Routine measurements of left and right ventricular output by gated blood pool emission tomography in comparison with thermodilution measurements: a preliminary study

Abstract

The aim of this preliminary study was to evaluate the accuracy of left and right ventricular output computed from a semi-automatic processing of tomographic radionuclide ventriculography data (TRVG) in comparison with the conventional thermodilution method. Twenty patients with various heart diseases were prospectively included in the study. Thermodilution and TRVG acquisitions were carried out on the same day for all patients. Analysis of gated blood pool slices was performed using a watershed-based segmentation algorithm. Right and left ventricular output measured by TRVG correlated well with the measurements obtained with thermodilution (r = 0.94 and 0.91 with SEE = 0.38 and 0.46 l/min, respectively, P < 0.001). The limits of agreement for TRVG and thermodilution measurements were -0.78-1.20 l/min for the left ventricle and -0.34-1.16 l/min for the right ventricle. No significant difference was found between the results of TRVG and thermodilution with respect to left ventricular output (P = 0.09). A small but significant difference was found between right ventricular output measured by TRVG and both left ventricular output measured by TRVG (mean difference = 0.17 l/min, P = 0.04) and thermodilution-derived cardiac output (mean difference = 0.41 l/min, P = 0.0001). It is concluded that the watershed-based semi-automatic segmentation of TRVG slices provides non-invasive measurements of right and left ventricular output and stroke volumes at equilibrium, in routine clinical settings. Further studies are necessary to check whether the accuracy of these measurements is good enough to permit correct assessment of intracardiac shunts.

Diagnosis of Diffuse and Localized Arrhythmogenic Right Ventricular Dysplasia by Gated Blood-Pool SPECT

“…In the last decade, segmentation software packages have been validated (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), and optimized methods for the extraction of local time-activity curves from GBPS segmented studies have been described (32). An algorithm for extracting local systolic parameters more accurately than with the usual multiharmonic fits has also been proposed (17).…”

“…In the last decade, software packages dedicated to the segmentation of gated blood-pool SPECT (GBPS) acquisitions have been developed and validated, making possible the widespread clinical use of this technique (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, in routine clinical settings, the time-activity curve that characterizes the wall motion at the scale of a single voxel on the surface of a ventricle involves the variation of limited activity and is thus affected by relatively large error from the random Poisson noise.…”

Comparative values of gated blood-pool SPECT and CMR for ejection fraction and volume estimation

“…Thus, it may permit simultaneous assessment at equilibrium of the LV and RV parameters [9,17,18]. Regional ventricular function measurements such as local EF or local times of end-systole are also available with this technique [19][20][21][22].…”

Influence of CT-based attenuation correction in assessment of left and right ventricular functions with count-based gated blood-pool SPECT

“…The previously described and validated Tompool Ò algorithm 5,7,9,27 was slightly modified and adapted to run on standard desktop personal computers running under Windows operating systems (Microsoft Corp., Redmond, WA). Iterative thinnings that were used to produce a skeleton by influence zones 5 were replaced by a full 3D immersion approach taking adjacent slices into consideration.…”

“…Thus, it may permit simultaneous assessment at equilibrium of the LV and RV parameters. [5][6][7][8] Regional ventricular function measurements like local EF or local times of end-systole are also available with this technique. [9][10][11][12] However, as for all nuclear medicine procedures, soft-tissue attenuation is a technical limitation when assessing tracer distribution, even with tomographic data and especially when only a 180°projection set is used.…”