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CLINICAL STUDIES

Assessment of regional and global left ventricular function by reinjection Tl-201 and rest Tc-99m sestamibi ECG-gated SPECT

Comparison with three-dimensional magnetic resonance imaging

Eiji Tadamura, MD^a, Takashi Kudoh, MD^a* , Makoto Motooka, MD^*, Masayuki Inubushi, MD^a* , Seiji Shirakawa, RT^a* , Naoya Hattori, MD^a* , Tomohisa Okada, MD^a* , Tetsuya Matsuda, MD^a, Takaaki Koshiji, MD, Kazunobu Nishimura, MD, Katsuhiko Matsuda, MD and Junji Konishi, MD^a*

^a Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
^* Third Division, Department of Internal Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
Department of Medical Informatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

Manuscript received June 3, 1998; revised manuscript received October 15, 1998, accepted December 4, 1998.

Reprint requests and correspondence: Dr. Eiji Tadamura, Department of Nuclear Medicine and Diagnostic Imaging, Kyoto University Graduate School of Medicine, 54 Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
et{at}kuhp.kyoto-u.ac.jp

OBJECTIVES

The purpose of this study was to test the ability of reinjection thallium-201 and rest technetium-99m sestamibi ECG (electrocardiographic)-gated SPECT (i.e., reinjection-g-SPECT [single-photon emission computed tomography] and MIBI-g-SPECT) to determine regional and global functional parameters.

BACKGROUND

The ECG-gated perfusion SPECT was reported to provide accurate left ventricular ejection fraction (LVEF) using an automated algorithm. We hypothesized that other various functional data may be obtained using reinjection-g-SPECT and MIBI-g-SPECT.

METHODS

Reinjection-g-SPECT, MIBI-g-SPECT, and three-dimensional magnetic resonance imaging (3DMRI) were conducted in 20 patients with coronary artery disease. Regional wall motion (RWM) and wall thickening (RWT) were analyzed using semiquantitative visual scoring by each g-SPECT and 3DMRI. The left ventricular end-systolic and end-diastolic volumes (EDV, ESV) and LVEF estimated by reinjection- and MIBI-g-SPECT were compared with the results of 3DMRI.

RESULTS

A high degree of agreement in RWM and RWT assessment was observed between each g-SPECT and 3DMRI (kappa >.70, p < .001). The LVEF values by reinjection- and MIBI-g-SPECT correlated and agreed well with those by 3DMRI (reinjection: r = .92, SEE = 5.9%, SD of differences = 5.7%; sestamibi: r = .94, SEE = 4.4%, SD of differences = 5.1%). The same also pertained to EDV (reinjection: r = .85, SEE = 18.7 ml, SD of differences = 18.4 ml; sestamibi: r = .92, SEE = 13.1 ml, SD of differences = 13.0 ml) and ESV (reinjection: r = .94, SEE = 10.3 ml, SD of differences = 10.3 ml; sestamibi: r = .97, SEE = 6.7 ml [p < .05 vs. reinjection by F test], SD of differences = 6.6 ml [p < .05 vs. reinjection by F test]).

CONCLUSIONS

Reinjection- and MIBI-g-SPECT provide clinically satisfactory various functional data. These functional data in combination with the perfusion information will improve diagnostic and prognostic accuracy without an increase in cost or the radiation dose to the patients.

Abbreviations and Acronyms   ECG = electrocardiogram, electrocardiographic   EDV = left ventricular end-diastolic volume   ESV = left ventricular end-systolic volume   LV = left ventricular   LVEF = left ventricular ejection fraction   reinjection Tl-201 ECG-gated SPECT = reinjection-g-SPECT   rest Tc-99m sestamibi ECG-gated SPECT = MIBI-g-SPECT   SPECT = single-photon emission computed tomography (tomographic)   Tc-99m = technetium-99m   Tl-201 = thallium-201

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