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Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report
© Feola et al; licensee BioMed Central Ltd. 2007
Received: 09 July 2007
Accepted: 30 October 2007
Published: 30 October 2007
Delayed-enhancement magnetic resonance imaging (DE-MRI) has been recently proposed as an alternative tool in identifying myocardial viability and transmural distribution of necrosis in the myocardium.
We describe a case of a 71-year-old man admitted for ischemic-like chest pain in which DE-MRI and post-nitrate 99mTc-tetrofosmin myocardial scintigraphy equally contributed to the diagnosis of previous lateral myocardial infarction.
In this patient with coronary artery disease, the absence of uptake of tracer at myocardial scintigraphy appeared to be closely correlated to DE-MRI data. Cardiologists can use SPECT or DE-MRI to obtain similar information about myocardial viability.
Delayed-enhancement magnetic resonance imaging (DE-MRI) is a highly accurate method for the non-invasive estimation of infarct size and location in acute or chronic myocardial infarction [1–3]. Cardiac MRI can also be used to detect the chronic consequence of myocardial infarction using its high degree of image definition . It has recently been proposed as an alternative tool for the assessment of myocardial necrosis. Diagnostic methods for assessing myocardial viability, such as positron-emission tomography, single-photon-emission computed tomography (SPECT) and dobutamine echocardiography all have demonstrated limits in identifying the transmural extension of necrosis and/or viability of the ventricular wall [5–7].
Previous studies [1, 8, 9] have documented the comparable efficacy of myocardial SPECT (using either thallium 201 or 99mTc-tetrofosmin) and DE-MRI in the evaluation of the presence, location, and transmural extension of myocardial necrosis. Furthermore, DE-MRI is a diagnostic method that is characterized by superior spatial resolution and the absence of ionizing radiation.
In this case report we describe the case of a man with a previous lateral myocardial infarction, in which MRI showed a DE in the lateral wall according to the result of post-nitrate 99mTc-tetrofosmin imaging.
The DE MRI technique has quickly been found to have potential utility as an important clinical method of evaluating cardiac viability in ischemic myocardium [3, 12]. In this case report the severity of the perfusion defect identified at myocardial SPECT after nitrate assumption closely correlated to the transmural distribution of DE-MRI. In 21 patients with severe ischemic left ventricular dysfunction, Giorgetti et al  demonstrated a clear correlation between the extension of 99mTc-tetrofosmin myocardial SPECT uptake injected during nitrate infusion and the distribution of necrosis at DE-MRI. The infusion of nitrate significantly increased the tracer uptake at SPECT scan in DE-MRI viable segments, improving the diagnostic accuracy in the detection of myocardial viability. In our patient we obtained the same information after sublingual nitrate administration before the tracer injection: this convenient method of drug administration is faster and might help in a clinical setting. Evidence of persistent viability after myocardial infarction not treated with reperfusion procedures should always be investigated. In fact, the OAT study did not demonstrated any clinical utility of percutaneous revascularization in stable patients with persistent total occlusion of the infarct-related artery .
In conclusion, the oral postnitrate 99mTc-tetrofosmin myocardial SPECT has been confirmed to be closely correlated with DE-MRI images indicating their comparable value to estimate myocardial viability. In patients with coronary artery disease, clinicians might obtain similar information about myocardial viability using either myocardial SPECT or DE-MRI.
We wish to acknowledge that the patient provided written consent for publication of this case report and these images.
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