Gated SPECT (GSPECT) perfusion imaging has been increasing in popularity both with 99Tc(m) agents and 201Tl. However, both higher activities than administered in the UK and multi-headed cameras are often used. The aim of this study was to assess GSPECT imaging using lower activities of 201Tl with a single-headed camera. Seventy patients underwent stress and redistribution GSPECT imaging after a mean injected activity of 62 +/- 7 MBq 201Tl. These patients also underwent radionuclide ventriculography (RNVG) imaging. The Cedars Sinai Quantitative Gated SPECT (QGS) package was used to calculate left ventricular ejection fraction (LVEF) from the GSPECT studies. Comparison of ejection fractions calculated using GSPECT with those calculated using RNVG yielded a correlation coefficient of 0.70 for the stress studies and 0.71 for the redistribution studies. The width of the mean 95% prediction interval ranged from 22 to 74 percentage points for the stress studies and 22 to 86 percentage points for the redistribution studies. Ejection fractions calculated from stress and redistribution GSPECT studies showed a correlation of 0.80 with a mean 95% prediction interval of 42.6 +/- 0.4 percentage points. In conclusion, left ventricular ejection fractions calculated using the QGS algorithm from 201Tl GSPECT studies are inadequate for use in clinical practice.

Gated SPECT (GSPECT) offers the possibility of obtaining additional functional information from perfusion studies, including calculation of left ventricular ejection fraction (LVEF). The calculation of LVEF relies upon the identification of the endocardial surface, which will be affected by the spatial resolution and statistical noise in the reconstructed images. The aim of this study was to compare LVEFs and ventricular volumes calculated from GSPECT using six reconstruction filters. GSPECT and radionuclide ventriculography (RNVG) were performed on 40 patients; filtered back projection was used to reconstruct the datasets with each filter. LVEFs and volumes were calculated using the Cedars-Sinai QGS package. The correlation coefficient between RNVG and GSPECT ranged from 0.81 to 0.86 with higher correlations for smoother filters. The narrowest prediction interval was 111 +/- 2%. There was a trend towards higher LVEF values with smoother filters, the ramp filter yielding LVEFs 2.55 +/- 3.10% (p < 0.001) lower than the Hann filter. There was an overall fall in ventricular volumes with smoother filters with a mean difference of 13.98 +/- 10.15 ml (p < 0.001) in EDV between the Butterworth-0.5 and Butterworth-0.3 filters. In conclusion, smoother reconstruction filters lead to lower volumes and higher ejection fractions with the QGS algorithm, with the Butterworth-0.4 filter giving the highest correlation with LVEFs from RNVG. Even if the optimal filter is chosen the uncertainty in the measured ejection fractions is still too great to be clinically acceptable.

Gated SPECT (GSPECT) was evaluated for the measurement of left ventricular ejection fraction (LVEF) by comparing with equilibrium gated radionuclide ventriculography (RNVG). A total of 99 subjects underwent GSPECT and RNVG imaging. All studies were acquired in list mode with GSPECT studies processed to give 16- and 8-frames per R-R interval, and RNVG studies 24 frames per R-R interval. The Cedars-Sinai QGS software was used to calculate ejection fraction from GSPECT studies. RNVG studies were processed using a manually drawn single region of interest technique. Comparison of LVEF from GSPECT with RNVG yielded correlation coefficients of 0.82 and 0.81 for 16- and 8-frame GSPECT studies respectively. The mean 95% prediction interval was 33 +/- 11 percentage points for both 16- and 8-frame studies, indicating a great disparity between predicted ejection fraction values from GSPECT and actual RNVG values. Subgroup analysis of 29 patients with pathological Q-wave evidence of myocardial infarction demonstrated a poorer correlation coefficient of r = 0.69. Subgroup analysis of 32 patients with end-diastolic volumes < 100 ml demonstrated a poorer correlation coefficient of r = 0.32. Ejection fractions calculated from 16- and 8-frame studies showed a correlation of 0.99 with a mean 95% prediction interval of 8.7 +/- 0.04 percentage points. The 8-frame studies underestimated LVEF by 3.6 +/- 2.3% compared to the 16-frame studies. In conclusion, left ventricular ejection fractions calculated using the QGS algorithm from GSPECT studies are inadequate for use in clinical practice.

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