Coronary disease & ACSCohort study
Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection
- retrospective single-center study
Authors' conclusion
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.
Study context
- Population
- Patients undergoing contrast CMR and nuclear myocardial perfusion imaging (MPI) within 1 year; patients with myocardial infarction or revascularization between studies excludedper MPI modality · SPECTAC 328 · SPECTNoAC 246 · PET 240
- Participants
- 328 / 246 / 240
- Exposure
- Myocardial scar detection by fixed perfusion defects (FPD) on nuclear MPI vs cardiovascular magnetic resonance late gadolinium enhancement (CMR-LGE)
- SPECTACn = 328
- SPECTNoACn = 246
- PETn = 240
Main finding
As reported in the abstract
Scar detection
LGE present (predominantly nonischemic)
354 patients (43%)
Scar detected by nuclear MPI
30%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| MACE · higher MACE risk with both LGE and FPD | 4.95 (3.01–8.11) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
Nuclear scar and ischemic LGE
- Association of nuclear scar with ischemic LGE, OR (95% CI 3.64-9.43; P < 0.001)
- 5.86
- Not associated with nonischemic LGE
Specificity for ischemic and ≥50% transmural LGE
- PET higher specificity than single-photon emission computed tomography (SPECT)
- P < 0.01
MBFMin
- ≥50% transmural LGE vs not (lower with ≥50% transmural LGE)
- 0.61 [0.53-0.68] vs 0.80 [0.74-0.85] mL/min/g; P < 0.001
Original publication
Real-World Comparison of Cardiac MRI and Nuclear Perfusion Imaging for Myocardial Scar Detection. JACC Adv. Published 5 October 2026. doi:10.1016/j.jacadv.2026.103303
Summarised from the published abstract; every number is checked against it