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Gated Cardiac ¹³N-NH₃ PET for Assessment of Left Ventricular Volumes, Mass, and Ejection Fraction: Comparison with Electrocardiography-Gated ¹⁸F-FDG PET

¹ Department of Cardiology, Medical University of Vienna, Vienna, Austria
² Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
³ Department of Medical Computer Sciences, Medical University of Vienna, Vienna, Austria
⁴ Rudolfinerhaus, Vienna, Austria

The purpose of this study was to evaluate myocardial electrocardiography (ECG)-gated ¹³N-ammonia (¹³N-NH₃) PET for the assessment of cardiac end-diastolic volume (EDV), cardiac end-systolic volume (ESV), left ventricular (LV) myocardial mass (LVMM), and LV ejection fraction (LVEF) with gated ¹⁸F-FDG PET as a reference method. Methods: ECG-gated ¹³N-NH₃ and ¹⁸F-FDG scans were performed for 27 patients (23 men and 4 women; mean ± SD age, 55 ± 15 y) for the evaluation of myocardial perfusion and viability. For both ¹³N-NH₃ and ¹⁸F-FDG studies, a model-based image analysis tool was used to estimate endocardial and epicardial borders of the left ventricle on a set of short-axis images and to calculate values for EDV, ESV, LVEF, and LVMM. Results: The LV volumes determined by ¹³N-NH₃ and ¹⁸F-FDG were 108 ± 60 mL and 106 ± 63 mL for ESV and 175 ± 71 mL and 169 ± 73 mL for EDV, respectively. The LVEFs determined by ¹³N-NH₃ and ¹⁸F-FDG were 42% ± 13% and 41% ± 13%, respectively. The LVMMs determined by ¹³N-NH₃ and ¹⁸F-FDG were 179 ± 40 g and 183 ± 43 g, respectively. All P values were not significant, as determined by paired t tests. A significant correlation was observed between ¹³N-NH₃ imaging and ¹⁸F-FDG imaging for the calculation of ESV (r = 0.97, SEE = 14.1, P < 0.0001), EDV (r = 0.98, SEE = 15.4, P < 0.0001), LVEF (r = 0.9, SEE = 5.6, P < 0.0001), and LVMM (r = 0.93, SEE = 15.5, P < 0.0001). Conclusion: Model-based analysis of ECG-gated ¹³N-NH₃ PET images is accurate in determining LV volumes, LVMM, and LVEF. Therefore, ECG-gated ¹³N-NH₃ can be used for the simultaneous assessment of myocardial perfusion, LV geometry, and contractile function.

Key Words: cardiac PET • ECG-gated acquisition • model-based image analysis • left ventricular function

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