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Assessment of Myocardial Scar; Comparison Between F-FDG PET, CMR and Tc-Sestamibi

Andrew Crean1, Sadia N Khan, L Ceri Davies

  • 1Department of Radiology, Papworth Hospital, Papworth Everard, Cambridge, England.

Clinical Medicine. Cardiology
|May 29, 2010
PubMed

Insights

Assessing myocardial scar in heart failure patients reveals significant differences between imaging techniques. Technetium-99m-Sestamibi (MIBI) and cardiac magnetic resonance (CMR) identify more scar than fluorodeoxyglucose (FDG), suggesting MIBI alone is insufficient for viability assessment.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Radiology

Background:

  • Patients with heart failure and ischemic heart disease may benefit from revascularization if viable dysfunctional myocardium is present.
  • Accurate identification of myocardial viability is crucial due to increased operative risks in these patients.
  • This study compares three imaging modalities for detecting myocardial scar.

Purpose of the Study:

  • To compare the utility of (99)Tc-Sestamibi (MIBI), (18)F-flurodeoxyglucose (FDG), and cardiac magnetic resonance (CMR) in detecting myocardial scar.
  • To evaluate the agreement between these imaging modalities in assessing myocardial viability.
  • To inform the selection of appropriate imaging techniques for patients with coronary artery disease and heart failure.

Main Methods:

  • Prospective, descriptive study conducted at a tertiary cardiac center.
  • 35 patients with coronary artery disease and heart failure symptoms were assessed.
  • Myocardial scar was evaluated using MIBI, FDG, and CMR, with scar presence determined by a 20-segment model.

Main Results:

  • MIBI identified significantly more nonviable scar segments compared to FDG and CMR (p = 0.0001).
  • FDG identified the fewest scar segments per patient.
  • Agreement between modalities was moderate to good, with the strongest agreement in the anterior wall and weakest in the inferior wall.

Conclusions:

  • There is considerable variation among MIBI, FDG, and CMR in identifying scarred myocardium.
  • MIBI and CMR detect more scar tissue than FDG.
  • MIBI should not be used as the sole imaging modality for myocardial viability assessment in patients with coronary disease and heart failure.
Abstract

Keywords:
CMRMIBIPETheart failurehibernation

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