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Comparison of Contrast-Enhanced MRI with Iodine-123 BMIPP for Detection of Myocardial Damage in Hypertrophic Cardiomyopathy

¹ Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
² Department of First Internal Medicine, Nippon Medical School, Tokyo, Japan.

Abstract

OBJECTIVE. The purpose of this study was to compare contrast-enhanced MRI with dual-radionuclide SPECT for the detection of myocardial damage associated with hypertrophic cardiomyopathy.

SUBJECTS AND METHODS. Twenty-three patients with hypertrophic cardiomyopathy were examined. Delayed hyperenhancement of the damaged myocardium was observed using contrast-enhanced MRI, and regional wall thickness and left ventricular ejection fraction were measured using cine balanced steady-state free precession MRI. Dual-radionuclide SPECT using technetium-99m sestamibi and iodine-123 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) was performed at rest. In the abnormal myocardial segments, agreement between the contrast-enhanced MRI and ¹²³I BMIPP SPECT was assessed. The relationships between the regional and global cardiac abnormalities and the delayed hyperenhancement on MRI and decreased uptake of ¹²³I BMIPP were also evaluated.

RESULTS. In 368 left ventricular segments, 57 segments showed delayed hyperenhancement on MRI, 43 segments showed decreased uptake of ¹²³I BMIPP, and seven showed decreased uptake of ^99mTc sestamibi. The delayed hyperenhancement and decreased uptake of ¹²³I BMIPP were frequently observed in the interventricular septal wall (p < 0.0001); however, the agreement between the methods in detecting myocardial abnormalities was fair ( = 0.38). The abnormal septal walls were significantly thicker than those without apparent abnormalities (p = 0.031). There was an inverse correlation between the number of enhancing segments and the ejection fraction (r = –0.53).

CONCLUSION. In hypertrophic cardiomyopathy, contrast-enhanced MRI was valuable for the detection of extensive myocardial damage.

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