Evaluation of the relationship between cardiac innervation scintigraphy and MRI in patients with cardiomyopathy

M. COZAR SANTIAGO, R. SANCHEZ JURADO, A. VICEDO GONZALEZ, P. GARCIA GONZALEZ, J. ESTORNELL ERILL , F. RIDOCCI SORIANO, J. FERRER REBOLLEDA.
SERVICIO DE MEDICINA NUCLEAR-ERESA HOSPITAL GENERAL DE VALENCIA. VALENCIA. SPAIN.

Disclosure Slide
Research Support 1:
BECA FIS INSTITUTO DE SALUD CARLOS III AND GENERALITAT VALENCIANA 2010-2011. RESEARCH GRANT ISCIII 10/01112 Programa I3SNS TO F. RIDOCCI. RESEARCH GRANT BECA FUNDACION ERESA

Consultant 2:NO

Speakers Bureau 3: NO
Honoraria and/or Stockholder 4: NO

AIM
Correlate possible disorders of sympathetic innervation in scar areas evaluated with 123IMIBG scintigraphy and MRI in patients with ischemic and nonischemic dilated cardiomyopathy.

MATERIALS AND METHODS

16 patients
6 with ischemic dilated cardiomyopathy (IDCM) all men (average age 62.8 9.9) 10 with nonischemic dilated cardiomyopathy (NIDCM): 3 women (average age 73.33 3.5 ) and 7 men (average age 58.42 13).

Scintigraphy was performed 4 h after iv administration of 10mCi 123I-MIBG with planar and SPECT acquisitions. We calculated the Heart-to-Mediastinum (H/M) ratio and processed the SPECT with an automatic quantitative program (AutoQuant v.7.2).

IMAGE PROCESSING

EARLY IMAGE

LATE IMAGE

MATERIALS AND METHODS

The SPECT images were measured according to the 17segment model with a score 1 (normal value), 2 (mild uptake) and 3 (moderate and severe decreased uptake) with expected values from 17 to 51. All patients underwent a gadolinium MRI scan and the presence of scar was also quantified following the same model (1 normal, 2 less than 50%, 3 greater than 50%). LVEF was calculated.

NON-ISCHEMIC DILATED CARDIOMYOPATHY

NIDCM SCORE: 22

NIDCM SCORE: 32

ISCHEMIC DILATED CARDIOMYOPATHY

IDCM SCORE: 36

IDCM SCORE: 28

ISCHEMIC DILATED CARDIOMYOPATHY

SCAR EVALUATION

SCORE: 31

NON-ISCHEMIC DILATED CARDIOMYOPATHY

SCAR EVALUATION

SCORE: 17

RESULTS
We obtained
score values between 21-45 (average 31) in the MIBG study in patients with IDCM and between 21-31 (average 26.33) in the MRI study. LVEF (average 32%). In patients with NIDCM score values obtained with MIBG were between 30-43 (average 36.3) and 17-32 (average 20.6) with MRI. LVEF (average 25.5%).

RESULTS
An excellent linear correlation (R2: 0.92) was found between MRI and SPECT assessment in patients with IDCM.
50 45 40 35
MIBG

30 25 20 15 10 5 0 0 5 10 15
MRI

20

25

30

35

RESULTS
while there was no statistical significance when we compared these two techniques in patients with DNICM.

CONCLUSIONS

123I-MIBG

scintigraphy for the detection of adrenergic dennervation in scar areas and MRI have a crucial role in the assessment of patients with IDCM showing a good correlation between both techniques.

Further investigations will give us about prognostic values in these patients.

CONCLUSIONS
The high prevalence of patients with concomitant ischemic and contractility disease makes it interesting and necessary to continue comparative studies in the evaluation of new diagnostic techniques such as scintigraphy of myocardial denervation.

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