Left ventricular regional wall motion assessment by multigated and end-diastolic, end-systolic gated radipnuclide left ventriculography

The validity and accuracy of three methods of gated cardiac blood pool imaging for the determination of regional wall motion were assessed in 124 patients undergoing contrast left ventriculography. Eighty-four patients had multigated acquisition and display, and 40 patients had end-diastolic, end-systolic gated acquisition and display in both a two frame movie format and on photographs. Both gated cardiac blood pool images and left ventriculograms were reviewed independently by three blinded observers and regional wall motion was qualitatively scored. For scoring purposes, the left ventricular wall was subdivided into anterolateral, apical, inferior, septal, apical-inferior and posterior segments. Segmental motion was graded on a five point grading scale as normal, mildly hypokinetic, moderately to severely hypokinetic, akinetic or dyskinetic. The graded scores for regional wall motion for each of the three observers were averaged and then compared. Regional wall motion scores for the gated blood pool study agreed within ± 1 grade with scores for contrast ventriculography in 338 of 402 segments (84 percent) studied with multigated acquisition and display, in 97 of 117 segments (83 percent) for the end-diastolic, end-systolic gated acquisition with motion display and in 99 of 117 segments (83 percent) for the end-diastolic, end-systolic gated acquisition with photographic display. The multigated display was least accurate in scoring of the apical segment, the end-diastolic, end-systolic gated movie display in scoring of the inferior segment and the end-diastolic, end-systolic gated photographic display in scoring of the apical and septal segments.

Scoring based on multigated blood pool images had a significantly greater percent agreement with results of contrast ventriculography when segments were normal on contrast ventriculography (88 percent) than when they were abnormal (79 percent) (p <0.05). However, analysis of receiver operating characteristics demonstrated similar levels of diagnostic accuracy for the three radionuclide blood pool imaging techniques in predicting abnormal wall motion on contrast ventriculography. Multi-gated cardiae blood pool imaging is a valid and accurate noninvasive means of detecting left ventricular regional wall motion abnormalities. End-diastolic, end-systolic gated blood pool imaging can be reliably used for regional wall motion determination when the equipment necessary for multigated acquisition is not available.