Thallium-gated SPECT in patients with major myocardial infarction: effect of filtering and zooming in comparison with equilibrium radionuclide imaging and left ventriculography.

UNLABELLED 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.

[1]  R. Reba,et al.  Comparison of technetium-99m sestamibi-gated tomographic perfusion imaging with echocardiography and electrocardiography for determination of left ventricular mass. , 1996, The American journal of cardiology.

[2]  G Germano,et al.  Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability. Correlation with echocardiography and rest thallium-201 scintigraphy. , 1994, Journal of the American College of Cardiology.

[3]  H Sandler,et al.  The use of single plane angiocardiograms for the calculation of left ventricular volume in man. , 1968, American heart journal.

[4]  G Germano,et al.  Quantitative LVEF and qualitative regional function from gated thallium-201 perfusion SPECT. , 1997, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  D. Berman,et al.  Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[6]  D. Berman,et al.  Effect of the number of projections collected on quantitative perfusion and left ventricular ejection fraction measurements from gated myocardial perfusion single-photon emission computed tomographic images , 1996, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[7]  I. Gardin,et al.  Comparative study of three automatic programs of left ventricular ejection fraction evaluation , 1995, Nuclear medicine communications.

[8]  G Germano,et al.  Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[9]  M S Rosenthal,et al.  Quantitative SPECT imaging: a review and recommendations by the Focus Committee of the Society of Nuclear Medicine Computer and Instrumentation Council. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[10]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[11]  S. Kaul,et al.  Prevalence and correlates of increased lung/heart ratio of thallium-201 during dipyridamole stress imaging for suspected coronary artery disease. , 1990, The American journal of cardiology.

[12]  M L Goris,et al.  Modelling the integration of myocardial regional perfusion and function , 1994, Nuclear medicine communications.

[13]  K. Williams,et al.  Left ventricular function in patients with coronary artery disease assessed by gated tomographic myocardial perfusion images. Comparison with assessment by contrast ventriculography and first-pass radionuclide angiography. , 1996, Journal of the American College of Cardiology.

[14]  R. Coleman,et al.  Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables. , 1990, Circulation.

[15]  C. J. Thompson,et al.  Quantification of left ventricular function with thallium-201 and technetium-99m-sestamibi myocardial gated SPECT. , 1997, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[16]  R. Okada,et al.  Increased lung uptake of thallium-201 during exercise myocardial imaging: clinical, hemodynamic and angiographic implications in patients with coronary artery disease. , 1980, The American journal of cardiology.

[17]  M. Konstam,et al.  Combined analysis of resting regional wall thickening and stress perfusion with electrocardiographic-gated technetium 99m-labeled sestamibi single-photon emission computed tomography: Prediction of stress defect reversibility , 1997, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[18]  E. Depuey,et al.  Using gated technetium-99m-sestamibi SPECT to characterize fixed myocardial defects as infarct or artifact. , 1995, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  E. Stokely,et al.  Quantification of three-dimensional left ventricular segmental wall motion and volumes from gated tomographic radionuclide ventriculograms. , 1989, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  P. Steg,et al.  Residual area at risk after anterior myocardial infarction: Are ST segment changes during coronary angioplasty a reliable indicator? A comparison with technetium 99m-labeled sestamibi single-photon emission computed tomography , 1997, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[21]  G. Pohost,et al.  Influence of coronary artery disease on pulmonary uptake of thallium-201. , 1980, American Journal of Cardiology.

[22]  E. Depuey,et al.  Comparative diagnostic accuracy of Tl-201 and Tc-99m sestamibi SPECT imaging (perfusion and ECG-gated SPECT) in detecting coronary artery disease in women. , 1997, Journal of the American College of Cardiology.