Can the estimation of ejection fraction during gated single photon emission computed tomography at rest add information to the cardiac perfusion study?
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Abstract:
Left ventricular function is an important prognostic indicator in patients with coronary artery disease. The electrocardiogram gated, myocardial, single photon emission tomography (SPECT) program is coming into wide use. This program permits measurement of end diastolic volume, end systolic volume, and ejection fraction. This study was designed to show whether the measurement of ejection fraction by using 99mTc tetrofosmin gated SPECT at rest could give additional information to the interpretation of perfusion. Exercise 99mTc tetrofosmin SPECT and gated 99mTc tetrofosmin SPECT at rest were performed in 33 patients with or suspected of having coronary artery disease. Left ventricular ejection fraction was calculated from reconstructed gated SPECT at rest with a software quantitative gated SPECT. The results showed a poor correlation between segmental ejection fraction and segmental perfusion in stress and rest. There was an increasing probability of reversibility as the ejection fraction increased, while there was a greater chance of a fixed defect as the ejection fraction decreased. It is concluded that gated SPECT using 99mTc tetrofosmin provides clinically satisfactory functional data that, in combination with the perfusion information, will improve diagnostic and prognostic accuracy without an increase in cost or radiation dose to patients.Keywords:
Gated SPECT
Emission computed tomography
Left-ventricular ejection fraction (LVEF) can be computed from gated myocardial perfusion SPECT studies using quantitative algorithms. The purpose of this study was to compare the LVEF obtained using the conventional high-resolution parallel-hole collimator (HRC) to the Cardiofocal collimator (CFC) (Siemens Medical Systems, Hoffman Estates, IL) using a quantitative LVEF program.Thirty-four patients (15 men, 19 women; mean age = 62 y) had either treadmill or pharmacological stress testing with 25-30 mCi 99mTc sestamibi injected at peak stress. Conventional gated SPECT imaging was performed approximately 30 min poststress, first with the HRC collimator, then with the CFC, using the same acquisition parameters on a single-head gamma camera. Traditional (TRAD) determination of LVEF using planar gated blood pool and/or cardiac catherization also was obtained for each patient.The correlation in LVEF between the CFC and HRC acquisitions was excellent, r = 0.99. The correlation between CFC and TRAD LVEF was good, r = 0.95, as was the HRC and TRAD correlation, r = 0.97. The mean LVEF value for HRC was slightly less than TRAD (54% vs. 55.4%), while the CFC mean LVEF was higher (62% vs. 55.4%). Although CFC LVEF correlated well with HRC, mean LVEF value using CFC was higher than HRC.The choice of collimator may alter the LVEF obtained from gated SPECT perfusion studies.
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Gated SPECT
Collimated light
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Emission computed tomography
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Syndrome X is used to describe patients with chest pain and a normal coronary angiogram. We reviewed technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion single photon emission computed tomography (SPECT) results and clinical data of 43 syndrome X patients and 30 healthy controls with normal left ventricular ejection fraction and no cardiac abnormalities. The Tc-99m TF myocardial perfusion SPECT results showed 12 (27.9%) syndrome X patients had normal myocardial perfusion and 31 (72.1%) had abnormal myocardial perfusion, including 6 (14.0%) patients with fixed defects, 20 (46.5%) patients with transient defects, and 5 (11.6%) patients with reverse defects. The results of exercise ECG were not related to perfusion defects in Tc-99m TF myocardial perfusion SPECT. In contrast, all of the 30 (100.0%) healthy controls had normal myocardial perfusion SPECT results. We conclude that abnormal Tc-99m TF myocardial perfusion SPECT is common in syndrome X and does not correlate well with the exercise ECG. However, further studies with larger case numbers and long term follow up in patients with myocardial events are necessary to support our findings.
Emission computed tomography
Technetium-99m
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D,L HM-PAO-99Tcm (PAO) is a lipophilic tracer complex which is avidly taken up by the brain. We have compared the regional distribution of PAO with regional cerebral blood flow (CBF). CBF was measured by single photon emission computed tomography (SPECT) by Tomomatic 64 after 133Xe inhalation in 41 patients. With the same SPECT the distribution of PAO was measured after intravenous injection. High resolution (HR) and low resolution (LR) studies were performed yielding a resolution of 6-10 mm (HR) and 15-20 mm (LR). PAO images showed close resemblance to 133Xe CBF tomograms. Only 20 per cent of the (decay corrected) brain counts were lost during 24 hours.
Emission computed tomography
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To investigate the value of left ventricular ejection fraction(LVEF) measured by 99mTc-MIBI gated myocardial perfusion single photon emission computed tomography (G-SPECT) with the software GS Quant. Methods: The values of LVEF measured by three methods were calculated and compared in twenty-four patients who had undergone 99mTc-MIBI gated myocardial SPECT, gated radionuclide angiocardiography and echocardiography within two weeks. Results: The value of LVEF from 99mTc-MIBI gated myocardial perfusion SPECT has an excellent positive correlation with those from gated radionuclide angiocardiography and echocardiography ( r = 0. 81, P 0. 05; r = 0. 76, P 0. 05, respectively). Conclusion: LVEF can be accurately assessed by 99mTc-MIBI gated myocardial SPECT with a good reproducibility. These results support a further clinical application of gated myocardial perfusion SPECT.
Gated SPECT
Emission computed tomography
Ventricular Function
Angiocardiography
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A method for functional mapping of ventricular contraction and phase was developed using gated blood-pool SPECT. Parameters of contraction and phase were calculated using length-based and count-based Fourier analyses. In length-based Fourier analysis (LFA), percentage-shortening and length-based phase were calculated based on the changes of lengths from a ventricular centre to edges. In count-based Fourier analysis (CFA), phase and amplitude were also calculated using serial tomographic phase images. Two-dimensional polar display format was employed to summarize the SPECT data of whole cardiac surface. This program was applied to evaluate coronary artery disease and conduction anomalies. The polar functional map using gated blood-pool SPECT can be an effective method to integrate three-dimensional cardiac information in conjunction with myocardial SPECT studies.
Emission computed tomography
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Gated SPECT
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The scintigraphic investigation of neuroendocrine tumours such as carcinoids has depended on standard techniques such as I-metaiodobenzylguanidine and In-pentetreotide imaging. More recently, the use of PET techniques such as Ga-DOTATATE has been advocated. An alternative improved modality is high-quality single photon emission computed tomography/computed tomography (SPECT/CT), which has the advantages of better sensitivity and specificity and has shown improved localization in up to 60% of cases. These advantages are especially true for pancreatic and lymph node lesions. Overall, SPECT/CT can result in a change in clinical management in 25% of patients. Although it is possible to combine SPECT and CT performed at different time points, there is better anatomical localization and improved reporter confidence when SPECT and CT are performed simultaneously.
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