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2: 358-67.
27 Schmidt M, Jochims M, Voth E. et al. Möglichkeiten der Ischämiediagnostik bei Patienten mit schlechten echokardiographischen Schallbedingungen: Vergleich von Dipyridamol Myokardszintigraphie und Dobutamin-Magnet-resonanztomographie. Nuklearmedizin 1999; 3: A28.
28 Sechtem U, Pflugfelder PW, White RD. et al. Cine MR imaging: potential for the evaluation of cardiovascular function. Am J Radiol 1987; 148: 239-46.
29 Segar DS, Brown SE, Sawada SG. et al. Dobutamine stress echocardiography: Correlation with coronary lesion severity as determined by quantitative angiography. J Am Coll Cardiol 1992; 19: 1197-202.
30 Seifert H, Chapot C, Schaefer A. et al. Die Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfu-sions-SPECT. Nuklearmedizin 1999; 38: 186-8.
31 Sodickson DK, Manning WJ. Simultaneous acquisition of spatial harmonics (SMASH): fast imaging with radiofrequency coil arrays. Magn Reson Med 1997; 38: 591-603.
32 Sugishita J, Koscki S, Matsudo M. et al. Dissociation between regional myocardial dysfunction and ECG changes during myocardial ischemia induced by exercise in patients with angina pectoris. Am Heart J 1983; 106: 1-8.
33 Takeuchi M, Araki M, Nakashima Y. et al. Comparison of dobutamine stress echocardiography and stress thallium-201 single-photon emission computed tomography for detecting coronary artery disease. J Am Soc Echocardiogr 1993; 6: 539-602.
34 Van Rugge FP, van der Wall EE, Spanjersberg SJ. et al. Magnetic resonance imaging during dobutamine stress for detection and localization of coronary artery disease: quantitative wall motion analysis using a modification of centerline method. Circulation 1994; 90: 127-38.
35 Verzijlbergen JF, Vermeersch PHMJ, Laarman GJ. et al. Inadequate exercise leads to suboptimal imaging. Thallium-201 myocardial perfusion imaging after dipyridamole combined with low-level exercise unmasks ischemia in symptomatic patients with non-diagnostic thallium-201 scans who exercise submaximally. J Nucl Med 1991; 32: 2071-8.
36 Zhao S, Croisille P, Janier M. et al. Comparison between qualitative and quantitative wall motion analyses using dipyridamole stress breath-hold cinemagnetic resonance imaging in patients with severe coronary artery stenosis. Magn Reson Imaging 1997; 15: 891-8.
37 Zoghbi AW, Barasch E. Dobutamine MRI: A serious contender in pharmacological stress imaging?. Circulation 1999; 99: 730-2.