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Research ArticleImaging

Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging

Troels Joergensen and Susanne Haase Hansson
Journal of Nuclear Medicine Technology September 2015, 43 (3) 193-200; DOI: https://doi.org/10.2967/jnmt.115.155382
Troels Joergensen
Department of Clinical Physiology and Nuclear Medicine, Naestved Hospital, Naestved, Denmark
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Susanne Haase Hansson
Department of Clinical Physiology and Nuclear Medicine, Naestved Hospital, Naestved, Denmark
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  • FIGURE 1.
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    FIGURE 1.

    Method A vs. B for EDV. (A) Scatterplot. Linear regression was calculated and is shown as full curve, and line of equality is illustrated by dotted curve. (B) Bland–Altman plot. One point in Bland–Altman plot is omitted due to scaling of x-axis. Bold curve = mean of differences; dotted curve = ±1.96 SDs; small dotted curves = CIs of mean and CIs of limit of agreement.

  • FIGURE 2.
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    FIGURE 2.

    Method A vs. B for ESV. (A) Scatterplot. Linear regression was calculated and is shown as full curve, and line of equality is illustrated by dotted curve. (B) Bland–Altman plot. One point in Bland–Altman plot is omitted due to scaling of x-axis. Bold curve = mean of differences; dotted curve = ±1.96 SDs; small dotted curves = CIs of mean and CIs of limit of agreement.

  • FIGURE 3.
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    FIGURE 3.

    Method A vs. B for LVEF. (A) Scatterplot. Linear regression was calculated and is shown as full curve, and line of equality is illustrated by dotted curve. (B) Bland–Altman plot. Bold curve = mean of differences; dotted curve = ±1.96 SDs; small dotted curves = CIs of mean and CIs of limit of agreement; gray area = predefined medical limits of 10% points.

  • FIGURE 4.
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    FIGURE 4.

    Method A vs. C for LVEF. (A) Scatterplot. Linear regression was calculated and is shown as full curve, and line of equality is illustrated by dotted curve. (B) Bland–Altman plot. Bold curve = mean of differences; dotted curve = ±1.96 SDs; small dotted curves = CIs of mean and CIs of limit of agreement; gray area = predefined medical limits of 10% points.

  • FIGURE 5.
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    FIGURE 5.

    Method B vs. C for LVEF. (A) Scatterplot. Linear regression was calculated and is shown as full curve, and line of equality is illustrated by dotted curve. (B) Bland–Altman plot. Bold curve = mean of differences; dotted curve = ±1.96 SDs; small dotted curves = CIs of mean and CIs of limit of agreement; gray area = predefined medical limits of 10% points.

  • FIGURE 6.
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    FIGURE 6.

    Screen capture of tap setup in 4DMSPECT. Determination of position of left ventricular (LV) center and apical and basal limits. (A) Results for method A. (B) Results for method B. Quality of images in method B is in this case reduced. Gaussian filtering in method A and B is equal.

  • FIGURE 7.
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    FIGURE 7.

    Screen capture of IQ-gSPECT data loaded into 4DMSPECT. Frame 4 of 8 is shown. (A) Results displayed for method A, EDV = 58 mL, ESV = 10 mL, and LVEF = 83%. (B) Results displayed for method B, EDV = 42 mL, ESV = 14 mL, and LVEF = 67%. LVEF for method C = 73%.

Tables

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    TABLE 1

    Settings for Acquisition and Data Processing for the 3 Methods

    Method
    SettingABC
    Radiopharmacy99mTc-sestamibi99mTc-sestamibi99mTc-UltraTag (Mallinckrodt Inc.)
    Dose (±2 SDs)650 ± 50 MBq650 ± 50 MBq740 ± 45 MBq
    CollimatorSMARTZOOMSMARTZOOMLEHR
    Bins per cardiac cycle8816
    Acquisition time5 min5 min20 min
    Matrix128 × 128128 × 12864 × 64
    Pixel size4.8 mm4.8 mm5.4 mm
    Zoom111.78
    Camera position2 detectors, 208°, 17 views2 detectors, 208°, 17 viewsSingle-head 45° left anterior oblique/best septal separation between ventricles by adjustment
    Processing software4DMSPECT4DMSPECTSiemens esoft (MIApps)
    Reconstruction algorithmIterative Flash3D (15i2s)Iterative Flash3D (12i1s)—
    FilteringGaussian 10 mmGaussian 10 mmLow-pass filtering
    • View popup
    TABLE 2

    Average Value, SD, and Range for LVEF, EDV, and ESV for All Patients and for Each of the Methods Applied

    Method
    ParameterABC
    EDV (mL)
     Mean ± SD87.0 ± 44.276.3 ± 46.3—
     Range36–27622–223—
    ESV (mL)
     Mean ± SD33.3 ± 40.729.3 ± 40.0—
     Range1.5–2275–223—
    LVEF (%)
     Mean ± SD67.5 ± 13.468.6 ± 11.464.4 ± 12.1
     Range18–8319–8218–83
    • EDV and ESV cannot be estimated in MUGA study.

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    TABLE 3

    Results of Kolmogorov–Smirnov Test for Each Method

    ParameterMethod A vs. B, D(n) D(n,α)Method A vs. C, D(n) D(n,α)Method B vs. C, D(n) D(n,α)
    LVEF, Kolmogorov–Smirnov test0.05 < 0.240.09 < 0.240.10 < 0.24
    EDV, Kolmogorov–Smirnov test0.06 < 0.24——
    ESV, Kolmogorov–Smirnov test0.08 < 0.24——
    • If data are normally distributed, then critical value D(n,α) will be larger than D(n). D(n,α) is found in Kolmogorov–Smirnov table, for n = 28 and α = 0.05 D(n,α) = 0.24. D(n) is calculated for each method comparison and is in all cases lower than D(n,α). All data are normally distributed.

    • View popup
    TABLE 4

    Results of Statistical Analysis for EDV and ESV for Comparison Between Method A and B

    Method
    AnalysisA vs. B, EDV (mL)A vs. B, ESV (mL)
    Bland–Altman
     Mean ± 2 SDs10.8 ± 224.0 ± 20
     CI of mean±1.9±1.9
     CI of limits±3.3±3.2
    Linear regression (y = ax +b )
     a1.040.97
     b−14−2.8
     R20.980.99
     r0.990.99
    • View popup
    TABLE 5

    Results of Statistical Analysis for LVEF for Each Comparison Between Methods A, B, and C

    Methods
    AnalysisA vs. B (% points)A vs. C (% points)B vs. C (% points)
    Bland–Altman
     Mean ± 2 SDs−1.1 ± 15.0−3.1 ± 17.2−4.2 ± 18.2
     CI of mean±2.8±3.3±3.4
     CI of limits±4.9±5.6±5.9
    Linear regression (y = ax + b)
     a0.710.860.67
     b20.612.225.6
     R20.690.600.50
     r0.830.770.70
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Journal of Nuclear Medicine Technology: 43 (3)
Journal of Nuclear Medicine Technology
Vol. 43, Issue 3
September 1, 2015
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Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging
Troels Joergensen, Susanne Haase Hansson
Journal of Nuclear Medicine Technology Sep 2015, 43 (3) 193-200; DOI: 10.2967/jnmt.115.155382

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Evaluation of the Left Ventricular Ejection Fraction with Gated IQ-SPECT Myocardial Perfusion Imaging
Troels Joergensen, Susanne Haase Hansson
Journal of Nuclear Medicine Technology Sep 2015, 43 (3) 193-200; DOI: 10.2967/jnmt.115.155382
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