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DOI: 10.1055/s-2002-32697
© Georg Thieme Verlag Stuttgart · New York
Myokardiale Vitalitätsdiagnostik mit kontrastverstärkter Magnetresonanztomographie -
Vergleich des „late enhancement”-Konzepts mit der Positronen-Emissions-Tomographie
Evaluation of myocardial viability with contrast-enhanced magnetic resonance imaging - comparison of the late enhancement technique with positronemission tomography
Publikationsverlauf
Publikationsdatum:
08. Juli 2002 (online)
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Zusammenfassung
Ziel: Vergleich der kontrastverstärkten MRT mit dem Referenzstandard [18F]-FDG-PET zur Detektion und Charakterisierung myokardialer Narben. Methoden: Bei 29 Patienten mit KHK und eingeschränkter LV-Funktion wurden eine [18]-FDG-PET und eine Perfusionsszintigraphie (SPECT) mit [201Tl]-TlCl durchgeführt. Danach erfolgte die MRT an einem 1,5 T-Scanner (Magnetom Sonata, Siemens). Nach der Steady-state free precession-Funktionsstudie erfolgte die i. v.-Gabe von 0,2 mmol/kg KG Gd-DTPA (Magnevist®, Schering). Zum Nachweis eines „late enhancement” (Narbe) wurden die langen LV-Achsen sowie kontinuierliche Kurzachsenschnitte von 8 mm Schichtdicke mit einer segmentierten Inversion Recovery Turbo Gradienten-Echo-Sequenz (TR 8,0 ms, TE 4,0 ms, TL 180 - 240 ms, FA 20 °) gemessen. Jeder Kurzachsenschnitt wurde in 8 (basal, mitt-ventrikulär) bzw. 4 (apikal) Segmente unterteilt, und zum Vergleich von MRT mit PET und SPECT wurde die myokardiale Vitalität für jedes Segment auf einer Skala von 1 - 4 beurteilt. Ergebnisse: Insgesamt wurden 1753 Segmente ausgewertet. Die PET detektierte myokardiale Narben in 25 % der Segmente. In der MRT wurden Narben in 40 % der Segmente gefunden. Für die Detektion von Myokardnarben zeigte die MRT eine sehr niedrige Interobserver-Variabilität (kappa 0,92). Im segmentalen Vergleich zur Referenzmethode ergab sich eine Sensitivität und Spezifität von 84 % und 76 %. 18 % aller Segmente zeigten „late enhancement” bei normaler FDG-Aufnahme, wovon 83 % subendokardiales Enhancement aufwiesen. Schlussfolgerung: Aufgrund der hohen räumlichen Auflösung, des hohen Bildkontrastes und der Möglichkeit, auch nicht-transmurale Narben sicher zu detektieren, ist die kontrastverstärkte MRT eine vielversprechende, neue Methode zur Beurteilung der myokardialen Vitalität. Größere Studien mit dem Endpunkt Funktionsverbesserung nach Revaskularisation müssen zeigen, ob die MRT die PET als Referenzstandard in der Vitalitätsdiagnostik ablösen kann.
Abstract
Purpose: To compare contrast-enhanced magnetic resonance imaging (MRI) and positron emission tomography (PET) in the evaluation of myocardial viability. Methods: [18F]-FDG-PET, [201Tl]-TlCl-SPECT and contrast-enhanced MRI were performed in 29 patients with proven coronary artery disease and impaired left ventricular function to assess myocardial viability. MRI scans were done on a 1.5 T scanner (Magnetom Sonata, Siemens, Germany). After the steady-state free precession cine study, 0.2 mmol/kg BW of Gd-DPTA (Magnevist®, Schering, Germany) were administered i. v. For the detection of “late enhancement” (LE) indicating scar, left ventricular long axes and contiguous short axis slices of 8 mm thickness were scanned using an inversion recovery turbo gradient echo sequence (TR 8.0 ms; TE 4.0 ms; TI 180 - 240 ms; FA 20 °). The evaluation of LE and FDG uptake in PET with perfusion defect in SPECT was done using an 8 (basal, mid) and 4 (apical) segment model in all short axes to cover the entire ventricle. The transmural extent of LE was assessed using a 4-point score system. Comparison between the two modalities was performed on a segmental basis. Results: A total of 1753 segments were assessed. In MRI, 40 % of the segments showed myocardial scar, whereas PET revealed impaired uptake in 25 %. MRI obtained a very low interobserver variability in detecting myocardial scar (kappa 0.92). Using PET as the standard of reference in the segmental comparison, contrast-enhanced MRI yielded a sensitivity of 84 % and a specificity of 76 % for the detection of scar. 18 % of all segments showed LE but normal FDG uptake, 83 % of them referred to subendocardial scars. Conclusions: There is close agreement between contrast-enhanced MRI and PET in detecting transmural moycardial scars. Superior spatial resolution enables MRI to detect and quantify even subendocardial scar. Therefore, larger studies using functional recovery after revascularisation as an endpoint have to prove whether MRI might replace PET as the standard of reference in the assessment of myocardial viability.
Schlüsselwörter
Magnetresonanztomographie - Myokardvitalität - Positronen-Emissions-Tomographie - Koronare Herzkrankheit - Myokardinfarkt
Key words
Heart, MR - Magnetic Resonance (MR) - Contrast enhancement - Myocardium, infarction - Heart, ischemia - Myocardium, PET
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Dr. med. Jörg Barkhausen
Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Essen
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