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Validation of the Yale Circumferential Quantification Method Using ²⁰¹Tl and ^99mTc: A Phantom Study

Section of Cardiovascular Medicine, Department of Internal Medicine, and the Cardiovascular Nuclear Imaging Laboratory, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut

Correspondence: For correspondence or reprints contact: Yi-Hwa Liu, PhD, Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8017.

ABSTRACT

The Yale circumferential quantification (Yale CQ) method for quantification of SPECT images has been validated previously using empirically derived correction factors. In the present studies, the Yale CQ method was further validated using 2 SPECT gamma cameras and 2 radioisotopes. Methods: SPECT images were acquired from cardiac phantoms with multiple tillable inserts to simulate myocardial perfusion defects of varying extents and severities. Seventy phantom configurations were created. One hundred and head SPECT camera. SPECT defects were quantified using the Yale CQ method, with incorporation of ^99mTc- and ²⁰¹Tl-derived normal databases and correction factors. Results: Quantified phantom SPECT defect sizes acquired with ^99mTc correlated well with actual calculated defect sizes (r = 0.96, y = 0.92x – 0.41). Bland-Altman analysis of agreement revealed strong agreement over a wide range of defect sizes, with a mean error of 1.2% and 2 SDs of 5.0%. Overall ²⁰¹Tl SPECT defect sizes also correlated well with actual defect sizes (r = 0.92), but there was a systematic underestimation (y = 0.72x – 0.76). Bland-Altman analysis showed underestimation over the entire range of defect sizes, with a mean error of 3.4% and 2 SDs of 7.5%. Implementation of a normal ²⁰¹Tl phantom database improved accuracy of quantification (r = 0.95, y = 0.87x – 1.36). The addition of ^99mTl-specific correction factors further improved accuracy (r = 0.94, y = 0.98x – 1.52). Reproducibility of SPECT defect sizes quantification for ^99mTc using 2 gamma cameras was excellent (r = 0.98, y = 0.98x + 0.84). Conclusion: The Yale CQ SPECT quantification method, using the empirically derived correction factors, provides accurate and reproducible quantification of phantom defects over a wide range of defect sizes. Accurate quantification of ²⁰¹Tl and ^99mTc SPECT defect sizes requires radiotracer-specific normal databases.

Key Words: SPECT quantification • Yale CQ method • phantom validation

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