Table 4 Comparison of Imaging Modalities for the evaluation of NICM
| Â | Echo | CMR | CT | SPECT | PET |
|---|---|---|---|---|---|
Scan time | 15-25 min | 30-45 min | 10 min | 2 hours | 1 h1/ 2-2 hours |
Radiation | None | None | 1.5-2 mSv (64-slice Coronary CT) | 41 mSv (Thallium stress/rest) 9 mSv (Sestamibi) | 14 mSv (F-18 FDG) |
|  |  |  | 6–10 mSv (multi-detector row CT) |  |  |
|  |  |  | 1–1.3 mSv |  |  |
| Â | Â | Â | 1.5-6 mSv (multi-detector coronary calcium scoring) [124] | Â | Â |
Risks | None | NSF (related to some types of gadolinium-based contrast if severe renal failure) | Radiation Renal failure Allergy | Radiation Allergy (rare) | Radiation Allergy (rare) |
Contra-indications | None | MRI-incompatible implants and devices Pregnancy during first trimester (precautionary) | Renal failure Pregnancy | Pregnancy | Pregnancy |
Limitations | Operator dependent Acoustic window (obese, COPD) Imaging of apical segments and RV (spatial resolution) | Availability Lower temporal resolution | Not ideal for serial follow-up owing to radiation Currently not suited for detection of fibrosis, perfusion and wall motion Blood flow cannot be assessed | Availability Low spatial resolution | Availability Low spatial resolution |
Accuracy of LV /RV function and volumes | ++ 3D echo | +++ | - | ++ | - |
Wall thickness /Mass quantification | + (localised hypertrophy can be missed) | +++ | + | - | - |
Detection of oedema | - (non-specific findings such as wall thickening) | +++ (STIR sequences) | - | + (non-specific; areas of reduced perfusion) | +++ FDG (uptake) |
Imaging of fibrosis | - (suspected with 2D strain) | +++ | + | - | + |
Detection of microvascular disease/ Stress Perfusion | + Contrast echo Stress echo | +++ | + Perfusion | ++ [125] | +++ (considered gold standard) |
Assessment of Myocyte Metabolism | - | + (Field of research, CMR spectroscopy) | - | + (technical limitations, quantitative methods unavailable) | +++ |