Snippet 164: Why CMR is Better than FDG-PET for Viability Assessment

Leaving aside the discussion about whether viability assessment is relevant after the STICH and REVIVED-BCIS2 trials, given that viability assessment is still an indication, the question of which modality to use keeps arising.

SPECT and DSE are not as good as FDG-PET and CMR in published trials. FDG-PET and CMR are equivalent when it comes to just assessment of viability, but then CMR brings so much to the table. It can assess all of the below apart from just viability.

• Microvascular obstruction (MVO) and intra-myocardial hemorrhage (IMH)
• Thrombi
• RV involvement
• Papillary muscle rupture and MR
• Aneurysm and ruptures

Given all the additional information that CMR can give, it automatically becomes the modality of choice for viability and infarct imaging.

The video below explains the reasoning with examples.