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Automatic Detection and Size Quantification of Infarcts by Myocardial Perfusion SPECT: Clinical Validation by Delayed-Enhancement MRI

¹ Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, California
² Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

View larger version (20K): [in a new window]   FIGURE 1. ROC curve for detection of infarct by TPD and EXT measures on rest 201Tl SPECT (n = 82), using presence of infarct on DE-MRI as a gold standard.

View larger version (73K): [in a new window]   FIGURE 2. DE-MRI images and corresponding SPECT images in patient with extensive infarcted regions. Defect quantification results were 27% by DE-MRI, 31% by SPECT EXT, and 25% by SPECT TPD. (Top row) DE-MRI image (A), coregistered slice from delayed 201Tl rest SPECT (B), and fused MRI/SPECT image (C). (Bottom row) Definition of infarct regions (red) and LV contours (blue) on DE-MRI image (D), LV contours on corresponding SPECT slice (E), and polar map SPECT quantification (F). Arrows point to defect locations in A and B. DE-MRI scan contains no-reflow zones in inferior wall hyperenhancement region. No-reflow zones were included by the operator in overall infarct region. Note that anterior wall infarct was clearly resolved by SPECT despite being nontransmural.

View larger version (88K): [in a new window]   FIGURE 3. Patient with smallest defect size as defined by DE-MRI in group of 82 patients. Quantification results were 0.8% by DE-MRI, 4.5% by SPECT EXT, and 4.8% by SPECT TPD. Labels A–F are the same as in Figure 2. Arrows point to defect locations in A and B.

View larger version (24K): [in a new window]   FIGURE 4. Delayed 201Tl SPECT vs. DE-MRI infarct size (n = 26). Vertical distance between individual observations and fitted regression line is shown on regression residual plot in units of SDs (standardized residuals). (A) Linear regression and regression residual plots for SPECT EXT measure vs. infarct size defined by DE-MRI. (B) Linear regression and regression residual plots for SPECT TPD measure vs. infarct size defined by DE-MRI.

View larger version (57K): [in a new window]   FIGURE 5. Example of phantom images with physical defect size of 21%. Results of quantification for this scan were EXT = 22.0% and TPD = 18.7%. Short-axis (SA), vertical long-axis (VLA), and horizontal long-axis (HLA) views are shown.

View larger version (22K): [in a new window]   FIGURE 6. SPECT defect size vs. physical defect size in phantom scans (n = 9). (A) Linear regression and regression residual plots for SPECT EXT measure. (B) Linear regression and regression residual plots for SPECT TPD measure.