Feasibility of detecting cardiac torsion in myocardial perfusion gated SPECT data

BACKGROUND: The dynamic twisting component of cardiac motion is not accounted for by radionuclide techniques so that maps of perfusion and wall thickening are motion-blurred by torsion. This study examined whether torsion can be estimated from gated single photon emission computed tomography data and whether torsion corrections affect cardiac measurements. METHODS AND RESULTS: Technetium 99m sestamibi myocardial perfusion gated tomograms were selected retrospectively for 52 patients who had x-ray contrast arteriograms: 12 with normal perfusion (group 1), 12 with abnormal perfusion (group 2), and 28 studied after angioplasty (group 3). The 8 gated perfusion maps were transformed by contrast normalization, the count minimums of which were tracked to quantify torsion. Measured torsion was used to correct maps of perfusion and wall thickening. Torsion was found to be visually detectable equally well in groups 1 and 2. Apical torsion was significantly greater for group 1 than groups 2 and 3 (15 degrees +/- 9 degrees vs 9 degrees +/- 15 degrees and 2 degrees +/- 12 degrees ) and was opposite in sign for patients with apical aneurysms (-4 degrees +/- 13 degrees ) and for patients after coronary artery bypass grafting (CABG) (-4 degrees +/- 15 degrees ). Maximum percent count differences were 10% +/- 16% between torsion-corrected versus uncorrected perfusion maps. The greatest wall thickening differences were seen for patients with left ventricular apical aneurysms and for patients after CABG versus group 1 (10% +/- 6% and 8% +/- 6% vs 3% +/- 1%, respectively). CONCLUSIONS: It is feasible to detect cardiac torsion in the majority of Tc-99m sestamibi myocardial perfusion scans. Abnormal twisting patterns distinguished patients after CABG and those with left ventricular aneurysms from subjects with normal perfusion in a manner similar to magnetic resonance imaging observations.