Comparison of multidetector CT with F-18-FDG-PET and SPECT in the assessment of myocardial viability in patients with myocardial infarction: A preliminary study

Objective: To evaluate the ability of MDCT to detect a nonviable myocardium in patients with myocardial infarction (MI). Methods and material: This study included 17 patients with MI in the acute (n = 13) or chronic stage (n = 4). MDCT, SPECT, and F-18-FDG-PET were performed in 10 patients during the acute stage and in 2 during the chronic stage of MI. MDCT and SPECT were performed in 13 patients with acute stage and in 4 with chronic stage of MI. Sixteen-slice MDCT was performed 10 min after injection of 120 mL of nonionic contrast media. MDCT, SPECT and PET images were analyzed using a 17-segment model. The depth of hyperenhancement >2/3 was defined as nonviable at MDCT. Results: MDCT and SPECT were concordant in localizing the MI in 84.2% (272/323 segments) and were discordant in 15.8% (51/323). MDCT and PET were concordant in localizing MI in 89.2% (182/204) and discordant in 10.8% (22/204). The sensitivity, specificity and diagnostic accuracy of MDCT in determining the nonviable segments were 70.4%, 85.3%, 81.4% as compared with PET, respectively, and 69.4%, 81.8%, 79.9% compared with SPECT, respectively, and 73.5%, 79.4%, 78.4% compared with combined PET and SPECT, respectively. MDCT findings suggested nonviability in additional 16 segments (5.0%) and 7 segments (3.4%) where MI was not detected on SPECT and FDG-PET, respectively. Conclusion: MDCT is useful for determining myocardial viability in patients with myocardial infarction and more sensitive than SPECT and FDG-PET in detecting a nonviable myocardium.