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      Comparison of Gated Blood Pool SPECT and Multi-Detector Row Computed Tomography for Measurements of Left Ventricular Volumes and Ejection Fraction in Patients with Atypical Chest Pain: Validation with Radionuclide Ventriculography

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          Abstract

          Gated blood pool SPECT (GBPS) is an alternative to planar radionuclide ventriculography (PRNV) and offers potential advantages. The aim of this study was to compare GBPS, multi-row detector spiral computed tomography (MDCT), and PRNV for the determination of left ventricular ejection fraction (LVEF) and left ventricular volumes (LV) in subjects with atypical chest pain. Method: Twenty-three consecutive patients (14 men, 9 women; mean age 56.2 ± 9.5 years) referred for MDCT for evaluation of atypical chest pain. All patients underwent PRNV, GBPS, and MDCT at the same day. Results: The mean LVEFs calculated with PRNA (57.3 ± 8.6%), GBPS (55.2 ± 6.6%), and MDCT (56 ± 9.1%) were not statistically different (F value 0.3374, p = 0.715). Comparison of LVEFs from GBPS and MDCT yielded correlation coefficients of 0.5238 (p = 0.0178, 95% CI = 0.1057–0.7845). The correlation of LVEFs between GBPS and PRNV showed a correlation coefficient of 0.8073 (p < 0.0001, 95% CI = 0.5676–0.9209) and 0.6190 (p = 0.0036, 95% CI = 0.2431–0.8333) between MDCT and PRNV. The mean LV end-diastolic volume (EDV) calculated with GBPS (82.7 ± 17.5 ml) was significantly lower than MDCT (106.8 ± 18.5 ml) (p = 0.0001). The mean LV end-systolic volume (ESV) calculated with GBPS (37.2 ± 9.6 ml) was also significantly lower than MDCT (48.1 ± 15.8 ml) (p = 0.012). Comparison of EDV from GBPS and MDCT yielded a correlation coefficient of 0.5220 (p = 0.0182, 95% CI = 0.1033–0.7835). The correlation of ESV between GBPS and MDCT showed a correlation coefficient of 0.6642 (p = 0.0014, 95% CI = 0.3140–0.8553). Conclusion: In conclusion, the LVEF, EDV, and ESV calculated by GBPS correlated significantly with those of obtained with 16-MDCT. In addition, there were no statistical differences of LVEF calculated from PRNV, GBPS, and MDCT. However, with regard to LV, EDV and ESV from GBPS revealed statistically significantly lower than those of MDCT. Also, these results should be addressed whether similar results could also be found in patients with cardiac diseases by the consequent larger population-based study.

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          Most cited references 11

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          Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.

          Multislice spiral computed tomography (MSCT) is a promising technique for noninvasive coronary angiography, although clinical application has remained limited because of frequently incomplete interpretability, caused by motion artifacts and calcifications. In 59 patients (53 male, aged 58+/-12 years) with suspected obstructive coronary artery disease, ECG-gated MSCT angiography was performed with a 16-slice MSCT scanner (0.42-s rotation time, 12x0.75-mm detector collimation). Thirty-four patients were given additional beta-blockers (average heart rate: 56+/-6 min(-1)). After contrast injection, all data were acquired during an approximately 20-s breath hold. The left main (LM), left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA), including > or =2.0-mm side branches, were independently evaluated by two blinded observers and screened for > or =50% stenoses. The consensus reading was compared with quantitative coronary angiography. MSCT was successful in 58 patients. Eighty-six of the 231 evaluated branches were significantly diseased. Without exclusion of branches, the sensitivity, specificity and positive and negative predictive value to identify > or =50% obstructed branches was 95% (82/86), 86% (125/145), 80% (82/102), and 97% (125/129), respectively. The overall accuracy for the LM, LAD, RCA, and LCX was 100%, 91%, 86%, and 81%, respectively. No obstructed LM, LAD, or RCA branches remained undetected. Classification of patients as having no, single, or multivessel disease was accurate in 78% (45/58) of patients and no patients with significant obstructions were incorrectly excluded. Improvements in MSCT technology, combined with heart rate control, allow reliable noninvasive detection of obstructive coronary artery disease.
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            Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction.

            We analyzed the accuracy of multi-detector row spiral computed tomography (MDCT) using a 16-slice CT scanner with improved spatial and temporal resolution, as well as routine premedication with beta-blockers for detection of coronary stenoses. Seventy-seven patients with suspected coronary disease were studied by MDCT (12x0.75-mm cross-sections, 420 ms rotation, 100 mL contrast agent IV at 5 mL/s). Patients with a heart rate above 60/min received 50 mg atenolol before the scan. In axial MDCT images and multiplanar reconstructions, all coronary arteries and side branches with a diameter of 1.5 mm or more were assessed for the presence of stenoses exceeding 50% diameter reduction. In comparison to invasive coronary angiography, MDCT correctly classified 35 of 41 patients (85%) as having at least 1 coronary stenosis and correctly detected 57 of 78 coronary lesions (73%). After excluding 38 of 308 coronary arteries (left main, left anterior descending, left circumflex, and right coronary artery in 77 patients) classified as unevaluable by MDCT (12%), 57 of 62 lesions were detected, and absence of stenosis was correctly identified in 194 of 208 arteries (sensitivity: 92%; specificity: 93%; accuracy: 93%; positive and negative predictive values: 79% and 97%). MDCT coronary angiography with improved spatial resolution and premedication with oral beta-blockade permits detection of coronary artery stenoses with high accuracy and a low rate of unevaluable arteries.
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              Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience.

              To determine left ventricular (LV) volumetric and functional parameters from retrospectively electrocardiographically gated multi-detector row computed tomography (CT) by using semiautomated analysis software and to correlate results with those of magnetic resonance (MR) imaging. In 30 patients (mean age, 59.2 years +/- 7.1 [SD]) known to have or suspected of having coronary artery disease, four-channel multi-detector row CT was performed with standard technique, and diastolic and systolic image reconstructions were generated. With commercially available analysis software capable of semiautomated contour detection, end diastolic and end systolic LV volumes were determined from short-axis secondary CT reformations. Steady-state free-precession cine MR images were acquired in short-axis orientation within 48 hours and analyzed by using dedicated software. Bland-Altman analysis was performed to calculate limits of agreement and systematic errors between CT and MR imaging. Mean end diastolic (138.8 mL +/- 31.9) and end systolic (53.9 mL +/- 21.2) LV volumes as determined with CT correlated well with MR imaging measurements (142.0 mL +/- 32.5 [r = 0.93] and 54.9 mL +/- 22.8 [r = 0.94], respectively [P <.001]). LV ejection fraction (61.6% +/- 10.6 for CT vs 62.3% +/- 10.1 for MR imaging; r = 0.89) and stroke volume (84.6 mL +/- 20.9 for CT vs 86.9 mL +/- 21.5 for MR imaging; r = 0.88) also showed good correlation (P <.001). Bland-Altman analysis showed acceptable limits of agreement (+/-9.8% for ejection fraction) without systematic errors. In selected patients, semiautomated analysis software enables LV volumetric and functional analysis based on multi-detector row CT data sets, the results of which correlate well with MR imaging findings. Copyright RSNA, 2004
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2007
                December 2006
                31 May 2006
                : 107
                : 1
                : 8-16
                Affiliations
                Departments of aNuclear Medicine, bRadiology, cInternal Medicine and dOrthopaedic Surgery, and eMedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
                Article
                93608 Cardiology 2007;107:8–16
                10.1159/000093608
                16741353
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 5, Tables: 1, References: 20, Pages: 9
                Categories
                Original Research

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