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PubMedDate not supplied

Two-dimensional time-of-flight magnetic resonance angiography of renal arteries without maximum intensity projection: a prospective comparison with angiography in 21 patients screened for renovascular hypertension.

PURPOSE: We compared magnetic resonance angiography (MRA) with conventional angiography to establish its value as a screening test in the workup for renal hypertension. METHODS: Twenty-one patients underwent MRA and angiography within a three-day interval. Fifteen patients were suspected of having renovascular hypertension on the basis of clinical findings; the remaining six had multivessel atherosclerosis with renal insufficiency. MRA was performed on a 1 Tesla magnet in three planes: axial, coronal and perpendicular to the axis of each renal artery, by means of several contiguous or overlapping individual slice acquisitions. The two examinations were read by the same two independent observers, before and after an interval of 3 months. RESULTS: Conventional angiography showed 48 renal arteries. All main and three of six accessory renal arteries were correctly identified by MRA, as well as 11 of 14 significant stenoses or thromboses. Overreading of stenoses by MRA was observed in 4 cases. There were two false negatives for the two readers. The sensitivity and specificity of MRA for the detection of stenoses of the main renal arteries were found to be 70 and 78% respectively, for the first reading and 85 and 86% for the second reading. CONCLUSION: MRA is considered a useful noninvasive method to determine the need for conventional angiography in patients in whom renal artery stenosis is suspected.

Adult↗

PubMed2006

Visualization of intrarenal vessels by 3.0-T MR angiography in comparison with digital subtraction angiography using renal specimens.

BACKGROUND: MRI at 3.0 T enables high-spatial resolution for renal MR angiography. OBJECTIVE: Evaluation of an arterial tree model in animal kidney specimens with comparison of digital subtraction angiography (DSA) and high-field MRI to find out the maximum spatial resolution of intrarenal vessels. It was considered that objective quantitation of angiogram quality could be achieved. MATERIALS AND METHODS: A total of 27 pig kidney specimens were examined by MR angiography (flash 3D) using a 3.0-T scanner (TRIO; Siemens, Erlangen, Germany) with an eight-channel head coil and a voxel size of 0.9x0.9x1.1 mm in the early arterial phase after implantation of a 4F catheter in the renal artery. DSA (Integris, Philips, Best, The Netherlands) was performed immediately after the MRI. With the help of semiautomated segmentation, all vessels were marked for comparison of the vessel trees. The Wilcoxon rank test was used for statistical evaluation of vessel numbers and branching depths. RESULTS: Objective comparison between DSA and MR angiography was achieved. High-field MR angiography had the ability to depict vessels up to the seventh branching on average. Significant differences in vessel delineation and counts were found from the fifth level of intrarenal branching onwards with DSA showing an advantage. CONCLUSION: High-field MRI has great potential in the detection of intrarenal arteries and is comparable to DSA in visualization of the central intrarenal vessel tree.

Angiography, Digital Subtraction↗

PubMed1992

Value of exercise stress test, radionuclide angiography and coronary angiography in predicting new coronary events in asymptomatic patients after a first episode of myocardial infarction.

One-hundred-and-fifty-five consecutive symptom-free patients underwent maximal treadmill exercise testing, rest and stress radionuclide angiography at least two months after an uncomplicated acute myocardial infarction; of these, 90 underwent coronary angiography. All patients were followed-up for a mean of 32 +/- 13 months regarding the prediction of hard (death and reinfarction) and soft (angina and coronary surgery) coronary events. The specificity, sensitivity, positive and negative predictive value of exercise stress test were 47%, 76% and 41% for any coronary events; none of the patients who incurred a hard coronary event showed ischemia during electrocardiographic exercise tests. Sensitivity, specificity and positive predictive value for failure to increase the ejection fraction of at least 5% were 60%, 45% and 30% for any coronary event and 25%, 49% and 2% for any hard coronary event. The presence of multivessel disease at coronary angiography showed a sensitivity of 62% for any coronary event and of 67% for hard coronary events; specificities were 66% and 57%, and predictive values were 52% and 10%, respectively. It is concluded that electrocardiographic exercise testing, radionuclide angiography and coronary angiography are not helpful two months after an episode of uncomplicated myocardial infarction in order to identify patients who will suffer a new coronary event.

Adult↗

PubMed2006

Accuracy of stepping-table lower extremity MR angiography with dual-level bolus timing and separate calf acquisition: hybrid peripheral MR angiography.

PURPOSE: To retrospectively evaluate the accuracy of hybrid peripheral magnetic resonance (MR) angiography by using conventional digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS: This retrospective study protocol received approval from the Office of Sponsored Research at Northwestern University, which included review by the Office for the Protection of Research Subjects. Informed consent was waived for this HIPAA-compliant study. One hundred twenty-one consecutive patients (67 men: mean age, 66 years +/- 12 [standard deviation]; 54 women: mean age, 69 years +/- 14), who were referred for evaluation of peripheral vascular disease, underwent peripheral contrast material-enhanced MR angiography. By using a hybrid technique, two independent timing measurements were performed in the pelvis and calves followed by MR angiography of the calves and, subsequently, a pelvis-thigh stepping-table acquisition. Images were evaluated for extent of disease, on the basis of degree of stenosis; for venous contamination, on the basis of venous signal intensity; and for diagnostic quality, on the basis of diagnostic confidence of the observer. DSA correlation of the extent of vascular disease was available in 45 of these patients, which was used to evaluate the diagnostic power of the hybrid technique. RESULTS: For detection of stenosis greater than 50%, the hybrid technique had 95% sensitivity (P < .05), 95% specificity (P < .05), and 95% accuracy (P < .05). There was no significant venous contamination in any of the examinations performed with this technique. CONCLUSION: The hybrid peripheral MR angiography technique provides diagnostic-quality examinations and virtually eliminates venous contamination.

Adult↗

PubMed1998

Aortic and lower-extremity arterial disease: evaluation with MR angiography versus conventional angiography.

PURPOSE: To compare magnetic resonance (MR) angiography with conventional angiography in evaluation of the aorta and lower-extremity arterial system. MATERIALS AND METHODS: Fifty-seven patients were evaluated with femoral conventional and MR angiography. Iliac artery segments were evaluated with two-dimensional and contrast material-enhanced three-dimensional time-of-flight MR angiography. Infrainguinal regions were evaluated with two-dimensional time-of-flight MR angiography with a dedicated lower-extremity coil. Arteries depicted on femoral images were separately interpreted as 20 anatomic segments. Disease classification included normal to moderate disease (0%-50% stenosis), severe stenosis (> 50% stenosis), diffuse disease (more than one severe stenosis), and occlusion. Four readers interpreted the images and rendered treatment recommendations. RESULTS: Substantial to almost perfect interobserver agreement (kappa, 0.66-1.00) was achieved in most cases for MR angiogram interpretation. The three most experienced readers achieved substantial to almost perfect intraobserver agreement (kappa, 0.61-1.00) between conventional and MR angiogram interpretation in most cases. Among three readers, moderate agreement (kappa, 0.43-0.53) was found between treatment recommendations based on conventional versus MR angiographic findings; for the most experienced reader, this agreement was almost perfect (kappa, 0.90). CONCLUSION: For experienced readers, there was substantial to almost perfect agreement between conventional and MR angiographic image interpretations of the aorta and lower-extremity arterial system.

Aged↗

PubMed1999

Hepatic blood supply: comparison of optimized dual phase contrast-enhanced three-dimensional MR angiography and digital subtraction angiography.

PURPOSE: To optimize and determine the value of dual-phase contrast material-enhanced three-dimensional (3D) magnetic resonance (MR) angiography for preoperative evaluation of the blood supply to the liver. MATERIALS AND METHODS: Dual phase 3D MR angiography of the hepatic arteries and portal vein was performed in 140 patients. In 80 patients, the value of fat saturation, digital image subtraction, an anticholinergic agent, and a high-caloric meal were evaluated. In the next 60 patients, MR angiographic and digital subtraction angiographic (DSA) image quality and diagnostic value were compared. RESULTS: Fat-saturated images were of significantly better quality (P < .01) than non-fat-saturated images. Digital image subtraction was useful in only 23 of 40 patients. The injection of an anticholinergic agent was superfluous, whereas administration of a high-caloric meal helped in demonstration of the superior mesenteric artery and portal vein. Classification on MR angiograms of the arterial blood supply was correct in 57 of 60 patients. All arterial and portal venous lesions were seen on MR angiograms, and MR angiograms had a significantly higher subjective image-quality ranking than did DSA images in the evaluation of the portal vein (P < .05). CONCLUSION: Fat saturation and use of a high-caloric meal improve the results of MR angiography of hepatic vessels. MR angiography was comparable to DSA for evaluation of the arterial system and was superior for demonstration of the portal vein; therefore, MR angiography could replace intraarterial DSA.

Angiography, Digital Subtraction↗

PubMed2000

Preoperative evaluation of living renal donors: comparison of CT angiography and MR angiography.

PURPOSE: To compare computed tomographic (CT) angiography and magnetic resonance (MR) angiography for preoperative evaluation of living renal donors. MATERIALS AND METHODS: Thirty-five living renal donors underwent preoperative contrast material-enhanced CT angiography and gadolinium-enhanced MR angiography. Each study was interpreted by two independent radiologists blinded to all other studies and to interpretations provided by other reviewers. Eighteen kidneys had surgical correlation. RESULTS: CT demonstrated 33 supernumerary arteries in 19 patients, bilateral solitary arteries in 16 patients, and 18 proximal arterial branches in 16 patients. MR demonstrated 26 supernumerary arteries in 15 patients, bilateral solitary renal arteries in 20 patients, and 21 proximal arterial branches in 16 patients. Interobserver agreements for MR (kappa = 0. 74) and CT (kappa = 0.73) were similar to the agreement between MR and CT (kappa = 0.74). Among the kidneys chosen for nephrectomy, one small accessory artery and one proximal arterial branch were missed with CT and MR. Two of the accessory arteries suggested at CT were not found at nephrectomy. By averaging data for both modalities, supernumerary arteries were present in 49% of kidney donors and were bilateral in approximately 17%. Proximal arterial branches were present in 46% of kidney donors. CONCLUSION: Preoperative CT and MR angiography of the renal arteries in renal donors demonstrate substantial agreement. Interobserver disagreement in the interpretation of CT and MR angiograms is related to 1-2-mm-diameter vessels.

Adult↗

PubMedDate not supplied

MR angiography and CT angiography of the artery of Adamkiewicz: noninvasive preoperative assessment of thoracoabdominal aortic aneurysm.

It is important to identify the artery of Adamkiewicz in patients with thoracoabdominal aortic aneurysm to aid in surgical planning and to prevent postoperative paraplegia or paraparesis. However, the artery of Adamkiewicz is difficult to visualize and impossible or very dangerous to evaluate with selective intercostal or lumbar angiography. The feasibility, advantages, and limitations of magnetic resonance (MR) angiography and computed tomographic (CT) angiography in the preoperative assessment of the artery of Adamkiewicz were evaluated in 30 patients with thoracoabdominal aortic aneurysm. Initial results indicate that MR angiography and CT angiography are safe, effective, noninvasive procedures that allow clear visualization of the artery of Adamkiewicz by providing detailed depiction of the vascular anatomy from the aorta to the anterior spinal artery. However, further studies will be needed to assess the efficacy of these modalities in decreasing surgical risk.

Aged↗

PubMed2002

Pulmonary embolism: comparison of angiography with spiral computed tomography, magnetic resonance angiography, and real-time magnetic resonance imaging.

In the last decade, spiral computed tomography (CT) and magnetic resonance (MR) angiography (MRA) have become a viable alternative to conventional angiography in the diagnosis of acute pulmonary embolism. However, patients with dyspnea are often unable to hold their breath for a longer time and thus image degradation is frequently observed. Consequently, an imaging sequence that allows free breathing is desirable. The aim of this animal study was to compare contrast-enhanced spiral CT, MRA and a real-time MR sequence, the latter without breath-hold, with pulmonary angiography as reference gold standard. Nine pigs with artificially induced pulmonary embolism underwent this multimodality comparison. All images were independently evaluated for the presence of pulmonary emboli by two reviewers. Forty-three filling defects were detected by conventional angiography on lobar and segmental levels. Sensitivity of CT images was 72.1 and 69.8% for Readers 1 and 2, respectively, and sensitivity of MRA images was 79.1 and 81.4%. With real-time MR imaging, however, the detection rate was 97.7% for both readers. We conclude that, under experimental conditions, real-time MR imaging without the use of radiation or iodinated contrast material is comparable with angiography in the detection of pulmonary emboli.

Angiography, Digital Subtraction↗

PubMed1996

Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography.

OBJECTIVE: MR coronary angiography is most often performed using two-dimensional techniques. Although three-dimensional (3D) acquisitions do have important advantages, they take too long for a single breath-hold and are thus susceptible to respiratory motion artifacts. The purpose of this study was to investigate the accuracy of a unique respiratory-gated 3D MR angiographic technique in identifying the proximal coronary arteries in patients suspected of having coronary artery disease. In addition, we investigated the capability of this technique to detect proximal stenoses. SUBJECTS AND METHODS: We performed a prospective blinded study in 20 patients who were referred for conventional coronary angiography. A cardiac-gated 3D gradient-echo sequence with fat suppression was used. Retrospective respiratory gating was performed using navigator echoes of the diaphragm position. Using multiplanar reformatting, two independent readers blindly analyzed the data sets for visualization of major coronary arteries, lengths of imaged segments, and detection of significant stenoses (> 50% occlusion of the luminal diameter by conventional angiography). RESULTS: Seventy-seven of 80 (96%) coronary arteries were positively identified. In one patient, an anomalous coronary anatomy was readily identified and confirmed by conventional angiography. The average lengths of the imaged segments of the right, left main, left anterior descending, and left circumflex coronary arteries were 58 +/- 13 mm, 9 +/- 5 mm, 59 +/- 16 mm, and 24 +/- 10 mm, respectively. Overall sensitivity for the detection of stenoses was low (38%), with a specificity of 95%. Interobserver agreement was 0.92, with a kappa value of 0.65. CONCLUSION: Respiratory-gated 3D MR angiography allows accurate identification of proximal coronary arteries and may be valuable for 3D imaging of coronary anomalies. Further technical improvements are required to enhance the value of the technique in detecting stenoses.

Adult↗

PubMed1995

Comparison of MR angiography with contrast angiography for the diagnosis of carotid artery stenosis.

To assess the accuracy of MR angiography for screening vascular stenosis of the extracranial carotid arteries, 20 consecutive patients with suspected extracranial carotid atherosclerotic disease were evaluated with time-of-flight MR angiography and intra-arterial contrast angiography. Both studies were independently reviewed by three observers in a blinded manner. The internal carotid arteries were graded as either normal or mildly stenotic (0%-29%), moderately stenotic (30%-69%), severely stenotic (70%-99%) or occluded. Results of the study indicate that time-of-flight MR angiography has a high rate of agreement with contrast angiography and is an accurate screening technique of the common carotid bifurcation in patients with suspected carotid stenosis.

Adult↗

PubMed1996

MR angiography with three-dimensional MR digital subtraction angiography.

We have developed a time-resolved, contrast-enhanced, volume-imaging technique for magnetic resonance (MR) angiography, known as three-dimensional (3D) MR digital subtraction angiography (DSA). This technique greatly improves MR angiogram quality because it combines the injection of a contrast agent with the ability to image the temporal passage of this agent and, thereby, obviates the need for timing scans or other complicated synchronization schemes. Three-dimensional MR DSA also represents a potential improvement in the sense that, relative to DSA and computed tomography (CT) angiography, the contrast agent is less toxic. Additionally, unlike CT angiography, images may be acquired during the passage of the contrast agent. Therefore, 3D MR DSA shows the sequential passage of contrast through the arterial and venous system, followed by uptake in various organs. Unlike conventional DSA, 3D MR DSA imaging acquires full volume datasets, which allows subsequent reprojection and reformatting. Because images are obtained at approximately 2-6 s time intervals using a temporal aperture on the order of several seconds, motion (such as respiration) causes only a temporary disruption of image quality, similar to that observed in MR fluoroscopy. These temporal characteristics also make the proposed sequence insensitive to variations in the shape and timing of the contrast-pass curve. Although the individual time-resolved images will have somewhat decreased signal-to-noise ratio (SNR) relative to nontime-resolved scans collected in the same acquisition time, the SNR improvement due to the gadolinium appears to accommodate this trade-off. Additionally, if motion between successive images is small, then the full suite of temporal processing schemes, previously investigated in connection with DSA and time-resolved two-dimensional (2D) MR, such as mask mode subtraction, simple matched filtering and Eigen filtering, can be used to obtain composite images. These derived images generally have an increased SNR or negligible venous signal if an arterial-phase image is not obtained in the early time-resolved images. In summary, 3D MR DSA will significantly advance MR angiography because of the following intrinsic advantages: (1) improved signal-to-noise, (2) scan orientation may be chosen independently of the direction of blood flow, (3) uniform vascular signal, even from regions of complex flow, (4) minimization of motion artifacts, (5) greatly reduced sensitivity to variation in the shape and timing of the contrast bolus, (6) ability to be reformatted or reprojected, and (7) ability to apply a variety of temporal postprocessing techniques.

Angiography, Digital Subtraction↗

PubMed1998

[Comparative value of MR-angiography, helical CT and digital angiography in the preoperative assessment of abdominal aortic aneurysms].

PURPOSE: To compare helical CT with MR angiography in pre-operative assessment of abdominal aortic aneurysm (AAA). MATERIAL AND METHODS: Twenty patients with AAA underwent helical-CT, MR-angiography and digital angiography. All exams were interpreted independently by two groups of observers. Kappa and rho were calculated to assess correlations. Sensitivity and specificity were calculated to compare each method with the "gold standard" digital angiography. RESULTS: Inter-observer correlation was excellent. There was a very good agreement between both methods in the assessment of the maximal diameter and the proximal neck of the aneurysm. There was no significant difference in the assessment of stenoses of the visceral and iliac arteries, the number of renal arteries, and iliac extension. CONCLUSION: Helical CT and MR angiography are equivalent in pre-operative assessment of AAA.

Aged↗

PubMed2005

Magnetic resonance angiography of the carotid arteries using three different techniques: accuracy compared with intraarterial x-ray angiography and endarterectomy specimens.

PURPOSE: To compare three different magnetic resonance angiography (MRA) techniques with x-ray angiography and endarterectomy specimens. MATERIALS AND METHODS: Twenty-one patients underwent x-ray angiography, three-dimensional time-of-flight (TOF) focusing on the carotid bifurcation, high-resolution (HR) contrast-enhanced (CE) MRA, and time-resolved CE MRA. Stenoses of internal carotid arteries were evaluated by three independent observers on identical projection of x-ray angiography and MRA. Maximum stenosis grades on MRA were assessed additionally and correlated with endarterectomy specimens in 12 cases. RESULTS: Sensitivity for the detection of severe stenoses was excellent (100%) for all MRA techniques, and specificity was superior for three-dimensional TOF (96.7%) compared with HR CE MRA (80.6%) and time-resolved CE MRA (83.9%). The correlation between x-ray angiography and MRA for all stenoses was slightly superior for three-dimensional TOF and HR CE MRA compared with the time-resolved technique (kappa = 0.87 and 0.86 vs. 0.84). The same trend was seen for the interobserver agreement and for the correlation with endarterectomy specimens. Eleven up to 17 stenoses (depending on the MRA technique) were graded higher using additional projections. CONCLUSION: Three-dimensional TOF MRA yielded even more accurate results than HR CE MRA in grading of stenoses near the carotid bifurcation. Therefore, a combination of both methods seems to be advantageous.

Aged↗

PubMed1997

[Invasive or noninvasive angiography? The role of "classical" catheter angiography].

Within the last decade, diagnostic and interventional angiography have been developed to a high degree of performance, due to the widespread use od DSA, the miniaturisation of the puncture trauma and the introduction sets (catheters, sheaths), the development of high-tech materials (e.g., Nitinol guidewires) and the application of non-ionic, low osmolal contrast media. The specific risks of the procedure, thereby, have been significantly reduced, but could not be totally eliminated. To evaluate vascular diseases non-invasively, special attention was attributed to the progress of colour coded duplex, (spiral) CT-angiography and (CE) MR-angiography, based on the established imaging with US, CT and MRT. The matter is question is whether or not they can substitute the role of conventional angiography as the "gold standard" of vessel imaging. Clinical validity and economic efficiency both determine the indication for the use of invasive or non-invasive methods. In diagnostic procedures, there is a growing tendency for the use of non-invasive techniques, like in imaging of the abdominal and thoracic aorta, the renal, pulmonary and extra- and intra-cranial arteries. Conventional angiography is still reserved for the evaluation of small vessels of the upper and lower extremities, and vessel status in preoperative conditions (carotid, celiac trunk, mesenteric and renal arteries and aneurysms of the cerebral vasculature). Fluoroscopic guiding of catheters and contrast enhancement in interventional procedures, however, cannot be substituted by alternative techniques in the foreseeable future.

Angiography↗

PubMed2004

Indocyanine green angiography and fluorescein angiography of malignant choroidal melanomas following proton beam irradiation.

BACKGROUND: The vascularisation features of intraocular tumours may be characterised by indocyanine green angiography (ICG-A) and fluorescein angiography (FA). Proton beam irradiation is an established method of treating malignant melanoma of the choroid. The aim of this study was to describe the vascularisation features of small choroidal melanomas and to examine the influence of proton beam irradiation on these tumours. METHODS: We examined 39 choroidal melanomas by ICG-A and FA from 1998 to 2001 in a prospective study. The tumours had a mean prominence of 3.65 mm (1.2-7.5 mm) and a common feature of all was their parapapillary or paramacular localisation. Angiography was always performed immediately before proton beam radiotherapy and at intervals of 3 months, half a year and 1 year thereafter. Two hundred and forty angiographies were analysed in total. RESULTS: Intra-tumoral vessels could be visualised in 89% of all tumours by ICG angiography but in only 33% by FA. Neither ICG-A nor FA detected changes 3 months after irradiation; however, ICG-A disclosed strong leakage from vessels in the tumour area after 6 months. These changes increased markedly after 12 months and were also visible by FA. A disadvantage of FA, however, was the faster escape of dye from the vessels, which caused rapid leakage in the tumour area and meant that details could no longer be demonstrated. CONCLUSIONS: ICG-A and FA detect marked vascular changes within the tumours examined.

Choroid Neoplasms↗

PubMed2004

Noninvasive coronary angiography: agreement of multi-slice spiral computed tomography and selective catheter angiography.

BACKGROUND: Technology advances in multislice detector computed tomography (MSCT) cardiac scanning, specifically in the application of intravenous injected contrast coronary angiography with EKG gating have led to the availability of this procedure in every day outpatient cardiac medicine. OBJECTIVE: The aim of this study is to test the head to head direct coronary angiography with MSCT coronary angiography in clinical situations where cardiac cath is traditionally utilized for management decisions. METHODS: We limited our analysis to vessels felt to be 1.5 mm or greater in diameter, recognizing diagnostic accuracy and medical importance of smaller vessels is low. All 50 patients (52% men, 48% women age range 34-78) were studied because of the clinical suspicion of obstructive coronary atherosclerosis. Blinded experts in direct and in MSCT independently read the studies and resolved disparities by a subsequent discussion. Standard protocols for direct and for MSCT angiography were used including use of IV and oral beta blockade to keep the heart rate at or below 60 beats per minute. RESULTS: 392 vessels were evaluated. MSCT provided images of sufficient technical quality to permit diagnosis in 98% (49/50) of cases. MSCT was 96% accurate in identifying patients as having either no disease, single vessel disease, or multiple vessel disease. For all vessels, MSCT identification of stenotic lesions of >50% were as follows: sensitivity 87%, specificity 97%, positive predictive value 80%, and negative predictive value 98%. Pearson correlation results between direct catheter and MSCT for absolute stenotic percentages were left main (0.92 p < 0.0001), left anterior descending (0.94 p < 0.0001), circumflex (0.94 p < 0.0001), first obtuse marginal (0.85 p < 0.0001), and right coronary artery (0.89 p < 0.0001). CONCLUSION: The accuracy of MSCT angiography compared favorably with that of direct cardiac cath in this cohort of patients. The high specificity of these findings suggest that one particular use of this technique will be to eliminate many unnecessary cardiac catheterization procedures by excluding obstructive, and therefore potentially PCI requiring, coronary artery disease. The medical cost savings of such an application may be very significant and bears further study.

Adrenergic beta-Antagonists↗

PubMed1985

Regional left ventricular wall motion assessment: comparison of two-dimensional echocardiography and radionuclide angiography with contrast angiography in healed myocardial infarction.

The diagnostic ability of radionuclide angiography (RNA) and 2-dimensional echocardiography (2-D echo) to assess regional left ventricular (LV) wall motion was compared with contrast angiography in 52 patients with healed myocardial infarction. After 5 patients were excluded for inadequate 2-D echocardiographic studies, the LV images of 47 patients obtained by all 3 techniques were divided into 7 segments for analysis. Both 2-D echo and RNA showed close agreement with contrast angiography in assessing normal vs abnormal wall motion in the anterobasal (91%, 91%), anterolateral (87%, 79%) and posterolateral segments (77%, 79%). The sensitivity in detecting wall motion abnormalities was highest for 2-D echo and RNA in the anterolateral (83%, 77%) and apical (95%, 84%) segments and lowest for the inferior segment (48%, 48%). Specificity of 2-D echo and RNA was high, ranging from 94% in the anterolateral segment to 71% in the septal segment for 2-D echo, and from 91% in the inferior segment to 81% in the posterobasal and septal segments for RNA. Major discrepancies with contrast angiography occurred more often in the posterobasal, posterolateral, inferior and septal LV segments. Thus, in comparison with contrast angiography, 2-D echo and RNA are reliable for detecting anterior and apical wall motion abnormalities, but relatively less sensitive for detecting wall motion abnormalities involving the inferior, posterobasal and posterolateral LV segments.

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