Head-to-head comparison of a 2-day myocardial perfusion gated SPECT protocol and cardiac magnetic resonance late gadolinium enhancement for the detection of myocardial infarction

The aim was to determine the sensitivity and specificity of gated myocardial perfusion SPECT (MPS) with a technetium-labelled (Tc) perfusion tracer to detect myocardial infarction (MI) in a clinical population referred for assessment of stress-induced ischemia using late gadolinium enhancement cardiac magnetic resonance (CMR) as reference method. 119 patients referred for evaluation of stress-induced ischemia with MPS were included. 108 patients (age 62 +/- A 10 years, 39% females) completed MPS and CMR. A 2-day protocol for MPS was used for most patients (n = 105). MI was found in 31 patients (29%) using MPS and in 30 patients using CMR (28%). The sensitivity and specificity on a patient basis were 93% and 96%, respectively. Positive predictive value (PPV) was 90% and negative predictive value (NPV) was 97%. Per territory, the sensitivity and specificity for LAD infarcts were 83% and 97%, respectively. PPV was 77% and NPV was 98% for LAD infarcts. The sensitivity and specificity for RCA/LCx infarcts were 95% and 95%, respectively. PPV was 84% and NPV was 99% for RCA/LCx infarcts. The MI size on CMR was 12.0 +/- A 7.3% of the LV and mean transmurality was 66.3 +/- A 12.0%. All MI > 3% were detected on gated SPECT. This study has demonstrated high sensitivity and specificity for gated Tc-MPS detecting subendocardial and transmural MI.