Horizon Scanning Technology Prioritising Summary Delayed enhancement MRI

DISCLAIMER: This report is based on information available at the time of research cannot be expected to cover any developments arising from subsequent improvements health technologies. This report is based on a limited literature search and is not a definitive statement on the safety, effectiveness or cost-effectiveness of the health technology covered. The Commonwealth does not guarantee the accuracy, currency or completeness of the information in this report. This report is not intended to be used as medical advice and intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used therapeutic purposes or as a substitute for a health professional's advice. The Commonwealth does not accept any liability for any injury, loss or damage incurred by use of or reliance the information. The production of this Horizon scanning prioritising summary was overseen by the Health Policy Advisory Committee on Technology (HealthPACT), a subcommittee of the Medical Services Advisory Committee (MSAC). HealthPACT comprises representatives from departments in all states and territories, the Australia and New Zealand governments; and ASERNIP-S. The Australian Health Ministers' Advisory Council (AHMAC) supports HealthPACT through funding. The new studies identified for this update focus on advances in the technique of DE-MRI assessment of myocardial viability. No large effectiveness studies or assessments of the cost effectiveness of DE-MRI were identified. Wu et al (2007) compared three diagnostic techniques for the assessment of myocardial viability: contrast-enhanced cardiovascular magnetic resonance (DE-MRI), gated thallium-201 (201 Tl) single photon emission computed tomography (SPECT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). The study was a retrospective analysis of patients who underwent both DE-MRI and SPECT within a one month timeframe. If patients underwent PET within this same time period then this was also analysed against DE-MRI and SPECT. Of the 116 patients who underwent DE-MRI and SPECT, 46 (39.7%) also underwent PET. DE-MRI and SPECT results correlated strongly (r= 0.90, p<0.0001). Using dichotomous categories (≥50% 201 Tl maximal activity on 4-h SPECT; and ≤50% DE on DE-MRI) the diagnosis of viability showed concordance of 96.8 per cent. Additionally the overall PET/SPECT agreement with DE-MRI was 92.7 per cent. In 29 subjects the diagnoses from PET/SPECT and DE-MRI showed complete concordance. Overall DE-MRI was superior in detecting small infarcts while PET was more effective at visualising myocardial viability when compared against the reference standard SPECT (Wu et al 2007) (level III-2 diagnostic evidence). Two studies investigated improvements …