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Peer-reviewedCC BYJACC. Advances

Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection.

  • Ibolya Csecs1
  • Ioannis Kyriakoulis2
  • Ahmed Ibrahim Ahmed1
  • Catherine X Wright1
  • Damianos Kokkinidis1
  • Edward J Miller3
  • Albert J Sinusas3
  • Attila Feher4
4 affiliations
  1. 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
  2. 2Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
  3. 3Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA.
  4. 4Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA. Electronic address: [email protected].
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Abstract

Background

Cardiovascular magnetic resonance late gadolinium enhancement (CMR-LGE) is the reference standard for scar detection, but data comparing LGE with fixed perfusion defects (FPD) on nuclear myocardial perfusion imaging (MPI) are limited.Objectives

This study aimed to evaluate concordance between myocardial scar detection by CMR-LGE and nuclear MPI.Methods

In this retrospective single-center study, patients undergoing contrast CMR and nuclear MPI within 1 year were included: single-photon emission computed tomography (SPECT) with CT attenuation correction (SPECTAC, n = 328), SPECT without attenuation correction (SPECTNoAC, n = 246), or 82-rubidium-positron emission tomography (PET) (n = 240). Scar was assessed by CMR-LGE and FPD on MPI. Minimal resting myocardial blood flow (MBFMin) was determined for PET. Patients with myocardial infarction or revascularization between studies were excluded. Associations of LGE and FPD with major adverse cardiovascular events (MACE) were analyzed.Results

LGE was present in 354 patients (43%), predominantly nonischemic, whereas nuclear MPI detected scar less frequently (30%, P < 0.01). Nuclear scar was associated with ischemic LGE (OR: 5.86; 95% CI: 3.64-9.43; P < 0.001), but not nonischemic LGE. PET demonstrated higher specificity than SPECT for detecting ischemic and ≥50% transmural LGE (P < 0.01). Patients with ≥50% transmural LGE had lower MBFMin (0.61 [0.53-0.68] vs 0.80 [0.74-0.85] mL/min/g; P < 0.001). Patients with both LGE and FPD had higher MACE risk than patients without these features (HR: 4.95 [95% CI: 3.01-8.11]; P < 0.001).Conclusions

MPI detected myocardial scar less frequently than CMR-LGE, with PET providing greater specificity than SPECT for ischemic and transmural scar. Combined LGE and FPD identified patients at highest risk of adverse outcomes, supporting PET MPI for myocardial scar characterization.

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Cite

BibTeXRIS
BibTeX
@article{csecs2026realworld,
  title = {{Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection.}},
  author = {Ibolya Csecs and Ioannis Kyriakoulis and Ahmed Ibrahim Ahmed and Catherine X Wright and Damianos Kokkinidis and Edward J Miller and Albert J Sinusas and Attila Feher},
  journal = {JACC. Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103303},
  url = {https://europepmc.org/article/MED/42832920},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection.
AU  - Ibolya Csecs
AU  - Ioannis Kyriakoulis
AU  - Ahmed Ibrahim Ahmed
AU  - Catherine X Wright
AU  - Damianos Kokkinidis
AU  - Edward J Miller
AU  - Albert J Sinusas
AU  - Attila Feher
PY  - 2026
DA  - 2026/10/05
JO  - JACC. Advances
DO  - 10.1016/j.jacadv.2026.103303
UR  - https://europepmc.org/article/MED/42832920
AB  - Background  Cardiovascular magnetic resonance late gadolinium enhancement (CMR-LGE) is the reference standard for scar detection, but data comparing LGE with fixed perfusion defects (FPD) on nuclear myocardial perfusion imaging (MPI) are limited.Objectives  This study aimed to evaluate concordance between myocardial scar detection by CMR-LGE and nuclear MPI.Methods  In this retrospective single-center study, patients undergoing contrast CMR and nuclear MPI within 1 year were included: single-photon emission computed tomography (SPECT) with CT attenuation correction (SPECTAC, n = 328), SPECT without attenuation correction (SPECTNoAC, n = 246), or 82-rubidium-positron emission tomography (PET) (n = 240). Scar was assessed by CMR-LGE and FPD on MPI. Minimal resting myocardial blood flow (MBFMin) was determined for PET. Patients with myocardial infarction or revascularization between studies were excluded. Associations of LGE and FPD with major adverse cardiovascular events (MACE) were analyzed.Results  LGE was present in 354 patients (43%), predominantly nonischemic, whereas nuclear MPI detected scar less frequently (30%, P < 0.01). Nuclear scar was associated with ischemic LGE (OR: 5.86; 95% CI: 3.64-9.43; P < 0.001), but not nonischemic LGE. PET demonstrated higher specificity than SPECT for detecting ischemic and ≥50% transmural LGE (P < 0.01). Patients with ≥50% transmural LGE had lower MBFMin (0.61 [0.53-0.68] vs 0.80 [0.74-0.85] mL/min/g; P < 0.001). Patients with both LGE and FPD had higher MACE risk than patients without these features (HR: 4.95 [95% CI: 3.01-8.11]; P < 0.001).Conclusions  MPI detected myocardial scar less frequently than CMR-LGE, with PET providing greater specificity than SPECT for ischemic and transmural scar. Combined LGE and FPD identified patients at highest risk of adverse outcomes, supporting PET MPI for myocardial scar characterization.
SN  - 2772-963X
ER  -