Normal Gated Miyokardiyal Perfüzyon Spect’ E Sahip Kadın Hastalarda Sol Ventrikül Ejeksiyon Fraksiyonu Ve Volüm Değerleri: 4d-Mspect Ve Siemens ICON®-QGS İle Karşılaştırma

Öz

Özet

Koroner arter hastalığı (KAH) teşhisinde gated miyokard perfüzyon SPECT (g-MPS) sık kullanılan bir yöntemidir. Kardiak performansın değerlendirmesinde sol ventrikül ejeksiyon fraksiyon (SVEF), sistol ve diastol sonu volüm en önemli parametrelerdir. Amacımız sol ventrikül ejeksiyon fraksiyonu ve volüm değerlerini normal myokardial perfüzyon ve fonksiyona sahip kadın hastalarda iki g-MPS bilgisayar yazılım programı (4D-MSPECT ve SIEMENS ICON® QGS) ile karşılaştırarak normal sınırlarını belirlemektir.

Hastalar ve Method

Çalışmaya KAH şüphesi nedeniyle Ekim 2004-Şubat 2007 tarihleri arasında g-MPS uygulanmış ve sonuçları normal raporlanmış 109 kadın (54 ± 10 yıl) hasta alındı. Tc-99m MIBI kullanılarak tek gün rest-stres g-MPS protokolü uygulandı. Modifiye Bruce protokolü ile hastalara treadmillde veya dobutamin ile efor testi yapıldı. Atenüasyon düzeltmesi yapılmadan "butterworth filtresi" aracılığıyla, rekonstrüksiyon yapıldı. 4DM ve QGS algoritmleri yardımıyla sol ventrikül % EF, end diastolik volüm (EDV;ml), end sistolik volüm (ESV;ml) değerleri hesaplandı. 

 

Bulgular

4DM ve QGS algoritmaları arasında ortalama rest ve stres EF değerlerinde tüm hastalarda anlamlı düzeyde (∆REF % [4DM-QGS])= 9.5; ∆SEF [4DM-QGS]=8.9; p<0.05) fark bulundu. Sonuçlar arasında geniş Blandt Alman limitleri (BAL) (BAL:[4DM-REF]-[QGS-REF]=26.4-(-7.8), R=0,61 P<0,05; 4DM-SEF-QGS-SEF:27.7-(-10.1), R=0,54; P=0,000) saptandı. Volüm ölçümlerinde güçlü korelasyon katsayı değerleri (r=0.81-0.93) yanında anlamlı farklılıklar (p<0.05) saptandı. 

 

Sonuç

İki g-MPS yazılım programı arasında, SVEF ve hacim ölçümünde, takipte birbirinin yerine kulllanımı sınırlandıran ortalamalar arası anlamlı derecede farklar saptanmıştır (p<0.05). Takiplerin, başlangıçta kullanılan yazılım programı ile yapılması daha uygundur. 

Anahtar Kelimeler

• Gated miyokardiyal perfüzyon SPECT,Sol ventrikül ejeksiyon fraksiyonu,Sol ventriküler sistol sonu ve diastol sonu volüm,4DM

Left ventricular ejection fraction, end-systolic and end-diastolic volume values in female with normal gated myocardial perfusion spect: the comparison with 4dm-spect and Siemens Icon®-Qgs

Öz

Abstract

Gated myocardial perfusion SPECT (g-MPS) is an important method in the diagnosis of coronary artery disease (CAD). Left ventricular ejection fraction (LVEF), end-systolic volume (ESV) and end-diastolic volume (EDV) are required parameters for evaluation of cardiac performance. Our aim is to compare LVEF and volume values and to determine normal limits in patients with normal myocardial perfusion using two (4D-MSPECT ve SIEMENS ICON® QGS)computer software programs.

 

Patients and Methods

One hundred nine females were included study with the suspicion of CAD but their g-MPS was reported as normal between October 2004 and February 2007. Single day rest-stress g-MPS protocol was applied. Modified Bruce protocol was done for effort test with tredmill performance or dobutamine injection for pharmacological effort. Reconstruction was performed via Butterworth filtration without attenuation correction. LVEF, ESV and EDV were calculated.

 

Results

The mean rest (REF) and stress (SEF) ejection fraction values between 4DM and QGS algorithms had significant differeneces statistically (∆REF[4DM-QGS])=9.5;

∆SEF[4DM-QGS]=8.9; p<0.05). Wide Blandt Alman limits (BAL) were detected among the results (BAL:[4DM-REF]-[QGS-REF]=26.4-(-7.8), R=0,61 P<0,05; 4DM-SEF-QGS-SEF:27.7-(-10.1), R=0,54; P=0,000). Significant differences (p<0.05) were found beside the strong correlation coefficient values (r=0.81-0.93) in the volumes.

 

Conclusion

There were significant differences in the averages between the two g-MPS software program in LEVF and volume values so they should not be used in place of each other at the follow-up of patients. 

Anahtar Kelimeler

• Gated myocardial perfusion SPECT,Left ventricule ejection fraction,end systolic volume,end diastolic volume,4DM

Kaynakça

1. 1- Paul A, Hasegawa S, Yoshioka J, Yamaguchi H, TsujimuraE, Tokita N, et al. Left ventricular volume and ejectionfraction from quantitative gated SPECT: comparison with gated pool SPECT and contrast ventriculography. J Nucl Med 1999; 40(P): 178.
2. 2- Atsma DE, Bavelaar-Croon CD, Germano G, Dibbets Schneider P, van Eck-Smit BL, Pauwels EK, van der Wall EE. Good correlation between gated single photon emission.
3. 3- Yoshioka J, Hasegawa S, Yamaguchi H, Tokita N, Paul AK, Xiuli M. Left ventricular volume and ejection fraction calculated from quantitative electrographic gated 99m technetium tetrofosmin myocardial SPECT. J Nucl Med1999; 40: 1693-1698.
4. 4- Chua T, Kiat H, Germano G, Maurer G, van Train K, Friedman J, Berman D. Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion,postexercise regional ventricular function and myocardial viability: correlation with echocardiography and rest thallium-201 scintigraphy. J Am Coll Cardiol 1994; 23:1107-1114.
5. 5- Nichols K, Lefkowitz D, Faber T, Folks R, Cooke D, Garcia EV, et al. Echocardiographic validation of gated SPECT ventricular function measurements. J Nucl Med 2000; 41:1308-1314.
6. 6- Bavelaar-Croon CD, Kayser HW, van der Wall EE, de Roos A, Dibbets-Schneider P, Pauwels EK, et al. Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values. Radiology 2000; 217: 572-575.
7. 7- Tadamura E, Kudoh T, Motooka M, Inubushi M, Shirakawa S, Hattori N, et al. Assessment of regional and global left ventricular function by reinjection T1-201 and rest Tc-99m sestamibi ECG-gated SPECT: comparison with threedimensional magnetic resonance imaging. J Am Coll Cardiol 1999; 33: 991-997.
8. 8-Wright GA, McDade M, Keeble W, Martin W, Hutton I.Quantitative gated SPECT myocardial perfusion imaging with 201Tl: An assessment of the limitations. Nucl MedCommun 2000; 21: 1147-1151.

9. 9- Wolfgang M. Schaefer, Claudia S.A. Lipke, Bernd Nowak, Hans-Juergen Kaiser, Patrick Reinartz, et al. Validation of QGS and 4D-MSPECT for Quantification of Left Ventricular Volumes and Ejection Fraction from Gated 18F-FDG PET:Comparison with Cardiac MRI. J Nucl Med 2004; 45:74–79.
10. 10- Mattleman S, Hakkı AH, Iskandrian AS, Kane SA. Effects of angiographic contrast medium on left ventricular function: evaluation by contrast angiography and radionuclide angiography.Cathet Cardiovasc Diagn 1984; 10: 129-36.
11. 11- Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH , McCallister BD, Thompson PD JR, Winters WL, Yanowitz FG, Ritchie JL, ACC/AHA Guidelinenes for the Clinical Aplication of Echocardiography. A Report of the American Collage of Cardiology/American Heart Assosiation Task Force on Practice Guidelines J Am Coll Cardiol 1997;29:862-879.
12. 12- Van Royen N, Jaffe CC, Krumholz HM, Johnson KM,Lynch PJ, Natale D, Atkinson P, Deman P, Wackers FJ. Comparison and reproducibility of visual echocardio-graphic and quantitative radionuclide left ventricular ejection fractions. Am J Cardioi 1996; 77:843.850.
13. 13- Turk J Nucl Med, 2001, Vol. 10, (Supp) Nuclear Cardiology- Procedure Guidelines Turkish Society of Nuclear Medicine Nuclear Cardiology Task group: sayfa 1/13.
14. 14- Daniel S. Berman/Leslee J. Shaw/ Guido Germano The Heart Tenth Ed. 2002; 525-538.
15. 15- Kirac S, Wackers F, ve , Liu Y. Validation of the Yale Circumferential Quantification Method Using 201T1and 99mTc:A Phantom Study. J Nucl Med 2000; 41=1436-1441.
16. 16- Wolfgang M. Schaefer, Claudia S.A. Lipke, Bernd Nowak, Hans-Juergen Kaiser, Patrick Reinartz, Arno Buecker, Gabriele A. Krombach, Udalrich Buell, and Harald P. Kühl, Validation of QGS and 4D-MSPECT for Quantification of Left Ventricular Volumes and Ejection Fraction from Gated 18F-FDG PET: Comparison with Cardiac MRI. J Nucl Med 2004; 45:74–79.
17. 17- Nichols K, Santana CA, Folks R, Krawczynska E, Cooke CD, Faber TL, Bergmann SR, Garcia EV. Comparison between ECTb and QGS for Assessment of Left Ventricular Function from Gated Myocardial Perfusion SPECT. J Nucl Cardiol 2002; 3:285-93.
18. 18- Lipke CS, Kuhl HP, Nowak B, Kaiser HJ, Reinartz P, Koch KC, Buell U, Schaefer WM. Validation of 4D-MSPECT and QGS for quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPET: Comparison with cardiac magnetic resonance imaging. Eur J Nucl Med Mol Imaging 2004; 4: 482-90.
19. 19- Lum DP, Coel MN. Comparison of automatic quantification software for the measurment of ventrcular volume and ejection fraction in gated myocardial perfusion SPECT. Nucl Med Com. 2003; 24:259-266.
20. 20- Nakajima K, Higuchi T, Taki J, Kawano M, Tonami N. Accuracy of ventricular volume and ejection fraction measured by Gated myocardial SPECT: Comparison of 4 Software Programs. J Nucl Med 2001; 42: 1571-1578.
21. 21- Schaefer WM, Lipke SA, Standke D, Kaiser HJ, et al. Quantification of left ventricular volumes and ejection fraction from gated Tc-99m MIBI SPECT: MRI Validation and comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT. J Nucl Med 2005; 46:1256-1263.