Download PDF
Nuklearmedizin 2006; 45(02): 63-73
DOI: 10.1055/s-0038-1623936
Original Article
Schattauer GmbH

Determination of ventricular volumes in coronary artery disease[*]

Comparison of two gated SPECT analysis tools with MRIBestimmung ventrikulärer Volumina bei koronarer HerzerkrankungVergleich zweier Gated-SPECT-Analyseverfahren mit MRT[*]
M. Gutberlet
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
S. Mehl
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
M. Fröhlich
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
H. Hausmann
2   Herz-, Gefäß- und Thoraxchirurgie, Deutsches Herzzentrum (Dir. Prof. Dr. Dr. h.c. R. Hetzer), Berlin
,
M. Plotkin
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
J. Ruf
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
T. Denecke
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
B. Spors
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
M. Grothoff
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
R. Hetzer
2   Herz-, Gefäß- und Thoraxchirurgie, Deutsches Herzzentrum (Dir. Prof. Dr. Dr. h.c. R. Hetzer), Berlin
,
R. Felix
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
,
H. Amthauer
1   Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinik für Strahlenheilkunde (Dir. Prof. Dr. Dr. h.c. R. Felix), Campus Virchow Klinikum, Charité-Universitätsmedizin
› Author Affiliations
Further Information

Publication History

Eingegangen: 05 March 2005

23 August 2005

Publication Date:
11 January 2018 (online)

Also available at
    Permissions and Reprints

Summary

Aim: Comparison of two gated SPECT analysis tools – gated SPECT quantification (GSQ) and emory cardiac toolbox (ECT) – in patients with coronary artery disease (CAD) and severely impaired left ventricular function (preoperative: EF <35% by cardiac catheter). Patients, methods: A total of 56 gatedSPECT examinations (oneday hybrid-protocol with 201Tl-chloride for rest and 99mTcsestamibi for stress applied during low-dose dobutamine stress MR-examination; temporal resolution; 8 phases per cardiac cycle) were performed in 36 patients (31 preoperatively, 25 postoperatively) and compared with MRI in 48 cases. Left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes as well as the left ventricular ejection fraction (LV-EF) were calculated. Results: The total volumetric assessment by both analysis algorithms (n = 56) showed good intraclass correlation coefficients preoperatively (n=31), but even better postoperatively (n=25). The mean reconstruction time was approximately 3 minutes (±2 SD) for GSQ and 15 minutes (±5 SD) for ECT. In comparison to MRI the results of both analysis tools also correlated well, but the agreement decreased in the presence of scared tissue. The mean LV-EF (MRI) preoperatively was 30.4%, in 6/36 patients above the values calculated from cardiac catheter, postoperatively 34.6%. Conclusion: Both gated SPECT analysis tools showed reliable volumetric assessments in high-risk patients with CAD and severely reduced LV-EF in comparison to MRI, with advantages for GSQ in terms of postprocessing time. However, for the calculation of LV-EF a markedly lower concordance with MR-results was observed for both methods depending on the presence of myocardial scars.

Zusammenfassung

Ziel: Softwarevergleich von GSQ (gated SPECT quantification) und ECT (emory cardiac toolbox) bei Patienten mit koronarer Herzerkrankung (KHK) und stark eingeschränkter Ventrikelfunktion (präoperativer Herzkatheter-EF <35%) mit der MRT. Patienten, Methoden: 36 Patienten mit KHK erhielten insgesamt 56 Gated-SPECT-Untersuchungen (31 prä-, 25 postoperativ; 1-Tages-Hybridprotokoll mit 201Tl- Chlorid in Ruhe und 99mTc-Sestamibi nach Low-dose-Dobutamin- Belastung; zeitliche Auflösung: 8 Phasen). In 48 Fällen wurden die Ergebnisse mit der MRT verglichen. Das enddiastolische (LV-EDV) und endsystolische (LV-ESV) Volumen und die Ejektionsfraktion (LV-EF) wurden berechnet. Ergebnisse: Die beiden Auswertealgorithmen untereinander (n=56) zeigten vor der Operation (n=31) und vor allem nach vollständigen Revaskularisation (n=25) eine gute Übereinstimmung. Die Rekonstruktionsdauer mit GSQ betrug im Mittel 3 (±2 SD), mit ECT 15 Minuten (±5 SD). Im Vergleich zur MRT ergaben sich für beide Methoden gute Korrelationen, im Falle von Narbenarealen waren sie schlechter. Die präoperative LV-EF (MRT) lag im Mittel bei 30,4%, postoperativ bei 34,6% und damit bei 6/36 Patienten über den im Herzkatheter ermittelten. Schlussfolgerung: Bei KHK-Hochrisikopatienten mit stark eingeschränkter LV-EF sind valide Werte für die Volumenbestimmung – im Vergleich zum Goldstandard MRT – aus den Gated-SPECT-Daten zu erzielen, mit deutlichem zeitlichem Vorteil für GSQ. Bei der LV-EF ergab sich eine geringere Übereinstimmung je nach Ausmaß des Narbenareals.

Keywords

Gated SPECT - cardiac volumetry - cardiac MRI - myocardial scar - coronary artery disease - heart failure

Schlüsselwörter

GatedSPECT - kardiale Volumetrie - kardiale MRT - Myokardnarbe - koronare Herzerkrankung - Herzinsuffizienz

* Diese Arbeit enthält Ergebnisse aus der Dissertation von Sebastian Mehl.


 

  • Literatur

  • 1 Achtert AD, King MA, Dahlberg ST. et al. An investigation of the estimation of ejection fractions and cardiac volumes by a quantitative gated SPECT software package in simulated gated SPECT images. J Nucl Cardiol 1998; 5: 144-52.
    CrossrefPubMedSearch in Google Scholar
  • 2 Achtert AD. Phantomuntersuchungen zur Ermittlung von kardialen Funktionsparametern aus EKG-getriggerten Myokard-Perfusions-SPECTStudien. Berlin: Humboldt-Univ., Diss. 2002 p. 1-104.
    PubMedSearch in Google Scholar
  • 3 Alexander C, Schaefer A, Trampert L. et al. 18Fluoro-FDG SPECT for the demonstration of hibernating myocardium: an interim account. Nuklearmedizin 1997; 36: 125-30.
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Atsma DE, Bavelaar-Croon CD, Germano G. et al. Good correlation between gated single photon emission computed myocardial tomography and contrast ventriculography in the assessment of global and regional left ventricular function. Int J Card Imaging 2000; 16: 447-53.
    CrossrefPubMedSearch in Google Scholar
  • 5 Berman DS, Hayes SW, Germano G. et al. Assessment of myocardial perfusion and viability with technetium-99M Perfusionsagents. In: DePuey EG, Garcia EV, Berman DS. (eds.). Cardiac SPECT Imaging. 2nd edition. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 179-210.
    Search in Google Scholar
  • 6 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-10.
    Search in Google Scholar
  • 7 Everaert H, Vanhove C, Franken PR. Effects of low-dose dobutamine on left ventricular function in normal subjects as assessed by gated singlephoton emission tomography myocardial perfusion studies. Eur J Nucl Med 1999; 26: 1298-303.
    CrossrefPubMedSearch in Google Scholar
  • 8 Faber TL, Cooke CD, Folks RD. et al. Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method. J Nucl Med 1999; 40: 650-9.
    PubMedSearch in Google Scholar
  • 9 Faber TL, Vansant JP, Pettigrew RI. et al. Evaluation of left ventricular endocardial volumes and ejection fractions computed from gated perfusion SPECT with magnetic resonance imaging: comparison of two methods. J Nucl Cardiol 2001; 8: 645-51.
    CrossrefPubMedSearch in Google Scholar
  • 10 Germano G, Kavanagh PB, Su HT. et al. Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. J Nucl Med 1995; 36: 1107-14.
    PubMedSearch in Google Scholar
  • 11 Germano G, Kiat H, Kavanagh PB. et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995; 36: 2138-47.
    PubMedSearch in Google Scholar
  • 12 Gutberlet M, Abdul-Khaliq H, Grothoff M. et al. Evaluation of left ventricular volumes in patients with congenital heart disease and abnormal left ventricular geometry. Comparison of MRI and transthoracic 3-dimensional echocardiography. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2003; 175: 942-51.
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Hammermeister KE, DeRouen TA, Dodge HT. Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation 1979; 59: 421-30.
    CrossrefPubMedSearch in Google Scholar
  • 14 Hausmann H, Siniawski H, Meyer R. et al. Coronary artery bypass grafting in patients with highly impaired ventricular function. Long-term outcome. Dtsch Med Wochenschr 2002; 127: 2503-7.
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 He ZX, Cwajg E, Preslar JS. et al. Accuracy of left ventricular ejection fraction determined by gated myocardial perfusion SPECT with Tl-201 and Tc-99m sestamibi: comparison with first-pass radionuclide angiography. J Nucl Cardiol 1999; 6: 412-7.
    CrossrefPubMedSearch in Google Scholar
  • 16 Imai K, Nakajima T, Gotou S. et al. Transient left ventricular dysfunction is still present one hour after exercise stress test: evaluation by gated SPECT with 99mTc-labeled perfusion agent. Kaku Igaku 2000; 37: 199-207.
    PubMedSearch in Google Scholar
  • 17 Ioannidis JP, Trikalinos TA, Danias PG. Electrocardiogram- gated single-photon emission computed tomography versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction: a meta-analysis. J Am Coll Cardiol 2002; 39: 2059-68.
    CrossrefPubMedSearch in Google Scholar
  • 18 Iskandrian AE, Germano G, VanDecker W. et al. Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging. J Nucl Cardiol 1998; 5: 574-8.
    CrossrefPubMedSearch in Google Scholar
  • 19 Leoncini M, Sciagra R, Bellandi F. et al. Low-dose dobutamine nitrate-enhanced technetium 99m sestamibi gated SPECT versus low-dose dobutamine echocardiography for detecting reversible dysfunction in ischemic cardiomyopathy. J Nucl Cardiol 2002; 9: 402-6.
    CrossrefPubMedSearch in Google Scholar
  • 20 Lin L. A concordance correlation coefficient to evaluate reproducibility. Biometrics 1989; 45: 255-68.
    CrossrefPubMedSearch in Google Scholar
  • 21 Manrique A, Faraggi M, Vera P. et al. 201Tl and 99mTc-MIBI gated SPECT in patients with large perfusion defects and left ventricular dysfunction: comparison with equilibrium radionuclide angiography. J Nucl Med 1999; 40: 805-9.
    PubMedSearch in Google Scholar
  • 22 Manrique A, Koning R, Cribier A, Vera P. Effect of temporal sampling on evaluation of left ventricular ejection fraction by means of thallium- 201 gated SPET: comparison of 16– and 8-interval gating, with reference to equilibrium radionuclide angiography. Eur J Nucl Med 2000; 27: 694-9.
    CrossrefPubMedSearch in Google Scholar
  • 23 Mazzanti M, Germano G, Kiat H. et al. Identification of severe and extensive coronary artery disease by automatic measurement of transient ischemic dilation of the left ventricle in dual-isotope myocardial perfusion SPECT. J Am Coll Cardiol 1996; 27: 1612-20.
    CrossrefPubMedSearch in Google Scholar
  • 24 Migrino RQ, Young JB, Ellis SG. et al. End-systolic volume index at 90 to 180 minutes into reperfusion therapy for acute myocardial infarction is a strong predictor of early and late mortality. The Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I Angiographic Investigators. Circulation 1997; 96: 116-21.
    CrossrefPubMedSearch in Google Scholar
  • 25 Mochizuki T, Murase K, Tanaka H. et al. Assessment of left ventricular volume using ECG-gated SPECT with technetium-99m-MIBI and technetium- 99m-tetrofosmin. J Nucl Med 1997; 38: 53-7.
    PubMedSearch in Google Scholar
  • 26 Muller R, Buttner P. A critical discussion of intraclass correlation coefficients. Stat Med 1994; 13: 2465-76.
    CrossrefPubMedSearch in Google Scholar
  • 27 Navare SM, Wackers FJ, Liu YH. Comparison of 16-frame and 8-frame gated SPET imaging for determination of left ventricular volumes and ejection fraction. Eur J Nucl Med Mol Imaging 2003; 30: 1330-37.
    CrossrefPubMedSearch in Google Scholar
  • 28 Nichols K, Tamis J, DePuey EG. et al. Relationship of gated SPECT ventricular function parameters to angiographic measurements. J Nucl Cardiol 1998; 5: 295-303.
    CrossrefPubMedSearch in Google Scholar
  • 29 Nichols K, Lefkowitz D, Faber T. et al. Echocardiographic validation of gated SPECT ventricular function measurements. J Nucl Med 2000; 41: 1308-14.
    PubMedSearch in Google Scholar
  • 30 Nichols K, Santana CA, Folks R. et al. Comparison between ECTb and QGS for assessment of left ventricular function from gated myocardial perfusion SPECT. J Nucl Cardiol 2002; 9: 285-93.
    CrossrefPubMedSearch in Google Scholar
  • 31 Reuland P, Irmer M, Stiehr T. Influence of patient position in myocardial SPECT on the diagnosis of CHD. Nuklearmedizin 1999; 38: 178-85.
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Schaefer WM, Lipke CS, Nowak B. et al. Validation of QGS and 4D-MSPECT for quantification of left ventricular volumes and ejection fraction from gated 18F-FDG PET: comparison with cardiac MRI. J Nucl Med 2004; 45: 74-9.
    PubMedSearch in Google Scholar
  • 33 Smanio PE, Watson DD, Segalla DL. et al. Value of gating of technetium-99m sestamibi single-photon emission computed tomographic imaging. J Am Coll Cardiol 1997; 30: 1687-92.
    CrossrefPubMedSearch in Google Scholar
  • 34 Smith WH, Kastner RJ, Calnon DA. Quantitative gated single photon emission computed tomography imaging: a counts-based method for display and measurement of regional and global ventricular systolic function. J Nucl Cardiol 1997; 4: 451-63.
    CrossrefPubMedSearch in Google Scholar
  • 35 Taillefer R, DePuey EG, Udelson JE. et al. Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECGgated SPECT) in detecting coronary artery disease in women. J Am Coll Cardiol 1997; 29: 69-77.
    CrossrefPubMedSearch in Google Scholar
  • 36 Vogel M, Gutberlet M, Dittrich S. et al. Comparison of transthoracic three dimensional echocardiography with magnetic resonance imaging in the assessment of right ventricular volume and mass. Heart 1997; 78: 127-30.
    CrossrefPubMedSearch in Google Scholar
  • 37 Weinmann P, Moretti JL. Effects of dipyridamole on left ventricular function. J Nucl Cardiol 2000; 7: 103-6.
    CrossrefPubMedSearch in Google Scholar
  • 38 White HD, Cross DB, Elliott JM. et al. Long-term prognostic importance of patency of the infarctrelated coronary artery after thrombolytic therapy for acute myocardial infarction. Circulation 1994; 89: 61-7.
    CrossrefPubMedSearch in Google Scholar
  • 39 Zajic T, Fischer R, Saurbier B. et al. Assessment of left ventricular function and volume by myocardial perfusion scintigraphy – comparison of two algorithms. Nuklearmedizin 2001; 40: 135-42.
    Thieme ConnectPubMedSearch in Google Scholar