Assessment of left ventricular function and volumes by myocardial perfusion scintigraphy - comparison of two algorithms

Summary

Aim: Left ventricular volume and function can be computed from gated SPECT myocardial perfusion imaging using Emory Cardiac Toolbox (ECT) or Gated SPECT Quantification (GS-Quant). The aim of this study was to compare both programs with respect to their practical application, stability and precision on heart-models as well as in clinical use. Methods: The volumes of five cardiac models were calculated by ECT and GS-Quant. 48 patients (13 female, 35 male) underwent a one day stress-rest protocol and gated SPECT. From these 96 gated SPECT images, left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ECT and GS-Quant. For 42 patients LVEF was also determined by echocardiography. Results: For the cardiac models the computed volumes showed high correlation with the model-volumes as well as high correlation between ECT and GS-Quant (r ≥ 0.99). Both programs underestimated the volume by approximately 20-30% independent of the ventricle-size. Calculating LVEF, EDV and ESV, GS-Quant and ECT correlated well to each other and to the LVEF estimated by echocardiography (r ≥ 0.86). LVEF values determined with ECT were about 10% higher than values determined with GS-Quant or echocardiography. The incorrect surfaces calculated by the automatic algorithm of GS-Quant for three examinations could not be corrected manually. 34 of the ECT studies were optimized by the operator. Conclusion: GS-Quant and ECT are two reliable programs in estimating LVEF. Both seem to underestimate the cardiac volume. In practical application GS-Quant was faster and easier to use. ECT allows the user to define the contour of the ventricle and thus is less susceptible to artifacts.

Zusammenfassung

Ziel: In EKG-getiiggerten SPECT-Untersuchungen des Herzens wurden linksventrikuläres Volumen und Funktion mittels »Gated SPECT Quantification« (GS-Quant) und »Emory Cardiac Toolbox« (ECT) bestimmt. Beide Verfahren sollten bezüglich ihrer Anwendung, Stabilität und Genauigkeit sowohl am Herzmodell als auch im klinischen Einsatz verglichen werden. Methode: Das Volumen von fünf Herzmodellen wurde in SPECT-Aufnahmen mittels ECT und GS-Quant berechnet. Des Weiteren sind an 48 Patienten (13 Frauen, 35 Männer) Untersuchungen jeweils in Ruhe und nach Belastung durchgeführt worden. In diesen 96 SPECT-Aufnahmen wurden links-ventrlkuläre Auswurffraktion (LVEF), enddiastolisches (EDV) und endsystolisches (ESV) Volumen bestimmt. Bei 42 dieser Patienten ist echokardiographisch die LVEF ermittelt worden. Ergebnisse: Die Volumenbestimmung am Herzmodell zeigte eine gute Korrelation beider Programme sowohl untereinander als auch zu den Volumina der Herzmodelle (r ≥ 0,99). Das absolute Modellvolumen wurde in allen Messungen um 20-30% unterschätzt. Bei der Bestimmung von LVEF, EDV und ESV in vivo wiesen ECT und GS-Quant wiederum untereinander und auch zur echokardiographisch ermittelten LVEF eine hohe Korrelation auf (r ≥ 0,86). ECT errechnete im Mittel eine 10% höhere LVEF. Bei drei Untersuchungen versagte die vollautomatische Konturfindung von GS-Quant. 34 Untersuchungen wurden mittels ECT manuell optimiert. Schlussfolgerung: Mit ECT und GS-Quant lagen zwei in sich stabile Verfahren zur Bestimmung der LVEF vor, die jedoch in Phantomuntersuchungen die Ventrikelvolumina konstant zu klein angaben. GS-Quant erwies sich als schneller und einfacher in der Bedienung. ECT ermöglichte eine weitgehende Einflussnahme auf die Herzkonliirfindung und war hierdurch weniger anfällig für Artefakte.

Keywords

Myocardial perfusion scintigraphy - gated SPECT - left ventricular volumes - left ventricular function - Tc-99m-MIBI

Schlüsselwörter

Myokardperfusionsszintigraphie - getriggerte SPECT-Aufnahmen - linksventrikuläres Volumen - LVEF - Tc-99m-MIBI

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