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1.
M Toba Y Ishida K Fukuchi K Fukushima T Katafuchi K Hayashida H Oka M Takamiya 《Kaku igaku. The Japanese journal of nuclear medicine》1999,36(1):23-30
We applied the QGS program for LV function analysis (described by Germano, 1995) to a 201Tl SPECT study at rest, and estimated its accuracy. We performed 201Tl ECG-gated myocardial SPECT in 25 patients with ischemic heart disease under an acquisition time used in the routine 99mTc ECG-gated SPECT study. The quality of the gated images was visually assessed with a 4-point grading system. LVEDV, LVESV, LVEF determined by the QGS program were compared with those by Simpson's method on biplane LVG in 25 patients. Regional wall motion scores in 7 myocardial segments were assessed on the three-dimensional display created by the QGS program and the cine display of biplane LVG with a 5-point grading system. Wall motion scores obtained by the QGS program were compared with those by LVG. Although 72.0% of 201Tl ECG-gated SPECT images were fair or poor in image quality, there were good correlations between the values obtained by the QGS program and LVG (LVEDV: r = 0.82, LVESV: r = 0.88, LVEF: r = 0.89). In addition, wall motion scores by the QGS program were correspondent to those by LVG in 77.1% of all 175 myocardial segments. We conclude that the QGS program provides high accuracy in evaluating left ventricular function even from 201Tl ECG-gated myocardial SPECT data. 相似文献
2.
Comparison of gated PET with MRI for evaluation of left ventricular function in patients with coronary artery disease. 总被引:4,自引:0,他引:4
Riemer H J A Slart Jeroen J Bax Richard M de Jong Jaep de Boer Hildo J Lamb Piet H Mook Antoon T M Willemsen Willem Vaalburg Dirk J van Veldhuisen Pieter L Jager 《Journal of nuclear medicine》2004,45(2):176-182
The aim of this study was to compare left ventricular (LV) volumes and regional wall motion determined by PET with those determined by the reference technique, cardiovascular MRI. METHODS: LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were measured and regional wall motion was scored in 38 patients with chronic coronary artery disease by both gated (18)F-FDG PET and MRI. A 9-segment model was used for PET and MRI to assess regional wall motion. RESULTS: Good correlations were observed between MRI and gated PET for all parameters (r values ranging from 0.91 to 0.96). With PET, there was a significant but small underestimation of LVEDV and LVEF. Mean +/- SD LVEDV, LVESV, and LVEF for MRI were 131 +/- 57 mL, 91 +/- 12 mL, and 33% +/- 12%, respectively, and those for gated PET were 117 +/- 56 mL, 85 +/- 51 mL, and 30% +/- 11%, respectively. For regional wall motion, an agreement of 85% was found, with a kappa-statistic of 0.79 (95% confidence interval, 0.70-0.89; SE, 0.049). CONCLUSION: LV volumes, LVEF, and regional wall motion can be assessed with gated (18)F-FDG PET and correlate well with these parameters assessed by MRI. 相似文献
3.
Henneman MM Bax JJ Schuijf JD Jukema JW Holman ER Stokkel MP Lamb HJ de Roos A van der Wall EE 《European journal of nuclear medicine and molecular imaging》2006,33(12):1452-1460
Purpose Global and regional left ventricular (LV) function are important indicators of the cardiac status in patients with coronary
artery disease (CAD). Therapy and prognosis are to a large extent dependent on LV function. Multi-slice computed tomography
(MSCT) has already earned its place as an imaging modality for non-invasive assessment of the coronary arteries, but since
retrospective gating to the patient’s ECG is performed, information on LV function can be derived.
Methods In 49 patients with known or suspected CAD, coronary angiography with MSCT imaging was performed, in addition to gated SPECT
and 2D echocardiography. LV end-diastolic and LV end-systolic volumes and LV ejection fraction were analysed with dedicated
software (CMR Analytical Software System, Medis, Leiden, The Netherlands for MSCT; gated SPECT by QGS, Cedars-Sinai Medical
Center, Los Angeles, CA, USA), and by the biplane Simpson’s rule for 2D echocardiography. Regional wall motion was evaluated
according to a 17-segment model and a three-point score system.
Results Correlations were fairly good between gated SPECT and MSCT (LVEDV: r=0.65; LVESV: r=0.63; LVEF: r=0.60), and excellent between 2D echocardiography and MSCT (LVEDV: r=0.92; LVESV: r=0.93; LVEF: r=0.80). Agreement for regional wall motion was 95% (κ=0.66) between gated SPECT and MSCT, and 96% (κ=0.73) between 2D echocardiography
and MSCT.
Conclusion Global and regional LV function and LV volumes can be adequately assessed with MSCT. Correlations with 2D echocardiography
are stronger than with gated SPECT. 相似文献
4.
Kumita S Cho K Nakajo H Toba M Fukushima Y Mizumura S Sano J Takano T Kumazaki T 《Annals of nuclear medicine》2005,19(5):379-386
The present study assessed left ventricular performance during dobutamine stress measured using gated SPECT, and compared the results to myocardial perfusion and fatty acid metabolism. METHODS: Thirty-six patients with myocardial infarction given (99m)Tc-sestamibi or (99m)Tc-tetrofosmin were examined by gated SPECT at rest and during dobutamine stress (4-20 microg x kg(-1) x min(-1)). After acquiring data at the highest dose, 201TlCl was injected and dual-isotope SPECT was performed to assess myocardial ischemia. Thirty of 36 patients also underwent myocardial SPECT with 123I-BMIPP. Regional wall motion changes during dobutamine infusion were determined from the gated SPECT data and classified as: (1) Improvement, (2) Worsening, (3) No change, and (4) Biphasic response. For myocardial segments of each infarct area, stress 201Tl, rest (99m)Tc and (123)I-BMIPP uptakes were graded on a five-point scoring system of defects from 0 (normal) to 4 (grossly defective). RESULTS: Rest 99mTc defect score index (DSI) in No change area was significantly higher than that in Biphasic area. The ADSI (stress 201Tl - rest (99m)Tc) in Biphasic area was significantly higher than those in Improvement and No change areas. The deltaDSI (BMIPP - (99m)Tc) in Worsening area tended to be higher than that in No Change area. Conclusions: Regional contractile response to dobutamine stress analyzed by gated SPECT showed that the response in-myocardial infarct areas could be classified by rest and stress myocardial perfusion and BMIPP accumulation. 相似文献
5.
BACKGROUND: Positron emission tomography (PET) with inhaled oxygen 15-labeled carbon monoxide (CO) is used as a marker of myocardial blood pool. Only a limited number of studies with small numbers of patients have reported on the assessment of left ventricular (LV) volumes by use of O-15-labeled CO. The aim of this study was to compare LV volumes and function as measured by routinely acquired blood pool images by use of gated O-15-labeled CO PET with the reference technique, cardiovascular magnetic resonance imaging (MRI). METHODS AND RESULTS: Thirty-four subjects with a varying degree of LV function were studied. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LV ejection fraction (LVEF) were determined by both MRI and gated PET by use of O-15-labeled CO. Volumes were comparable with respect to LVEDV (196 +/- 83 and 192 +/- 91 mL, respectively; P = not significant). LVESV, however, was slightly overestimated by PET (119 +/- 85 and 136 +/- 94 mL, respectively; P < .05), resulting in a significant underestimation of LVEF (44% +/- 19% and 35% +/- 18%, respectively; P < .05). Observed correlations for LVEDV, LVESV, and LVEF were 0.90, 0.96, and 0.86, respectively (all P < .01). CONCLUSIONS: Gated O-15-labeled CO PET measurements of LVEDV, LVESV, and LVEF show good correlation with MRI over a wide range of LV volumes during routinely acquired blood pool images. LVEF, however, may be underestimated compared with MRI. 相似文献
6.
A Rozanski K Nichols S S Yao S Malholtra R Cohen E G DePuey 《Journal of nuclear medicine》2000,41(9):1445-1450
Gated SPECT is a reproducible method for assessing left ventricular volume (LVV) and left ventricular ejection fraction (LVEF) from 99mTc-sestamibi myocardial perfusion imaging studies. LVV and LVEF measurements by this approach correlate well with those obtained from other cardiovascular imaging techniques. Nevertheless, the lack of criteria for abnormal test findings has limited the potential clinical application of this new imaging technique. METHODS: Gated SPECT measurements were evaluated for 214 patients with a low Bayesian likelihood (< 10%) of coronary artery disease (CAD) before performance of 99mTc-sestamibi stress-rest myocardial perfusion SPECT. The patients were grouped into normotensive patients (n = 98), hypertensive patients without left ventricular hypertrophy (LVH) (n = 80), and hypertensive patients with LVH on resting electrocardiography (n = 36). Gated SPECT measurements for left ventricular end-diastolic volume (LVEDV) index, left ventricular end-systolic volume (LVESV) index, and LVEF were obtained according to a published method, using a modified Simpson's rule technique. RESULTS: Similar results were obtained for mean LVV and LVEF measurements between normotensive patients and hypertensive patients without LVH. Hence, these groups were combined (as group 1). By contrast, hypertensive patients with LVH (group 2), had significantly lower LVEF values (P = 0.01) and higher mean LVESV index values than normotensive patients (P = 0.03). Sex differences were marked: women had significantly higher mean resting LVEF values than men (P < 0.0001) and significantly lower mean resting LVEDV index values (P < 0.0001). A significant relationship was seen between LVEDV index and LVEF (r = -0.60; P < 0.0001) and between LVEDV index and heart rate (r = -0.26; P < 0.001). The normal limits were LVEF > or = 41% in men and > or = 49% in women, LVEDV index < or = 76 mL/m2 in men and < or = 57 mL/m2 in women, and LVESV index < or 38 mL/m2 in men and < or =26 mL/m2 in women. Among hypertensive patients, 22% with LVH had an abnormally low LVEF and 19% had an increased LVEDV index according to these test criteria. By contrast, no hypertensive patients without LVH had an abnormally low LVEF, and only 6% had volume abnormalities. CONCLUSION: Using a cohort of low-likelihood patients, we generated sex-specific normal limits for LVV and LVEF for myocardial perfusion gated SPECT. Application of these findings resulted in the detection of occult left ventricular dysfunction in approximately one fifth of hypertensive patients for whom concomitant LVH was found through resting electrocardiography. These normal limits can now be evaluated prospectively for their potential clinical value. 相似文献
7.
Kawasaki T Ito K Okano A Nagata K Yoneyama S Sugihara H Katoh S 《Kaku igaku. The Japanese journal of nuclear medicine》1999,36(1):45-50
This study was designed to evaluate the clinical usefulness of 123I-BMIPP myocardial SPECT in patients with silent myocardial ischemia induced by vasospasm. Ultrasonic echocardiography (UCG), Holter electrocardiogram recording (Holter ECG), exercise 201Tl myocardial SPECT (EX-Tl) and rest 123I-BMIPP myocardial SPECT (BMIPP) were performed in 8 patients with asymptomatic vasospasm without history of myocardial infarction. The sensitivity of each modality in detecting coronary artery spasm was 37.5% (3 of 8 cases) for UCG, 37.5% (3 of 8 cases) in Holter ECG, 25.0% (2 of 8 cases) in Ex-Tl, 62.5% (5 of 8 cases) on initial BMIPP images and 75.0% (6 of 8 cases) on delayed BMIPP images. Severity of regional left ventricular wall motion abnormality in UCG correlated with the severity of regionally decreased tracer uptake in BMIPP. The washout rate of BMIPP was 18.7 +/- 2.4 in normal controls, 32.4 +/- 5.9 in asymptomatic vasospasm, and 38.2 +/- 4.0 in asymptomatic vasospasm with abnormal left ventricular wall motion. It was suggested that 123I-BMIPP myocardial SPECT might be useful for assessing asymptomatic vasospasm. 相似文献
8.
R. Parker Ward Ethan L. Gundeck Roberto M. Lang Kirk T. Spencer Kim A. Williams 《Journal of nuclear cardiology》2006,13(4):514-520
Background Postischemic global and regional left ventricular (LV) dysfunction on stressgated single photon emission computed tomography
(SPECT) imaging is attributed widely to myocardial stunning. We sought to determine the specificity of gated SPECT for the
detection of myocardial stunning after ischemic stress.
Methods and Results Twenty-seven patients with an ischemic response to stress on dual-isotope exercise SPECT were enrolled prospectively. Transthoracic
echocardiography was performed just before stress gated SPECT for assessment of regional wall motion and quantitative LV ejection
fraction (LVEF). The 17 myocardial segments for each patient were scored for myocardial perfusion by stress gated SPECT, and
regional wall motion by stress gated SPECT and echo. Of the 459 myocardial segments, 41% had perfusion defects, 15% had stress
gated SPECT regional wall motion abnormality, 4.8% had poststress echo regional wall motion abnormality, and 3.9% had baseline
regional wall motion abnormality. Overall, a stress gated SPECT regional wall motion abnormality had a sensitivity of 100%
and a specificity of 89%. Among reversible perfusion defects of moderate severity or more, a stress gated SPECT regional wall
motion abnormality had a specificity of 41% and a positive predictive value of 8%. Stress gated SPECT LVEF was similar to
poststress echo LVEF for all patients, but significantly lower in patients with reversible perfusion defects of moderate severity
or more.
Conclusion Post-stress gated SPECT imaging overestimates global and regional myocardial stunning. Caution should be exercised in interpreting
poststress global or regional LV function on stress gated SPECT in scans with reversible ischemia. 相似文献
9.
Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values 总被引:28,自引:0,他引:28
Bavelaar-Croon CD Kayser HW van der Wall EE de Roos A Dibbets-Schneider P Pauwels EK Germano G Atsma DE 《Radiology》2000,217(2):572-575
In 21 patients, the authors compared results with quantitative gated single photon emission computed tomography (SPECT) to results with magnetic resonance imaging in the assessment of left ventricular (LV) end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). Between the two methods, correlations were good for LVEF (r = 0.85), LVEDV (r = 0.94), and LVESV (r = 0.95). Quantitative gated SPECT can help determine LVEF, LVEDV, and LVESV. 相似文献
10.
Saskia L M A Beeres Jeroen J Bax Petra Dibbets Marcel P M Stokkel Katja Zeppenfeld Willem E Fibbe Ernst E van der Wall Martin J Schalij Douwe E Atsma 《Journal of nuclear medicine》2006,47(4):574-580
Intramyocardial injection of bone marrow cells has been proposed as a new therapeutic option for patients with chronic ischemic heart disease. We investigated whether autologous bone marrow-derived mononuclear cell injection into the myocardium of patients with drug-refractory ischemia reduces anginal symptoms, improves left ventricular (LV) function, increases myocardial perfusion, and alters the extent of scar tissue. METHODS: In 25 patients (mean age +/- SD, 64 +/- 10 y; 21 male) with drug-refractory angina pectoris (Canadian Cardiovascular Society [CCS] class III-IV), despite optimized medical therapy and without options for conventional revascularization, bone marrow was aspirated from the iliac crest. Mononuclear cell injections were targeted at myocardial regions with stress-induced ischemia on gated (99m)Tc-tetrofosmin SPECT. Anginal symptoms were reassessed at 3- and 6-mo follow-up. At baseline and 3-mo follow-up, gated (99m)Tc-tetrofosmin SPECT and (18)F-FDG SPECT were performed to assess LV function, LV volumes, myocardial perfusion (stress and rest, 17-segment model), and extent of scar tissue. RESULTS: Mean CCS score improved from 3.4 +/- 0.6 at baseline to 2.3 +/- 0.6 at 3 mo (P < 0.01) and remained unchanged at 6 mo (2.3 +/- 0.6; P < 0.01 vs. baseline and P = not significant [NS] vs. 3 mo). Gated (99m)Tc-tetrofosmin SPECT demonstrated an increased LV ejection fraction (from 47.6% +/- 13.5% to 54.1% +/- 16.9%; P < 0.01) and a reduced LV end-systolic volume (from 81 +/- 68 mL to 75 +/- 70 mL; P < 0.01). Segmental regional wall thickening increased from 34% +/- 12% at baseline to 39% +/- 17% at 3-mo follow-up (P = 0.01). The number of segments with stress-inducible ischemia per patient decreased from 4.6 +/- 3.2 to 2.0 +/- 2.6 (P < 0.01). Both segmental stress and segmental rest score improved, although the improvement in stress score was more pronounced (decrease in segmental stress score 0.22 +/- 0.20 vs. decrease in segmental rest score 0.04 +/- 0.06; P < 0.01). Myocardial perfusion improved in 53% of the injected segments and in 13% of the noninjected segments (P < 0.01). The percentage of myocardial segments with some extent of scar remained unchanged at 3-mo follow-up (13% vs. 12%; P = NS). CONCLUSION: Autologous bone marrow-derived mononuclear cell injection in patients with drug-refractory angina and chronic ischemia improves anginal symptoms, increases LV function, and predominantly enhances myocardial stress perfusion in injected segments, whereas the extent of myocardial scar tissue remains unchanged. 相似文献
11.
A Manrique M Faraggi P Véra D Vilain R Lebtahi A Cribier D Le Guludec 《Journal of nuclear medicine》1999,40(5):805-809
Left ventricular ejection fraction (LVEF) is a major prognostic factor in coronary artery disease and may be computed by 99mTc-methoxyisobutyl isonitrile (MIBI) gated SPECT. However, 201Tl remains widely used for assessing myocardial perfusion and viability. Therefore, we evaluated the feasibility and accuracy of both 99mTc-MIBI and 201Tl gated SPECT in assessing LVEF in patients with myocardial infarction, large perfusion defects and left ventricular (LV) dysfunction. METHODS: Fifty consecutive patients (43 men, 7 women; mean age 61 +/- 17 y) with a history of myocardial infarction (anterior, 26; inferior, 18; lateral, 6) were studied. All patients underwent equilibnum radionuclide angiography (ERNA) and rest myocardial gated SPECT, either 1 h after the injection of 1110 MBq 99mTc-MIBI (n = 19, group 1) or 4 h after the injection of 185-203 MBq 201Tl (n = 31, group 2) using a 90 degrees dual-head camera. After filtered backprojection (Butterworth filter: order 5, cutoff 0.25 99mTc or 0.20 201Tl), LVEF was calculated from reconstructed gated SPECT with a previously validated semiautomatic commercially available software quantitative gated SPECT (QGS). Perfusion defects were expressed as a percentage of the whole myocardium planimetered by bull's-eye polar map of composite nongated SPECT. RESULTS: Gated SPECT image quality was considered suitable for LVEF measurement in all patients. Mean perfusion defects were 36% +/- 18% (group 1), 33% +/- 17% (group 2), 34% +/- 17% (group 1 + group 2). LVEF was underestimated using gated SPECT compared with ERNA (34% +/- 12% and 39% +/- 12%, respectively; P = 0.0001). Correlations were high (group 1, r= 0.88; group 2, r = 0.76; group 1 + group 2, r = 0.82), and Bland-Altman plots showed a fair agreement between gated SPECT and ERNA. The difference between the two methods did not vary as LVEF, perfusion defect size or seventy increased or when the mitral valve plane was involved in the defect. CONCLUSION: LVEF measurement is feasible using myocardial gated SPECT with the QGS method in patients with large perfusion defects and LV dysfunction. However, both 201Tl and 99mTc-MIBI gated SPECT similarly and significantly underestimated LVEF in patients with LV dysfunction and large perfusion defects. 相似文献
12.
P Véra A Manrique V Pontvianne A Hitzel R Koning A Cribier 《Journal of nuclear medicine》1999,40(4):513-521
The effect of filtering and zooming on 201TI-gated SPECT was evaluated in patients with major myocardial infarction. METHODS: Rest thallium (TI)-gated SPECT was performed with a 90 degrees dual-head camera, 4 h after injection of 185 MBq 201TI in 32 patients (mean age 61 +/- 11 y) with large myocardial infarction (33% +/- 17% defect on bull's eye). End diastolic volume (EDV), end systolic volume (ESV) and left ventricular ejection fraction (LVEF) were calculated using a commercially available semiautomatic validated software. First, images were reconstructed using a 2.5 zoom, a Butterworth filter (order = 5) and six Nyquist cutoff frequencies: 0.13 (B5.13), 0.15 (B5.15), 0.20 (B5.20), 0.25 (B5.25), 0.30 (B5.30) and 0.35 (B5.35). Second, images were reconstructed using a zoom of 1 and a Butterworth filter (order = 5) (cutoff frequency 0.20 [B5.20Z1]) (total = 32 x 7 = 224 reconstructions). LVEF was calculated in all patients using equilibrium radionuclide angiocardiography (ERNA). EDV, ESV and LVEF were measured with contrast left ventriculography (LVG). RESULTS: LVEF was 39% +/- 2% (mean +/- SEM) for ERNA and 40% +/- 13% for LVG (P = 0.51). Gated SPECT with B5.20Z2.5 simultaneously offered a mean LVEF value (39% +/- 2%) similar to ERNA (39% +/- 2%) and LVG (40% +/- 3%), optimal correlations with both ERNA (r = 0.83) and LVG (r = 0.70) and minimal differences with both ERNA (-0.9% +/- 7.5% [mean +/- SD]) and LVG (1.1% +/- 10.5%). As a function of filter and zoom choice, correlation coefficients between ERNA or LVG LVEF, and gated SPECT ranged from 0.26 to 0.88; and correlation coefficients between LVG and gated SPECT volumes ranged from 0.87 to 0.94. There was a significant effect of filtering and zooming on EDV, ESV and LVEF (P < 0.0001). Low cutoff frequency (B5.13) overestimated LVEF (P < 0.0001 versus ERNA and LVG). Gated SPECT with 2.5 zoom and high cutoff frequencies (B5.15, B5.20, B5.25, B5.30 and B5.35) overestimated EDV and ESV (P < 0.04) compared with LVG. This volume overestimation with TI-gated SPECT in patients with large myocardial infarction was correlated to the infarct size. A zoom of 1 underestimated EDV, ESV and LVEF compared with a 2.5 zoom (P < 0.02). CONCLUSION: Accurate LVEF measurement is possible with TI-gated SPECT in patients with major myocardial infarction. However, filtering and zooming greatly influence EDV, ESV and LVEF measurements, and TI-gated SPECT overestimates left ventricular volumes, particularly when the infarct size increases. 相似文献
13.
Shin-ichiro Kumita Keiichi Cho Hidenobu Nakajo Masahiro Toba Mariko Uwamori Sunao Mizumura Tatsuo Kumazaki Junko Sano Shunta Sakai Kazuo Munakata 《Journal of nuclear cardiology》2001,8(5):568-574
BACKGROUND: Technetium-labeled myocardial perfusion tracers allow the simultaneous assessment of myocardial perfusion and left ventricular function by electrocardiography (ECG)-gated myocardial perfusion single photon emission computed tomography (SPECT). This study evaluates left ventricular systolic and diastolic function by ECG-gated SPECT with the use of higher framing (32 frames per cardiac cycle) data acquisition. METHODS AND RESULTS: After receiving an injection of technetium 99m tetrofosmin, 48 patients with cardiac diseases were examined by ECG-gated myocardial perfusion SPECT with a 3-headed gamma camera. During gated data collection, 32 frames per cardiac cycle were acquired over 360 degrees in 60 steps, each of which consisted of 60 beats. Immediately thereafter, the 32 frames taken at each projection angle were combined into 16-frame and 8-frame data sets. Left ventricular end-diastolic volume (LVEDV, in milliliters), left ventricular end-systolic volume (LVESV, in milliliters), and left ventricular ejection fraction (LVEF, percentage) were automatically calculated from the 32-frame, 16-frame, and 8-frame gated data sets. Left ventricular time-volume curves from the 3 data sets were generated by Fourier curve fitting analysis with the use of 3 harmonics, and then peak filling rate (PFR, per second) was measured. Twenty-nine patients also underwent multigated equilibrium radionuclide angiography (ERNA) to determine the LVEF and PFR. Combining the 32-frame data into 16-frame and 8-frame data sets from the 48 patients generated a smaller LVEDV and a larger LVESV, and LVEF was significantly lower in accordance with the decreasing number of frames. Compared with ERNA studies (n = 29), the Bland-Altman method showed underestimated LVEFs and larger 95% limits of agreement in lower framing gated SPECT. CONCLUSIONS: Left ventricular functional parameters obtained from 32-frame gated SPECT correlated closely with those determined by ERNA studies. ECG-gated SPECT with 32-frame data can provide comprehensive information with which to evaluate many types of cardiac diseases. 相似文献
14.
M Narita T Kurihara K Murano M Usami M Honda 《Kaku igaku. The Japanese journal of nuclear medicine》1991,28(1):51-61
To elucidate the usefulness of gated cardiac blood-pool single photon emission CT (SPECT) with Tc-99m for the evaluation of left ventricular (LV) global and regional functions, 18 patients with coronary artery disease were studied. Thirty-two gated projection images were obtained over 360-degree at 16 frames per cardiac cycle. As LV volume was calculated by integrating the numbers of voxels which constituted LV and multiplying by the volume of a single voxel (0.1143 ml), we performed phantom studies to determine the appropriate cut-off level to detect LV outline. These cut-off levels were affected by the background activity and organ volume itself. So we constructed Volume-Cut-Level-Curve at each background activity. In clinical studies, short axis images which constituted LV were selected and provisional LV volumes were calculated at the cut-off levels of 45, 50 and 55%. These volumes were plotted on the Volume-Cut-Level-Curve and the true cut-off levels were obtained to calculate LV end-diastolic or end-systolic volume (EDV, ESV). The cut-off levels were different at every patient and ED or ES. EDV, ESV and LV ejection fraction obtained by SPECT were correlated well with those obtained by contrast ventriculography (LVG) (r = 0.89, 0.94, 0.94 each, p less than 0.01). For the LV wall motion analysis, LVGs obtained at two projections were compared with SPECT or gated cardiac blood-pool planar imaging (Planar) in 5 segments. In addition to visual comparison, wall motion scores (WMS) based on the degree of wall motion abnormality were calculated in each segment. Correlation of WMS between LVG and SPECT (r = 0.84) was significantly (p less than 0.01) superior to that between LVG and Planar (r = 0.62). Especially in SPECT, wall motion analyses at septal and infero-posterior segments were superior to those in Planar. Although gated SPECT requires relatively long time to perform, it is a useful method to detect LV global and regional functions. 相似文献
15.
Berk F Isgoren S Demir H Kozdag G Sahin T Ural D Kahraman G 《Nuclear medicine communications》2005,26(8):701-710
AIM: Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to compare the effectiveness of two-dimensional echocardiography and gated single photon emission computed tomography (SPECT) to evaluate these parameters in patients with DCM. METHODS: Gated SPECT and two-dimensional echocardiography were performed in 45 patients with DCM, and in 10 normal subjects as the control group. Patients were divided into two groups according to the aetiology of DCM: group I, ischaemic DCM (n=30); group II, non-ischaemic DCM (n=15). All patients and the control group underwent resting myocardial gated SPECT, 45 min after injection of 555 MBq of Tc-methoxyisobutyl-isonitrile (Tc-MIBI). Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Simpson's method was used to evaluate these parameters. Regional wall motion was evaluated using both modalities and scored using a 16-segment model with a five-point scoring system. Perfusion defects were expressed as a percentage of the whole myocardium planimetered by a bull's-eye polar map of composite non-gated SPECT. Myocardial perfusion was scored using a 16-segment model with a four-point scoring system. RESULTS: Mean perfusion defects and perfusion defect scores were 25+/-13% and 1.12+/-0.36 in group I and 4+/-8% and 0.76+/-0.26 in group II (P<0.01). The overall agreement between the two imaging modalities for the assessment of regional wall motion was 57% (403/720 segments: 269/480 segments in group I and 134/240 segments in group II). With gated SPECT, LVEF was 27+/-9%, the end-diastolic volume (EDV) was 212+/-71 ml and the end-systolic volume (ESV) was 160+/-67 ml. With echocardiography, these values were 29+/-8%, 197+/-56 ml and 139+/-47 ml, respectively. The correlation between gated SPECT and two-dimensional echocardiography was good (r=0.72, P<0.01) for the assessment of LVEF. The correlation was also good for EDV and ESV, but with wider limits of agreement (r= 0.71, P<0.01 and r=0.71, P<0.01, respectively) and with significantly higher values with gated SPECT (P<0.01). For patients with a perfusion defect of <20% or low myocardial perfusion scores, a higher correlation was found between the two methods for the assessment of LVEF, EDV and ESV. On the other hand, the correlation was lower for the assessment of wall motion. CONCLUSIONS: Gated SPECT and two-dimensional echocardiography correlate well for the assessment of left ventricular function and volumes. Gated SPECT has the advantage of providing information about left ventricular function, dimensions and perfusion. 相似文献
16.
Jens C. Stollfuss Felix Haas Ichiro Matsunari Jodi Neverve Stephan Nekolla Jan Schneider-Eicke Ullrich Schricke Sybille Ziegler Markus Schwaiger 《European journal of nuclear medicine and molecular imaging》1998,25(5):522-530
We investigated the use of visual and quantitative technetium 99m tetrofosmin ECG-gated single-photon emission tomography
(SPET) for the assessment of regional myocardial wall thickening (WT) and left ventricular (LV) ejection fraction (EF) in
comparison with gated magnetic resonance imaging (MRI) in patients with a low angiographic LVEF. Gated SPET using 99mTc-labelled flow tracers offers potential for simultaneous assessment of myocardial perfusion and LV function. Few data are
available on the use of visual and quantitative gated SPET in patients with low LVEF. In this study 21 patients with low angiographic
LVEF (mean 37%±5%) were studied. Resting gated 99mTc-tetrofosmin SPET and gated MRI were performed within 48 h. WT was assessed by visual interpretation (five point score)
and quantitative analysis based on count increase. There was good agreement for EF measurements by MRI and gated SPET (mean
EF: 33%±12% vs 35%±11%, r = 0.86, P<0.001). Areas under receiver operator characteristic curves (AUC) for differentiation between MRI WT score points ranged
from 0.60 to 0.66 for visual SPET WT analysis, from 0.59 to 0.71 for delta count increase values and from 0.46 to 0.60 for
% WT, indicating substantial overlap between WT categories. Absolute agreement for visual WT between MRI and gated SPET ranged
from 25% to 57% (kappa 0.03–0.25) depending on tracer uptake, and was limited in areas with moderate to severe perfusion defects
(kappa 0.03–0.13). It is concluded that gated SPET provided reliable estimates of regional WT and global function in patients
with low angiographic LVEF.
Received 15 October 1997 and in revised form 31 January 1998 相似文献
17.
Hashimoto A Nakata T Wakabayashi T Kyuma M Takahashi T Tsuchihashi K Shimamoto K 《Nuclear medicine communications》2002,23(9):887-898
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 (99m)Tc 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. 相似文献
18.
Samuel Fleischmann Pascal Koepfli Mehdi Namdar Christophe A Wyss Rolf Jenni Philipp A Kaufmann 《Journal of nuclear medicine》2004,45(5):754-759
Soft-tissue attenuation artifacts generally appear as fixed perfusion-scan defects. Gated (99m)Tc-tetrofosmin SPECT may help differentiate myocardial infarction (MI) from artifacts, as fixed defects with decreased function (wall motion and thickening) probably represent MI, whereas attenuation artifacts represent preserved function. METHODS: Ungated stress and gated rest (99m)Tc-tetrofosmin SPECT was performed on 153 consecutive patients referred for evaluation of coronary artery disease. From stress and summed gated rest images, 107 patients (70%) were identified with isolated fixed defects. The function of the defects was assessed semiquantitatively from gated stress images. The findings were correlated with clinical (history or electrocardiographic Q waves) evidence of MI. RESULTS: Of 62 patients with fixed defects and clinical MI, 60 (97%) had an abnormal defect function. Of 45 patients with no clinical MI, 16 (36%) had decreased function of the defect, possibly indicating silent MI. In 29 of the 45 patients (64%) with no clinical MI, defect function was normal. Because most (90%) fixed defects with normal systolic function occurred in men with inferior fixed defects (87%) or women with anterior fixed defects (3%), these were most likely attenuation artifacts. By reclassifying the condition of patients with fixed defects and normal function as normal, patients with unexplained fixed defects (no clinical MI) decreased from 29% to 10%. CONCLUSION: Gating adds considerable value to (99m)Tc-tetrofosmin SPECT myocardial perfusion imaging in characterizing fixed defects and potentially improves test specificity. 相似文献
19.
Y Ishino 《Kaku igaku. The Japanese journal of nuclear medicine》1992,29(9):1069-1081
Forty-three patients underwent the analysis of left and right ventricular (LV and RV) volumes, and LV regional wall motion by multigated cardiac blood pool single photon emission computed tomography (SPECT) with 99mTc. To calculate the cardiac volume correctly, the optimal cutoff level in relation to background level was first obtained by a phantom study. Left ventricular end-diastolic, end-systolic volume (EDV and ESV) and ejection fraction (EF) calculated thus with SPECT were correlated well with the data obtained with left ventriculography (LVG) and magnetic resonance imaging (MRI), especially using horizontal long axial image. RV stroke volume (SV) without shunt or valvular diseases was also correlated well with that of LV when it was calculated using horizontal long axial image. However, SV ratio (LVSV/RVSV) was not necessarily ideal numerical 1. In addition LV wall motion was evaluated by multicontour systolic display and phase analysis in SPECT and gated planar images. The results obtained with SPECT were better correlated with those of LVG than gated planar images. It is concluded that multigated cardiac blood pool SPECT is a clinically useful method for an evaluation of cardiac function and left ventricular regional wall motion. 相似文献
20.
Comparison of 64-slice CT with gated SPECT for evaluation of left ventricular function. 总被引:11,自引:0,他引:11
Tiziano Schepis Oliver Gaemperli Pascal Koepfli Ines Valenta Klaus Strobel Andrea Brunner Sebastian Leschka Lotus Desbiolles Lars Husmann Hatem Alkadhi Philipp A Kaufmann 《Journal of nuclear medicine》2006,47(8):1288-1294
Precise and reliable assessment of left ventricular (LV) function and dimensions is prognostically important in cardiac patients. As the integration of SPECT and multislice CT into hybrid scanners will promote the combined use of both techniques in the same patient, a comparison of the 2 methods is pertinent. We aimed at comparing LV dimensions, muscle mass, and function obtained by electrocardiographically gated 64-slice CT versus gated-SPECT. METHODS: Sixty patients (mean age, 64 +/- 8 y) referred for evaluation of coronary artery disease underwent 99mTc-tetrofosmin gated SPECT and 64-slice CT within 4 +/- 2 d. LV ejection fraction (LVEF), end-systolic volume (ESV), and end-diastolic volume (EDV) from CT were compared with SPECT. Additionally, LV muscle mass and quantitative regional wall motion were assessed in 20 patients with both methods. RESULTS: CT was in good agreement with SPECT for quantification of LVEF (r = 0.825), EDV (r = 0.898), and ESV (r = 0.956; all P < 0.0001). LVEF was 59% +/- 13% measured by SPECT and slightly higher but not significantly different by CT (60% +/- 12%; mean difference compared with SPECT, 1.1% +/- 1.7%; P = not significant). A systematic overestimation using CT for EDV (147 +/- 60 mL vs. 113 +/- 52 mL; mean difference, 33.5 +/- 23.1 mL) and ESV (63 +/- 55 mL vs. 53 +/- 49 mL; mean difference, 9.3 +/- 15.9 mL; P < 0.0001) was found compared with SPECT. A good correlation for muscle mass was found between the 2 methods (r = 0.868; P < 0.005). However, muscle mass calculated by SPECT was significantly lower compared with CT (127 +/- 24 g vs. 148 +/- 37 g; mean difference, 23.0 +/- 12.2 g; P < 0.001). The correlation for regional wall motion between the 2 methods was moderate (r = 0.648; P < 0.0001). CONCLUSION: LVEF and LV functional parameters as determined by 64-slice CT agree over a wide range of clinically relevant values with gated SPECT. However, interchangeable use of the 2 techniques should be avoided for LV volumes, muscle mass, and regional wall motion because of variances inherent to the different techniques. 相似文献