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Review


Several studies have compared MRI with FDG-PET, which is considered the gold standard for the detection of myocardial viability. An excellent correlation between the two methods was found.56


The American Heart Hospital Journal Gadolinium MRI was found to


have 96 % sensitivity and 84 % specificity when compared with FDG-PET.


Conclusions


ICM remains one of the most common causes of CHF. Despite the development of multiple pharmacological and therapeutic options, mortality and morbidity continue to be high. Myocardial revascularization is one of the most effective treatment modalities in a properly chosen patient population. Viability studies remain a cornerstone of risk stratification for patients prior to referral for coronary artery bypass surgery. With the aging of the population and increase in the amount of comorbidities of patients referred for surgery, a proper evaluation is increasingly important to determine the best possible treatment strategy for CHF patients.


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MRI is another method for the evaluation of viable myocardium. Its sensitivity and specificity for the detection of viable myocardium are similar to PET. With the more widespread use of this technology it appears to be a reasonable alternative to PET.


SPECT using thallium-201 and dobutamine echocardiography appear to be inferior to PET and MRI in sensitivity and specificity of diagnosing viable myocardium. However these tests remain a practical alternative to both PET and MRI and are currently widely used throughout the US. n


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Winter 2011


PET scan is considered to be the gold standard for viability evaluation. However, the higher cost and lack of availability of this technique have limited its use in the past. Quantitative coronary blood flow determination by PET and calculation of regional coronary flow reserve can further enhance myocardial perfusion assessment for comparison with metabolism.57


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