Assessment of Myocardial Viability in Persistent Defects on Thallium-201 SPECT after Reinjection Using Gradient-Echo MRI

Summary

This prospective study assessed myocardial viability in 30 patients with coronary heart disease and persistent defects despite reinjection on TI-201 single-photon computed tomography (SPECT). In each patient, three observers graded TI-201 uptake in 7 left ventricular wall segments. Gradient-echo magnetic resonance imaging in the region of the persistent defect generated 12 to 16 short axis views representing a cardiac cycle. A total of 120 segments were analyzed. Mean end-diastolic wall thickness and systolic wall thickening (± SD) was 11.5 ± 2.7 mm and 5.8 ± 3.9 mm in 48 segments with normal TI-201 uptake, 10.1 ± 3.4 mm and 3.7 ± 3.1 mm in 31 with reversible lesions, 11.3 ± 2.8 mm and 3.3 ± 1.9 mm in 10 with mild persistent defects, 9.2 ± 2.9 mm and 3.2 ±2.2 mm in 15 with moderate persistent defects, 5.8 ± 1.7 mm and 1.3 ± 1.4 mm in 16 with severe persistent defects, respectively. Significant differences in mean end-diastolic wall thickness (p <0.0005) and systolic wall thickening (p <0.005) were found only between segments with severe persistent defects and all other groups, but not among the other groups. On follow-up in 11 patients after revascularization, 6 segments with mild-to-moderate persistent defects showed improvement in mean systolic wall thickening that was not seen in 6 other segments with severe persistent defects. These data indicate that most myocardial segments with mild and moderate persistent TI-201 defects after reinjection still contain viable tissue. Segments with severe persistent defects, however, represent predominantly nonviable myocardium without contractile function.

Zusammenfassung

In einer prospektiven Studie wurde bei 30 Patienten mit koronarer Herzerkrankung und persistierendem Speicherdefekt bei der TI-201-Single-Photon-Emissions-Computertomographie (SPECT) trotz Reinjektion die Myokardvitalität erfaßt. Bei jedem Patienten beurteilten drei Befunder die Tl-201-Belegung in 7 linksventrikulären Wandsegmenten. Mit Magnetresonanztomographie in Gradienten-Echo-Technik wurden 12-16 einen Herzzyklus repräsentierende Kurzachsenschnitte im Bereich des persistierenden Defekts generiert. Insgesamt wurden 120 Segmente analysiert. Die mittlere diastolische Wanddicke und die systolische Wanddickenzunahme (± Standardabweichung) lagen in 48 Segmenten mit normaler TI-201-Aufnahme bei 11,5 ± 2,7 mm bzw. 5,8 ± 3,9 mm, in 31 mit reversiblem Defekt bei 10,1 ± 3,4 mm bzw. 3,7 ± 3,1 mm, in 10 mit gering ausgeprägtem persistierendem Defekt bei 11,3 ± 2,8 mm bzw. 3,3 ± 1,9 mm, in 15 mit mäßig ausgeprägtem persistierendem Defekt bei 9,2 ± 2,9 mm bzw. 3,2 ± 2,2 mm und in 16 mit schwerem persistierendem Defekt bei 5,8 ± 1,7 mm bzw. 1,3 ± 1,4 mm. Signifikante Unterschiede in der mittleren diastolischen Wanddicke (p <0,0005) und der systolischen Wanddickenzunahme (p <0,005) wurden nur zwischen Segmenten mit schwerem persistierendem Defekt und allen anderen Gruppen gefunden, nicht jedoch zwischen den anderen Gruppen. Eine Nachuntersuchung von 11 Patienten nach Revaskularisation zeigte in 6 Segmenten mit gering bis mäßig ausgeprägtem persistierendem Defekt eine Verbesserung der mittleren systolischen Wanddickenzunahme, die in 6 anderen Segmenten mit schwerem persistierendem Defekt nicht gesehen wurde. Diese Daten weisen darauf hin, daß die meisten Myokardsegmente mit gering bis mäßig ausgeprägtem persistierendem TI-201-Defekt nach Reinjektion noch vitales Gewebe enthalten. Segmente mit schwerem persistierendem Defekt hingegen stellen überwiegend devitales Myokard ohne kontraktile Funktion dar.

Keywords

Thallium-201 - SPECT - reinjection - viability - magnetic resonance imaging - gradient-echo technique

Schlüsselwörter

Thallium-201 - SPECT - Reinjektion - Vitalität - Magnetresonanztomographie - Gradienten-Echo-Technik

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