Abstract
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Objectives: Planar first-pass radionuclide angiography (FPRNA) is a well-established method to evaluate biventricular cardiac functions and intracardiac shunting. The requirement of sub-second frame time made it impossible to translate into single-photon emission computed tomography (SPECT) with conventional gamma camera. The recently introduced cadmium-zinc-telluride (CZT) camera, providing ultra-high geometric efficiency, may overcome this problem. The aim of this study is to evaluate the feasibility of FPRNA SPECT using a CZT camera. We also correlate the result with equilibrium radionuclide angiographic (ERNA) SPECT.
Methods: We prospectively recruited 30 consecutive patents referred for equilibrium radionuclide angiography. The patients were placed on the CZT camera in supine position after intravenous injection of stannous pyrophosphate. Dynamic acquisition with list-mode storage was performed for 60 seconds after Tc-99m pertechnetate injection. Routine gated ERNA SPECT was performed afterwards without moving the patient. The dynamic images were reconstructed into serial 40ms frames by using a spatial-temporal maximum-a-posteriori expectation maximization algorithm. Two volumes of interest (VOI) were placed on both ventricles, and time-activity curves were obtained. The bi-ventricular ejection fractions were calculated by averaging the total count change within the VOIs during consecutive 3-5 cardiac cycles. The results were compared to ERNA SPECT.
Results: The left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) can be calculated by using FPRNA SPECT. There were good correlations of both LVEF (r=0.946, p<0.001) and RVEF (r=0.934, p<0.001) between FPRNA SPECT and ERNA SPECT. The inter-cardiac cycle variability was 4.3% (range: 1.1%-9.1%) for LVEF and 3.8% (range: 0.3%-8.3%) for RVEF.
Conclusion: The first-pass radionuclide angiographic SPECT is a clinically feasible and reliable tool to evaluate biventricular ejection fractions. With this technique, the radionuclide angiographic SPECT can be achieved with lower radiation dose (with Tc-99m DTPA), shorter scan time (1-minute acquisition), and without the requirement of proximal veins. Research Support: n/a
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