Background: Both myocardial contrast echocardiography (MCE) and contrast enhanced magnetic resonance imaging (MRI) can identify myocardial perfusion following acute myocardial infarction (AMI). We sought to compare the relative accuracy of these techniques in the assessment of myocardial perfusion and prediction of the recovery of myocardial wall motion abnormality. Method: Twenty patients (age : 58 짹 10 years, 17 men) with AMI who were successfully revascularized by direct PTCA underwent MCE and MRI within 7 days after revascularization. Intact myocardial perfusion by MCE was defined as full enhancement of myocardium with microbubbles until the 10th endsystolic cardiac cycle after high mechanical bubble destruction. Delayed hyperenhancement of less than 50% transmural thickness on MRI was considered as preserved myocardial perfusion. The recovery of regional wall motion abnormality was assessed by echocardiography 8 to 12 weeks later. Results: Total 320 myocardial segments(16 segments per patient) were analyzed. Sensitivity and specificity of intact myocardial perfusion by MCE in the prediction of myocardial wall motion recovery was 86.3% and 59.3% respectively. Delayed hyperenhancement of less than 50% transmural thickness on MRI predicted myocardial wall motion recovery with sensitivity of 82.4% and specificity of 90.7% respectively. Concordance between MCE and MRI for the identification of myocardial perfusion was 78.3% (kappa = 0.42). Conclusions: There was fair concordance between MCE and MRI for the assessment of myocardial perfusion after AMI. Both techniques had comparable sensitivity for prediction of myocardial wall motion recovery, however, MRI showed better specificity.