[Assessment of left ventricular function by electrocardiogram-gated myocardial single photon emission computed tomography using quantitative gated single photon emission computed tomography software].
Koichi MoritaI AdachiMasashi KonnoNaoki KuboMuhammad Babar ImranTakashi MochizukiYoshinori ItohTetsuro KohyaAkira KitabatakeEriko TsukamotoNagara Tamaki
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Gated SPECT
Emission computed tomography
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Electrocardiogram-gated single photon omission computed tomography (SPECT) provides valuable information in the assessment of both myocardial perfusion and ventricular function. Tl-201 is a suboptimal isotope for gating. Tl-201 images are more blurred compared with Tc-99m tracers due to the increased amount of scattered photons and use of a smooth filter. The average myocardial count densities are approximately one-half those of conventional technetium tracers. However, Tl-201 is still widely used because of its well-established utility for assessing myocardial perfusion, viability and risk stratification. Gated SPECT with Tl-201 enables us to assess both post-stress and rest left ventricular volume and function. Previous studies with gated Tl-201 SPECT measurements of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) have shown high correlation with first-pass radionuclide angiography, gated blood pool scan, Tc-99m-MIBI gated SPECT, contrast ventriculography, echocardiography, and 3-dimensional magnetic resonance imaging. However, problems related to these studies include few agreement data of EDV and ESV, use of a reference method that is likely to have the same systemic errors (gated Tc-99m-MIBI SPECT), and other technical factors related to the count density of gated SPECT. With optimization of gated imaging protocols and more validation studies, gated Tl-201 SPECT would be an accurate method to provide perfusion and function information in patients with coronary artery disease.
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To assess the prevalence of myocardial viability by technetium-99m (Tc-99m)-tetrofosmin/fluorine-18-fluorodeoxyglucose (FDG) single photon emission computed tomography (SPECT) in patients with ischaemic cardiomyopathy.A retrospective observational study.Thoraxcenter Rotterdam (a tertiary referral centre).104 patients with chronic coronary artery disease and severely depressed left ventricular function presenting with heart failure symptoms.Prevalence of myocardial viability as evaluated by Tc-99m-tetrofosmin/FDG SPECT imaging. Two strategies for assessing viability in dysfunctional myocardium were used: perfusion imaging alone, and the combination of perfusion and metabolic imaging.On perfusion imaging alone, 56 patients (54%) had a significant amount of viable myocardium, whereas 48 patients (46%) did not. Among the 48 patients with no significant viability by perfusion imaging alone, seven additional patients (15%) had significantly viable myocardium on combined perfusion and metabolic imaging. Thus with a combination of perfusion and metabolic imaging, 63 patients (61%) had viable myocardium and 41 (39%) did not.On the basis of the presence of viable dysfunctional myocardium, 61% of patients with chronic coronary artery disease and depressed left ventricular ejection fraction presenting with heart failure symptoms may be considered for coronary revascularisation. The combination of perfusion and metabolic imaging identified more patients with significant viability than myocardial perfusion imaging alone.
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Despite its ability to quantify regional perfusion and function, there is no established method for quantification of regional perfusion and function by myocardial gated single photon emission computed tomography (SPECT). The aim of this study was to establish a quantitative index for regional perfusion and systolic function assessment using gated SPECT. Myocardial SPECT was performed at rest using 99mTc sestamibi with 8-frame gating in 62 consecutive patients. In addition to computation of left ventricular ejection fraction (LVEF), a new computerized method for quantifying, displaying and automatically grading regional data was developed. Regional function was quantified as wall motion, regional EF, and imaged based, count based, and normalized per cent wall thickenings (%WTs). Regional perfusion was assessed as a relative per cent peak count. Data were displayed on a 25-segmented polar map and automatically graded with a 5-point scale, and then summed scores were calculated. These quantitative parameters were compared to data from radionuclide ventriculography (RNV) and contrast left ventriculography. Gated SPECT had high reproducibilities for calculating global and regional ejection fractions and %WT indices (r = 0.811-0.984, P<0.0001), but measurement of wall motion was less reproducible (r = 0.555, SEE = 7.9, P<0.011). LVEF estimated by gated SPECT and summed perfusion scores correlated closely (P<0.0001) with angiographic LVEF. Among the summed function indices that correlated closely with LVEF, normalized %WT had the closest correlations with LVEF estimated by RNV (r = 0.657, P<0.0001) and by gated SPECT (r = 0.778, P<0.0001). Assessment by visual reviewing of cine-mode playback or by normalized %WT had greater overall sensitivity, specificity, and positive and negative predictive values for detecting impaired regional function among the functional parameters: 71%, 79%, 63% and 84% for cine format analysis, and 78%, 73%, 59% and 87% for normalized %WT, respectively. Thus, besides LVEF, quantitative gated SPECT can provide reproducible and reliable quantitative data on regional perfusion and function. Automated summed scores obtained by gated SPECT can reflect integrated abnormalities of regional perfusion and function of the left ventricle. Both visual analyses by cine-mode display and a functional map of normalized wall thickening have greater diagnostic values for detecting regional function deficit related to coronary artery disease.
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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.
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This study evaluated the performance of gated single photon emission computed tomography (SPECT) with thallium-201 (201Tl) in assessing left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) in Taiwanese by determining repeatability and correlation with two-dimensional (2D) echocardiography. A total of 18 patients underwent two sequential gated SPECT acquisitions within 30 minutes in the resting state to assess repeatability. Another 28 patients who underwent gated SPECT and 2D echocardiography within 7 days were included for comparison. The two sequential measurements were well correlated with respect to LVEF, EDV, and ESV (r = 0.97, 0.95, and 0.97, respectively, all p < 0.0001). Bland-Altman analysis revealed that two standard deviations of the absolute difference between the two sequential measurements for LVEF, EDV, and ESV were 6.4%, 16.8 mL, and 8.6 mL, respectively. For LVEF, EDV, and ESV, correlations between redistribution 201Tl-gated SPECT and echocardiography were also excellent (all r = 0.83, p < 0.0001). LVEF was similar with 201Tl-gated SPECT and echocardiography, but EDV and ESV were significantly higher with echocardiography (p < 0.05). Our study revealed that 201Tl-gated SPECT has high repeatability and excellent correlation with echocardiography for the assessment of LVEF and volumes in Taiwanese. These results support the clinical application of gated SPECT in routine 201Tl myocardial perfusion imaging in Taiwanese.
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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.
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Objective To explore the correlation of automatic quantification of left ventricular ejection fraction (LVEF) from gated myocardial perfusion SPECT with 201Tl and rest equilibrium gated bloodpool imaging with 99mTc-red blood cell.Methods Rest gated myocardial perfusion SPECT with 201Tlwas performed on 72 cases.AUTOQUANT 4.21 software was used to measure LVEF.Rest equilibrium gated blood-pool imaging was also performed within 24 h.The values of LVEF measured by two methods were gated myocardial perfusion SPECT and rest equilibrium gated blood-pool imaging(r=0.554,P=0.000).There methods were(64.68±10.77)%and(62.46±8.99)%.The values of LVEF measured by gated myocardial perfusion SPECT was higher 3.55%than rest equilibrium gated blood-pool imaging.Conclusion There was good correlation between the LVEF measured with gated myocardial perfusion SPECT by AUTOQUANT 4.21 software and gated blood-pool imaging.The LVEF can be accurately evaluated using gated myocardial perfusion SPECT with 201Tl.The value of LVEF measured by gated myocardial perfusion SPECT was higher than rest equilibrium gated blood-pool imaging.
Key words:
Gated blood-pool imaging; Gated myocardial imaging; Thallium radioisotopes; Tomography,emission-computed,single photon
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Objective:The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), 201 Tl perfusion status at rest, 201 Tl 24 hours redistribution and systolic wall thickening of 99m Tc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery.Materials and Methods: A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 ± 8 standard in years) who underwent both pre-and 3 months post-CABG myocardial SPECT.We analyzed 17 myocardial segments per patient.Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system.Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG.Results: The left ventricular ejection fraction (LVEF) significantly increased from 37.8 ± 9.0% to 45.5 ± 12.3% (p < 0.001) in 22 patients who had a pre-CABG LVEF lower than 50%.Among 590 myocardial segments in the re-vascularized area, 115 showed abnormal wall motion before CABG and 73.9% (85 of 115) had wall motion improvement after CABG.In the univariate analysis (n = 115 segments), stress/rest reversibility (p < 0.001) and 201 Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement.However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001).Conclusion: Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.
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