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Research ArticleImaging

Software Discrepancies in Radionuclide-Derived Left Ventricular Ejection Fraction

Rune H. Kappel, Helle Precht, Thomas Q. Christensen, Søren Hess and Martin W. Kusk
Journal of Nuclear Medicine Technology March 2025, 53 (1) 36-43; DOI: https://doi.org/10.2967/jnmt.124.268665
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Rune H. Kappel
1Faculty of Health Science, University of Southern Denmark, Odense, Denmark;
2Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark;
3Radiography Education, UCL University College, Odense, Denmark;
4Department of Nuclear Medicine, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark;
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Helle Precht
3Radiography Education, UCL University College, Odense, Denmark;
5Department of Radiology, Lillebaelt Hospital–University Hospital of Southern Denmark, Kolding, Denmark;
6Health Sciences Research Centre, UCL University College, Odense, Denmark;
7Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;
8Discipline of Medical Imaging and Radiation Therapy, Cork University College, Cork, Ireland;
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Thomas Q. Christensen
7Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;
9Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark;
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Søren Hess
2Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark;
10Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark;
11Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; and
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Martin W. Kusk
2Department of Radiology and Nuclear Medicine, University Hospital of Southern Denmark, Esbjerg, Denmark;
7Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;
12Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
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Abstract

Gated equilibrium radionuclide angiography (ERNA), or multigated acquisition scanning, is a well-established technique to monitor left ventricular ejection fraction (LVEF) in patients treated with potentially cardiotoxic chemotherapy. To determine the results of a true change in LVEF, low inter- and intrareader variability is important. The aim of this study was to investigate inter- and intrareader variability in LVEF measurements using 2 different commercially available software packages with cardiac MR (CMR) as a reference standard. Methods: In 46 ERNA scans, LVEF was measured by 2 experienced nuclear medicine technologists, using the 2 software packages Xeleris and Corridor4DM. All patients had CMR performed within 1.5 h from ERNA. CMR-derived LVEF was measured by a cardiologist using cvi42 software. Eight patients were reanalyzed to investigate intrareader variability. Bland–Altman analysis was used to assess agreement between readers and software. Repeated-measures ANOVA was used to assess interactions between readers and software. Differences in mean LVEF were compared using a t test. The Lin concordance correlation coefficient (CCC) was used to test LVEF agreement between software packages and readers and the reference CMR results. Results: Corridor4DM had a significantly higher mean LVEF than did Xeleris. No significant interreader difference was observed within the same software. ANOVA found that readers did not influence LVEFs. The CCC between software packages was similar for both readers, at 0.409 for reader 1 and 0.418 for reader 2. Both software packages showed a significant LVEF bias compared with CMR (4% for Xeleris vs. 11% for Corridor4DM). For both readers, the CCC for correlation with MRI was higher for Xeleris (0.438/0.572) than for Corridor4DM (0.257/0.244). Conclusion: A high degree of variability was found between the 2 different software packages for the calculation of LVEF. No significant difference in LVEF was found between readers using the same software. Corridor4DM gave higher LVEF estimates than did Xeleris. Our findings suggest that different software programs for assessing LVEF in ERNA examinations are not interchangeable. The utmost caution is recommended if switching between different types of software.

  • LVEF
  • inter-/intrareader
  • software
  • ERNA/MUGA
  • CMR

Footnotes

  • Published online Jan. 15, 2025.

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Journal of Nuclear Medicine Technology: 53 (1)
Journal of Nuclear Medicine Technology
Vol. 53, Issue 1
March 1, 2025
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Software Discrepancies in Radionuclide-Derived Left Ventricular Ejection Fraction
Rune H. Kappel, Helle Precht, Thomas Q. Christensen, Søren Hess, Martin W. Kusk
Journal of Nuclear Medicine Technology Mar 2025, 53 (1) 36-43; DOI: 10.2967/jnmt.124.268665
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Keywords

  • LVEF
  • inter-/intrareader
  • software
  • ERNA/MUGA
  • CMR
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Software Discrepancies in Radionuclide-Derived Left Ventricular Ejection Fraction
Rune H. Kappel, Helle Precht, Thomas Q. Christensen, Søren Hess, Martin W. Kusk
Journal of Nuclear Medicine Technology Mar 2025, 53 (1) 36-43; DOI: 10.2967/jnmt.124.268665

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