Noninvasive stress testing of myocardial perfusion defects: head-to-head comparison of thallium-201 SPECT to MRI perfusion

Vincenti, Gabriella ; Nkoulou, René ; Steiner, Charles ; Imperiano, Hestia ; Ambrosio, Giuseppe ; Mach, François ; Ratib, Osman ; Vallee, Jean-Paul ; Schindler, Thomas

In: Journal of Nuclear Cardiology, 2009, vol. 16, no. 4, p. 549-561

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    Background: To evaluate the diagnostic value of magnetic resonance imaging (MRI) of myocardial perfusion in the assessment of flow-limiting epicardial stenosis in a head-to-head comparison with abnormal thallium-201 (201TI) single photon emission tomography (SPECT) studies in patients with predominantly known coronary artery disease (CAD). Methods and Results: Twenty-one patients (mean age 65±10years) with reversible myocardial perfusion defects on 201TI-SPECT images during dipyridamole-stimulated hyperemia were recruited for study purpose. Within 5days of the 201TI-SPECT study, myocardial perfusion was studied again with MRI during dipyridamole stimulation and at rest. Overall, 201TI-SPECT identified 30 reversible regional perfusion defects. The sensitivity to detect hypoperfused segments was 70% (21/30) with the GRE-MRI perfusion analysis with 201TI-SPECT as reference. When patients were subgrouped according to the extent of regional reversible perfusion defects on 201TI-SPECT, mild- (SDS: 2-4), moderate- (SDS: 5-8), and severe- (SDS>8) perfusion defects were also identified by GRE-MRI perfusion analysis in 75% (6/8), in 56% (9/16) and 100% (6/6), respectively. Conclusions: GRE-MRI first-pass stress perfusion imaging may not identify up to 30% of mild-to-moderate perfusion defects in a group of preselected patients with predominantly known CAD and abnormal 201TI-SPECT studies