Assessment of Myocardial Viability with Contrast-enhanced Magnetic Resonance Imaging and Technetium Scintigraphy

Background: In patients with coronary artery disease (CAD), assessment of viable myocardium has important prognostic implications. The aim of this study was to compare contrast-enhanced magnetic resonance imaging (ce-MRI) with single-photon emission computed tomography (SPECT), using (TC)-T-99m-sestamibi for detection of myocardial viability. Methods: Twenty-seven patients with coronary artery disease and an ejection fraction (EF) <40% were enrolled. For the ce-MRI, the segmental extent of hyperenhancement (SEH) was quantified after the administration of a gadolinium-based contrast agent, and for the SPECT a 4-hour redistribution protocol was used. For the assessment of EF, we used echocardiography. Comparison of viability assessment was performed in 1458 segments. Results: Agreement between two modalities was obtained in 1332 (91.4%) segments, resulting in a kappa value of 0.8. In 126 segments, we had discordant results. 102 SPECT viable segments were non-viable according to ce-MRI and 24 ce-MRI viable segments were described as non-viable by SPECT. Conclusions: SPECT was comparable to ce-MRI for myocardial viability assessment, but we were not able to define which of them was superior.