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Diagnosis of Diffuse and Localized Arrhythmogenic Right Ventricular Dysplasia by Gated Blood-Pool SPECT

¹ Department of Nuclear Medicine, Lapeyronie University Hospital, Montpellier, France; ² Department of Nuclear Medicine, Bichat University Hospital, Paris, France; and ³ Department of Statistics and Epidemiology, Lapeyronie University Hospital, Montpellier, France

Correspondence: For correspondence or reprints contact: Denis Mariano-Goulart, MD, PhD, Service Central de Médecine Nucléaire, CHU Lapeyronie 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France. E-mail: d-mariano_goulart{at}chu-montpellier.fr

This study aimed to assess the ability of global and local systolic parameters measured with gated blood-pool SPECT (GBPS) to diagnose and characterize the severity of diffuse or localized arrhythmogenic right ventricular dysplasia (ARVD). Methods: Fifty-nine subjects with symptomatic ventricular arrhythmias were prospectively included in the study. With the International Society and Federation of Cardiology criteria for ARVD as a gold standard, these subjects were classified as subjects without ARVD (21 control subjects) and patients with localized ARVD (16 patients) or diffuse ARVD (22 patients). Right ventricular volumes, right ventricular ejection fractions (EF), the SD of local EF (-EF), and the SD of the local times of end systole (-TES) were computed from GBPS data and compared among the groups in the study population. Results: -EF did not differ between control subjects and patients with diffuse or localized ARVD. Right ventricular EF and volumes differed between patients with diffuse ARVD and control subjects, with similar areas under the receiver-operating-characteristic curves, but right ventricular EF and volumes failed to differentiate patients with localized ARVD. In contrast, -TES differed between patients with diffuse or localized ARVD and control subjects. Regression analysis showed that the systolic parameter most strongly associated with the diagnosis of ARVD was -TES. The probabilities of a randomly chosen patient in the diffuse ARVD group and of a randomly chosen patient in the localized ARVD group having -TES values greater than that of a randomly chosen control subject were 98.5% and 96.7%, respectively. For the diagnosis of localized ARVD, a threshold of 80 ms for -TES corresponded to sensitivity, specificity, and positive and negative predictive values of 100%, 81%, 80%, and 100%, respectively. Conclusion: With GBPS, both diffuse ARVD and localized ARVD can be accurately diagnosed by computing -TES for all of the pixels on the surface of the right ventricle.

Key Words: arrhythmogenic right ventricular dysplasia • tomographic gated blood-pool ventriculography • time of end systole • phase analysis • time–activity curve

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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