Validation of 4D-MSPECT and QGS for quantification of left ventricular volumes and ejection fraction from gated 99m Tc-MIBI SPET: comparison with cardiac magnetic resonance imaging

Abstract

The main aim of this study was to validate the accuracy of 4D-MSPECT in the assessment of left ventricular (LV) end-diastolic/end-systolic volumes (EDV, ESV) and ejection fraction (LVEF) from gated technetium-99m methoxyisobutylisonitrile single-photon emission tomography ((99m)Tc-MIBI SPET), using cardiac magnetic resonance imaging (cMRI) as the reference method. By further comparing 4D-MSPECT and QGS with cMRI, the software-specific characteristics were analysed to elucidate clinical applicability. Fifty-four patients with suspected or proven coronary artery disease (CAD) were examined with gated (99m)Tc-MIBI SPET (8 gates/cardiac cycle) about 60 min after tracer injection at rest. LV EDV, ESV and LVEF were calculated from gated (99m)Tc-MIBI SPET using 4D-MSPECT and QGS. On the same day, cMRI (20 gates/cardiac cycle) was performed, with LV EDV, ESV and LVEF calculated using Simpson's rule. Both algorithms worked with all data sets. Correlation between the results of gated (99m)Tc-MIBI SPET and cMRI was high for EDV [ R=0.89 (4D-MSPECT), R=0.92 (QGS)], ESV [ R=0.96 (4D-MSPECT), R=0.96 (QGS)] and LVEF [ R=0.89 (4D-MSPECT), R=0.90 (QGS)]. In contrast to ESV, EDV was significantly underestimated by 4D-MSPECT and QGS compared to cMRI [130+/-45 ml (4D-MSPECT), 122+/-41 ml (QGS), 139+/-36 ml (cMRI)]. For LVEF, 4D-MSPECT and cMRI revealed no significant differences, whereas QGS yielded significantly lower values than cMRI [57.5%+/-13.7% (4D-MSPECT), 52.2%+/-12.4% (QGS), 60.0%+/-15.8% (cMRI)]. In conclusion, agreement between gated (99m)Tc-MIBI SPET and cMRI is good across a wide range of clinically relevant LV volume and LVEF values assessed by 4D-MSPECT and QGS. However, algorithm-varying underestimation of LVEF should be accounted for in the clinical context and limits interchangeable use of software.

Development and validation of a new automatic algorithm for quantification of left ventricular volumes and function in gated myocardial perfusion SPECT using cardiac magnetic resonance as reference standard

“…The correlation coefficients between MPS and CMR for LV volumes and EF were similar between Segment and the four other MPS software packages, and in line with results reported in earlier studies [10][11][12][13]16,[14][15][17][18][19]. In the current study the EDV and ESV were underestimated by MPS, as compared to CMR, when using QGS, MyoMetrix, ECTb and Exini.…”

“…In the majority of the studies the end-diastolic volume (EDV) and end-systolic volume (ESV) were underestimated by MPS [10][11][12][13][14][15]. End-diastolic volume by MPS has also been shown to range from overestimation to underestimation compared to CMR depending on the software package used [16][17][18]. Only one study has shown an overestimation in both EDV and ESV by MPS [19].…”

The expanding role of left ventricular functional assessment using gated myocardial perfusion SPECT: the supporting actor is stealing the scene

“…The Emory Cardiac Toolbox (ECTb, Emory University, Atlanta, GA) has also been extensively validated by comparison with first-pass radionuclide ventriculography, ERNA, echocardiography and magnetic resonance imaging [23,25,30,34,55]. Furthermore, comparative studies with ERNA and magnetic resonance imaging have confirmed the reliability of 4D-MSPECT (University of Michigan Medical Center, Ann Arbor, MI) [32,34,55,56]. Other quantitative algorithms that have achieved commercial diffusion are the MultiDim (Stanford University, Palo Alto, CA), the W-L CQ (Yale University, New Haven, CT), the Left Ventricular Global Thickening Fraction (LVGTF) and the Perfusion and Functional Analysis for Gated SPECT (pFAST, Sapporo Medical University, Sapporo, Japan) [57][58][59][60].…”

Creation and characterization of Japanese standards for myocardial perfusion SPECT: database from the Japanese Society of Nuclear Medicine Working Group

“…We also consulted the developers of the major myocardial SPECT quantification software, namely, Quantitative Gated SPECT and Perfusion SPECT (QGS/QPS, Cedars-Sinai Medical Center, Los Angeles, CA), the Emory Cardiac Toolbox (ECTb; Emory University, Atlanta, GA) and 4D-MSPECT (University of Michigan Medical Center, Ann Arbor, MI). [3][4][5][6][7][8][9][10] The data collection was approved in each hospital by the appropriate ethical committee or review board.…”

“…[3][4][5][6][7][8][9][10] In this manuscript, a QPS software algorithm was used to generate perfusion polar maps and to characterize the mean and the mean deviation of 17 segments. The QPS algorithm used the normalization of the maximal values so that normal segments had 100% values to eliminate errors due to maxima located in small hot spots.…”