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Quantitative LVEF and Qualitative Regional Function from Gated Thallium-201 Perfusion SPECT

Department of Medical Physics and Imaging, Division of Nuclear Medicine, Department of Imaging, and Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles
Departments of Radiological Sciences and Medicine, University of California at Los Angeles School of Medicine, Los Angeles, California

Correspondence: For correspondence reprints contact: Guido Germano, PhD, Director, Nuclear Medicine Physics, Cedars-Sinai Medical Center A047 N, 8700 Beverly Blvd., Los Angeles, CA 90048.

ABSTRACT

This study investigates the feasibility of routine clinical ²⁰¹Tl gated perfusion SPECT (gatedTl), and compares quantitative left ventricular ejection fraction (LVEF) and visually-assessed regional wall motion and thickening to analogous values obtained from ^99mTc sestamibi gated perfusion SPECT (gated MIBI). Methods: We studied 121 patients with a rest gated 11(3–3.5 mCi, 35 sec/projection)/poststress gated MIBI (25–30 mCi, 25 sec/projection) separate dual-isotope protocol on a 90° dual-detector camera. Automatic quantitation of LVEFs was accomplished using previously developed and validated software, while visual scoring of motion and thickening was performed using four-point scales. Results: Average myocardial counts were lower in gated 11 images (306 ± 81 counts/pixel) compared to gated MIBI images(789 ± 237 counts/pixel). The quality of gated 11 images was ranked as excellent, good, fair and poor in 24.0%, 42.1%, 24.8% and 9.1%, respectively, of the patients, compared to 43.0%, 43.8%, 9.1% and 4.1%, respectively, for gated MIBI images. Quantitative-gated 11 and gated MIBI LVEFs correlated well (y = 0.11+1.05x, r = 0.918, SEE = 6.35). Possible poststress myocardial stunning may have caused gated Tl LVEFs to overestimate gated MIBI LVEFs by a larger (p = 0.03) amount in ischemic patients (n = 47, y = –0.69+1.09x, r = 0.914, s.e.e. = 6.44) compared to nonischemic patients (n = 64, y = –1.58+1.05x, r = 0.919, s.e.e. = 5.93), the residual difference in LVEFs for this latter group being likely due to different isotope resolution in conjunction with small left ventricles. Exact agreement between gated Tl and gated MIBI segmental myocardial function in 41 nonischemic patients was 92.2% (kappa = 0.619) and 95.4% (kappa = 0.586) for motion and thickening scores, respectively. Conclusion: Thallium-201 gated SPECT imaging can be effectively performed on the majority of patients in our clinical environment and offers the opportunity to assess both myocardial perfusion and function using one injection and one imaging sequence, similarly to what is done with ^99mTc-based agents.

Key Words: gated myocardial perfusion SPECT • thallium-201 • automatic quantitative LVEF

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