Brian P. Cupps, PhD, Douglas R. Bree, MD, Jason R

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Myocardial Viability Mapping by Magnetic Resonance-Based Multiparametric Systolic Strain Analysis Brian P. Cupps, PhD, Douglas R. Bree, MD, Jason R. Wollmuth, MD, Analyn C. Howells, RN, Rochus K. Voeller, MD, Joseph G. Rogers, MD, Michael K. Pasque, MD The Annals of Thoracic Surgery Volume 86, Issue 5, Pages 1546-1553 (November 2008) DOI: 10.1016/j.athoracsur.2008.06.072 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Region-based left ventricular finite element model. The attachment points of the right ventricular free wall to the septum serve as fiducial landmarks to consistently and uniformly divide the left ventricle into six clinical standard regions. Each region is then divided into basal, middle, and apical segments. The standardized finite element mesh for the left ventricular model consists, therefore, of six hexahedral elements each for the basal and middle regions of the left ventricle and six pentahedral elements covering the apex. The Annals of Thoracic Surgery 2008 86, 1546-1553DOI: (10.1016/j.athoracsur.2008.06.072) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Thallium single-photon emission computed tomography (SPECT) viability imaging versus magnetic resonance imaging (MRI)–based multiparametric strain Z-score color-contour modeling. Similarity is demonstrated between the blue areas of irreversible abnormal perfusion in the left-sided thallium SPECT image and the yellow (Z-score > 1.5) and red (Z-score > 2.25) areas of the corresponding MRI-based multiparametric strain Z-score color-contour images on the right. For each of three representative patients, a thallium SPECT scan on the left is compared with its corresponding multiparametric strain Z-score three-dimensional color-contour model on the right. Each three-dimensional multiparametric strain image was rotated to obtain the anatomically analogous view of the myocardial region of interest. The common finding of extension of infarction boundaries across multiple regions of the left ventricle is well demonstrated. (ANT = anterior; INF = inferior; LAT = lateral; SEPT = septal.) The Annals of Thoracic Surgery 2008 86, 1546-1553DOI: (10.1016/j.athoracsur.2008.06.072) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Magnetic resonance imaging (MRI)–based multiparametric strain Z-score color-contour modeling versus positron emission tomography (PET) viability imaging. The PET scan results from 3 representative patients are presented in two-dimensional cross-sectional format. A corresponding two-dimensional slice was obtained for comparison by subjecting the MRI-based multiparametric strain Z-score three-dimensional color-contour model to a postprocessing cutting tool. In each comparison, the PET scan is found on the left with a comparable slice through our model in the same patient being found immediately to the right. Nonviable areas on the PET images are represented by a gap in the red, yellow, or green circular contour of the ventricular cross-section. Once again, similarities are demonstrated between the PET nonviable regions on the left and the yellow (Z-score > 1.5) and red (Z-score > 2.25) areas of the corresponding MRI-based multiparametric strain Z-score color-contour images on the right. The propensity of irreversible injury from myocardial infarction to extend across multiple regional boundaries of the heart is again apparent. The Annals of Thoracic Surgery 2008 86, 1546-1553DOI: (10.1016/j.athoracsur.2008.06.072) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Receiver-operator characteristic (ROC) curve generated from multiparametric Z-score data. The average multiparametric strain composite Z-score from each left ventricular region (n = 120) was compared with the respective clinical standard viability testing result and used to construct a ROC curve. The area under the curve was found to be 0.941 (p < 0.001) with a 95% confidence interval having a lower bound of 0.897 and an upper bound of 0.985. The Annals of Thoracic Surgery 2008 86, 1546-1553DOI: (10.1016/j.athoracsur.2008.06.072) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions