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Updated: Apr 30, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Peri-infarct ischaemia assessed by cardiovascular MRI: comparison with quantitative perfusion single photon emission
E Gerbaud1, H Cochet, E Bullier
11 Soins Intensifs Cardiologiques, Plateau de Cardiologie Interventionnelle, CHU de Bordeaux, Hôpital du Haut Lévêque, Pessac, France.
Objective:
To develop a new method for the cardiac MR (CMR) quantification of peri-infarct ischaemia using fused perfusion and delayed-enhanced images and to evaluate this method using quantitative single photon emission CT (SPECT) imaging as a reference.
Methods:
40 patients presenting with peri-infarct ischaemia on a routine stress (99m)Tc-SPECT imaging were recruited. Within 8 days of the SPECT study, myocardial perfusion was evaluated using stress adenosine CMR. Using fused perfusion and delayed-enhanced images, peri-infarct ischaemia was quantified as the percentage of myocardium with stress-induced perfusion defect that was adjacent to and larger than a scar. This parameter was compared with both the percent myocardium ischaemia (SD%) and the ischaemic total perfusion deficit (TPD). The diagnostic performance of CMR in detection of significant coronary artery stenosis (of ≥70%) was also determined.
Results:
On SPECT imaging, in addition to peri-infarct ischaemia, reversible perfusion abnormalities were detected in a remote zone in seven patients. In the 33 patients presenting with only peri-infarct ischaemia, the agreement between CMR peri-infarct ischaemia and both SD% and ischaemic TPD was excellent [intraclass coefficient of correlation (ICC) = 0.969 and ICC = 0.877, respectively]. CMR-defined peri-infarct ischaemia for the detection of a significant coronary artery stenosis showed an areas under receiver-operating characteristic curve of 0.856 (95% confidence interval, 0.680-0.939). The best cut-off value was 8.1% and allowed a 72% sensitivity, 96% specificity, 60% negative predictive value and 97% positive predictive value.
Conclusion:
This proof-of-concept study shows that CMR imaging has the potential as a test for quantification of peri-infarct ischaemia.
Advances In Knowledge:
This study demonstrates the proof of concept of a commonly known intuitive idea, that is, evaluating the peri-infarct ischaemic burden by subtracting delayed enhancement from first-pass perfusion imaging on CMR.
Insights
Cardiac MRI (CMR) can quantify peri-infarct ischemia by fusing perfusion and delayed-enhancement images. This new method shows excellent agreement with SPECT imaging, offering potential for improved ischemia assessment.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Radiology
Background:
- Peri-infarct ischemia assessment is crucial for managing myocardial infarction.
- Current methods like SPECT have limitations in precise quantification.
- Cardiac Magnetic Resonance (CMR) offers advanced imaging capabilities for myocardial assessment.
Purpose of the Study:
- To develop and evaluate a novel CMR method for quantifying peri-infarct ischemia.
- To fuse perfusion and delayed-enhanced CMR images for improved accuracy.
- To validate the CMR method against quantitative single-photon emission CT (SPECT) imaging.
Main Methods:
- Forty patients with peri-infarct ischemia on SPECT were recruited.
- Myocardial perfusion was assessed using stress adenosine CMR.
- Peri-infarct ischemia quantified by fused CMR images was compared to SPECT-derived metrics (SD% and TPD).
Main Results:
- Excellent agreement was found between CMR-quantified peri-infarct ischemia and SPECT measures (ICC=0.969 for SD%, ICC=0.877 for TPD).
- CMR demonstrated high diagnostic performance for detecting significant coronary artery stenosis (AUC=0.856).
- The optimal cut-off of 8.1% for CMR-defined ischemia yielded 96% specificity and 97% positive predictive value.
Conclusions:
- CMR imaging, using fused perfusion and delayed-enhancement, shows potential for accurate peri-infarct ischemia quantification.
- This technique validates the intuitive approach of subtracting scar from perfusion defects.
- The findings support CMR as a valuable tool in the assessment of ischemic heart disease.
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