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Performance of OSEM and Depth-Dependent Resolution Recovery Algorithms for the Evaluation of Global Left Ventricular Function in ²⁰¹Tl Gated Myocardial Perfusion SPECT

¹ Department of Nuclear Medicine, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
² Foch Hospital, Suresnes, France
³ Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
⁴ Department of Cardiology, Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France

It is unknown whether the use of ordered-subsets expectation maximization (OSEM) and depth-dependent resolution recovery (RR) will increase the accuracy of ²⁰¹Tl electrocardiogram-gated SPECT (GSPECT) for the measurement of global left ventricular (LV) function. Methods: Fifty-six patients having both rest ²⁰¹Tl GSPECT and planar equilibrium radionuclide angiography (planar_RNA) on the same day were studied. Twenty-nine patients also had LV conventional contrast angiography (Rx). LV ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) were calculated with the quantitative gated SPECT software (QGS) using 4 different processing methods: filtered backprojection (FBP), OSEM, RR + FBP, and RR + OSEM. LVEF calculated with planar_RNA and LV EDV and ESV calculated with Rx were considered gold standards. LVEF and volumes provided with the GSPECT methods were compared with the gold standard methods. Results: LVEF calculated with GSPECT methods (FBP, OSEM, RR + FBP, and RR + OSEM) were similar (not statistically significant) and correlated well with planar_RNA. On Bland-Altman analysis, the mean ± SD of absolute difference in LVEF with GSPECT FBP, OSEM, RR + FBP, and RR + OSEM methods versus planar_RNA were similar, with relatively large limits of agreement. LV volumes calculated with the 4 GSPECT methods were significantly lower but correlated well with Rx LV volumes. LV volumes calculated with FBP and OSEM were lower than those calculated with RR + FBP and RR + OSEM (P < 0.01). On Bland-Altman analysis, the mean ± SD of absolute difference in LV volumes with FBP, OSEM, RR + FBP, and RR + OSEM versus Rx was, respectively, 56 ± 45 mL (P < 0.01 vs. the other 3 methods), 57 ± 45 mL (P < 0.01 vs. the other 3 methods), 43 ± 48 mL, and 46 ± 47 mL, with correspondingly large limits of agreement. The variance of random error did not differ between FBP, OSEM, RR + FBP, and RR + OSEM for either LVEF or volumes. Conclusion: OSEM and FBP presented similar accuracy for LVEF and volume measured with the QGS software. Their combination with depth-dependent RR provided similar LVEF but more accurate LV volumes.

Key Words: left ventricular function • depth-dependent resolution recovery • iterative reconstruction • ²⁰¹Tl • gated SPECT

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