• Nuclear Medicine and Molecular Imaging
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• 제42권6호
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• pp.435-443
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• 2008

Purpose: Gated myocardial perfusion SPECT provides not only myocardial perfusion status but also various functional parameters of left ventricle. We compared left ventricular ejection fraction, end-diastolic volume, LV mass by cardiac SPECT using Quantitative Gated SPECT (QGS), 4D-MSPECT software and standard 2D-echocardiography. Materials and Methods: One hundred fourteen patients (male 51, female 63; 29-85 years old, mean $61.3\;{\pm}\;13.3$ years old) with normal perfusion status on Tc-99m tetrofosmin gated myocardial perfusion SPECT were analyzed retrospectively. Ejection fraction (LVEF), End-diastolic volume (LVED), LV mass (LVM) were calculated using QGS, 4D-MSPECT, and LVEF, LVM using 2D-echocardiography. Statistical analysis including Bland-Altman plot was performed using $MedCalc^{(R)}$ (MedCalc software, Mariakerke, Belgium). Results: The correlation of LVEF between methods was good: 0.95/0.96 (stress/rest) between QGS and 4D-MSPECT, 0.79 between QGS and echocardiography, 0.79 between 4D-MSPECT and echocardiography (p<0.001). Using Bland-Altman plot, the 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -12.7% to 7.3% / from -12.2% to 6.5% (stress/rest). The agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -17.4% to 24.0%, and -14.8% to 27.0% respectively. The correlation of LVM between methods was also good: 0.95 between QGS and 4D-MSPECT, 0.76 between QGS and echocardiography, 0.73 between 4D-MSPECT and echocardiography (p<0.001). The 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -33.8g to 14.1g (stress/rest), The 95% confidence interval of agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -148.7 g to 21.8. g, and -142.8 g to 35.5 g, respectively. Conclusion: There was a good correlation for LVEF, LVEO, LVM among methods (QGS, 4D-MSPECT, echocardiography), but the variance between methods was big. Therefore, the functional parameters by each method cannot be used interchangeably.

• The Korean Journal of Nuclear Medicine Technology
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• 제15권2호
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• pp.88-93
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• 2011

Purpose: As to analytical method of data, the AutoQUANT software in which it is used quantitative rating of the myocardial perfusion SPECT are reported that there is a difference. Therefore the measured value error of the mutual program is expected to be generated even if the quantitative analysis is made data of the same patient. The purpose of this study is to offer the comparative analysis of myocardial extract method in Quantitative Perfusion SPECT. Materials and methods: We analyzed the 51 patients who were examined by Tc-99m MIBI gated myocardial SPECT in nuclear medicine department of Pusan National University Hospital from June to December 2010(34 men, 17 women, mean age $66.5{\pm}9.9$). We acquired the extracted image in myocardial extract protocol. QPS program that uses the AutoQUANT software measured TID(Transient Ischemic Dilation), ESD(Extent of Stress Defect), SSS(Summed Stress Score). Then analyzed the results. Results: The correlation of appyling myocardial extract is TID(r=0.98), ESD(r=0.99), SSS(r=0.99). In the 95% confidence limit, there was no satistically significant difference(TID p=0.78, ESD p=0.31, SSS p=0.19). After blinding test with a physician for making a qualitative analysis, there was no difference. Conclusion: Quantitative indices in QPS program showed good correlation and the results showed no statistically signigicant difference. The variance between method was small. therefore, the functional parameters by each method can be used interchangeably. Also, we expect patient's satisfaction.

• Journal of Chest Surgery
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• 제30권11호
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• pp.1083-1091
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• 1997

This study was purposed to assess the result of coronary artery bypass graft surgery by analyzing and comparing the pre and postoperative myocardial perfusion state quantitatively by using myocardial SPECT. Twenty patients who received coronary artery bypass graft surgery since 1993 underwent both preoperative and postoperative myocardial SPECT and the result were analyzed. The mean age was 56.4$\pm$9.0 years, and the patients were composed of thirteen males and seven females. For quantitative analysis, we used polar maps of SPECT generated by Cedars-Sin i Medical Center program and we calculated perfusion scores, ischemic myocardial area ratios and reperfusion scores from polar maps. Preoperative mean stressfrest perfusion score was 7.3$\pm$ 1.117.7$\pm$ 1.0 and postoperative score was 8.1 $\pm$ 1 118.3$\pm$ 1.1. Preoperative mean stress ischemic myocardial area ratio was 0.32$\pm$0.2 and postoperative ratio was 0.15 $\pm$0.1. Postoperative mean perfusion score was significantly increased but, on the other hand, mean ischemic myocardial area ratio was significantly decreased as compared with preoperative values(p<0.01). Preoperative mean perfusion score of patients with postoperative roper(usion score more than 1.5 was significantly higher(p<0.01) than that of patients with postoperative reperfusion score less than 1.5. Preoperative perfusion scores of coronary artery territories that had fixed perfusion defect at myocardial SPECT were significantly low(4.3 $\pm$0.514.6$\pm$0.6, stresslrest), nevertheless it proved quantitatively that there was improvement in myocardial perfusion after surgery by showing improved perfusion scores postoperatively. In conclusion, myocardial SPECT is useful method for quantitative analysis of the myocardial perfusion state after coronary artery bypass grafting surgery.

• Nuclear Medicine and Molecular Imaging
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• 제43권3호
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• pp.165-173
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• 2009

Nuclear cardiology in Korea is less active, compared to nuclear oncology, but it has been specialized and ramified. Lately, sophisticated nuclear cardiac imaging methods provide more convenience for patients. It is necessary to accurately estimate the recent progress in the imaging devices for nuclear cardiology. Myocardial perfusion imaging is a well established study to evaluate heart function. Myocardial perfusion SPECT and PET have been used for assessment of coronary artery disease with various radiopharmaceuticals. And of late, the development of advanced imaging devices - multi-pinhole technique and high definition imaging technique - and software made the scanning time shorter and expanded the application field. Therefore, it is required to review the nuclear cardiology hardware/software for the clinical practice and research. In this review, the characteristics about recently-developed SPECT/PET and software for nuclear cardiology are described. It is hoped that this information would contribute to improving the activity of nuclear cardiac research in Korea where the research for the fusion imaging combining a and nuclear imaging is drawing more attention.

• The Korean Journal of Nuclear Medicine
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• 제37권2호
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• pp.73-82
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• 2003

Objectives: A new software (Cardiac SPECT Analyzer: CSA) was developed for quantification of volumes and election fraction on gated myocardial SPECT. Volumes and ejection fraction by CSA were validated by comparing with those quantified by Quantitative Gated SPECT (QGS) software. Materials and Methods: Gated myocardial SPECT was peformed in 40 patients with ejection fraction from 15% to 85%. In 26 patients, gated myocardial SPECT was acquired again with the patients in situ. A cylinder model was used to eliminate noise semi-automatically and profile data was extracted using Gaussian fitting after smoothing. The boundary points of endo- and epicardium were found using an iterative learning algorithm. Enddiastolic (EDV) and endsystolic volumes (ESV) and election fraction (EF) were calculated. These values were compared with those calculated by QGS and the same gated SPECT data was repeatedly quantified by CSA and variation of the values on sequential measurements of the same patients on the repeated acquisition. Results: From the 40 patient data, EF, EDV and ESV by CSA were correlated with those by QGS with the correlation coefficients of 0.97, 0.92, 0.96. Two standard deviation (SD) of EF on Bland Altman plot was 10.1%. Repeated measurements of EF, EDV, and ESV by CSA were correlated with each other with the coefficients of 0.96, 0.99, and 0.99 for EF, EDV and ESV respectively. On repeated acquisition, reproducibility was also excellent with correlation coefficients of 0.89, 0.97, 0.98, and coefficient of variation of 8.2%, 5.4mL, 8.5mL and 2SD of 10.6%, 21.2mL, and 16.4mL on Bland Altman plot for EF, EDV and ESV. Conclusion: We developed the software of CSA for quantification of volumes and ejection fraction on gated myocardial SPECT. Volumes and ejection fraction quantified using this software was found valid for its correctness and precision.

• The Korean Journal of Nuclear Medicine
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• 제32권3호
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• pp.250-258
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• 1998

Purpose: ATP (adenosine triphosphate) is a potent coronary vasodilator with a rapid onset of action and a very short half-life. Myocardial perfusion scintigraphy with intravenous ATP has not yet been sufficiently proven in the diagnosis, follow-up, and risk stratification of coronary artery disease. The purpose of this study was to evaluate the safety, feasibility and diagnostic accuracy of pharmacologic stress thallium-201 myocardial SPECT using an intra-venous ATP infusion in patients with suspected coronary artery disease. Materials and Methods: Thallium-201 myocardial SPECT in 319 patients with suspected coronary artery disease were performed after the infusion of ATP (0.08 mg/kg/min for 6 min). The adverse effects were carefully monitored. Coronary angiography was also performed within 3 weeks. Results: Although 76.5% of the patients had some adverse effects, they were transient, mild, and well tolerated. In all patients, the ATP infusion protocol was completed and only 2 patients required aminophylline. The adverse effects were dyspnea in 63%, headache in 31%, flushing in 21%, chest pain in 14% and abdominal discomfort in 5% of the patients. The sensitivity and specificity were 80% and 90% respectively. Conclusion: Thallium-201 myocardial SPECT after 6 min-infusion of ATP at a rate of 0.08 mg/kg/min is safe and has a diagnostic value in detecting coronary artery disease.

• The Korean Journal of Nuclear Medicine
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• 제25권1호
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• pp.37-45
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• 1991

Infarct size is a major determinant of prognosis after acute myocardial infarction. Up to date, however, clinically available tests to estimate this size have not been sufficiently accurate. Twelve lead electrocardiogram and wall motion abnormality measurement are not quantitative, and creatine phophokinase (CPK) measurement is inaccurate in the presence of reperfusion or right ventricular infarction. Methods have been developed to localize and size acute myocardial infarcts with agents that are selectively sequestered in areas of myocardial damage, but previously used agents have lacked sufficient specificity. Antibodies that bind specifically only to damaged myocardial cells may resolve this problem and provide an accurate method for noninvasively measuring infarct size. We determined the accuracy with which infarcted myocardial mass can be measured using single photon emission computed tomography (SPECT) and radiolabeled antimyosin antibodies. Seven patients with acute myocardial infarction and one stable angina patient were injected with 2 mCi of Indium-111 labeled antimyosin antibodies. Planar image and SPECT was performed 24 hours later. None of the patients had history of prior infarcts, and none had undergone reperfusion techniques prior to the study, which was done within 4 days of the attack. Planar image showed all infarct patients to have postive uptakes in the cardiac region. The location of this uptake correlated to the infarct site as indicated by electrocardiography in most of the cases. The angina patient, however, showed no such abnormal uptake. Infarct size was determined from transverse slices of the SPECT image using a 45% threshold value obtained from a phantom study. Measured infarct size ranged from 40 to 192 gr. There was significant correlation between the infarct size measured by SPECT and that estimated from serial measurements of CPK (r=0.73, p<0.05). These date suggest that acute myocardial infarct size can be accurately measured from SPECT Indium-111 antimyosin imaging. This method may be especially valuable in situations where other methods are unreliable, such as early reperfusion technique, right ventricular infarct or presence of prior infarcts.

• The Korean Journal of Nuclear Medicine Technology
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• 제13권3호
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• pp.3-9
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• 2009

Purpose: It is well-known that stress-induced stunning and reversible perfusion defect have impact on ejection fraction (EF) when performing myocardial perfusion SPECT. Due to these reasons, gated SPECT is recommended at stress and rest studies. And there was many experiments to analyze between Stress and Rest EF by using $^{99m}Tc$-MIBI. The aim of this study is to analyze between stress EF and rest EF at myocardial perfusion SPECT by using $^{201}Tl$ and define possible predictors of EF variability. Materials and Methods: From 2008 June to 2009 February, we analyzed 144 patients undergoing $^{201}Tl$ gated myocardial perfusion SPECT in ASAN medical center. To analyze the data, we use QGS (Quantitative gated SPECT) software, and derived End-systolic volume (ESV), End-diastolic volume (EDV), EF from the result. In this study, we comparatively analyzed stress/rest EF correlation based on stress/rest EF, EDV, ESV and reversibility of myocardial perfusion defect by using paired t-test, Bland-Altman analysis. Results: Mached pairs of stress EF and rest EF demonstrated excellent correlation (r=0.92) with no statistically significant difference (p=0.11). Bland-Altman analysis demonstrated a mean ${\Delta}EF$ was 0.52% (95% confidential interval[CI], -1.17~0.12%). No statistically significant difference between a mean ${\Delta}EF$ and hypothetic mean of 0 (${\Delta}EF$=0) (p=0.10). In the correlation of ${\Delta}EF$ according to stress/rest EDV and ESV, except rest ESV of <28mL (p<0.05), there was no statistically significant difference. In the correlation of ${\Delta}EF$ according to reversibility of perfusion defect, patients with reversible perfusion defect has statistically significant difference of ${\Delta}EF$ (p<0.05). ${\Delta}EF$ of stress/rest EF showed no statistically significant difference except 55% of rest EF (p<0.05). Conclusion: Like studies with $^{99m}Tc$-MIBI, there was generally no statistically significant difference between stress and rest EF in this study results. However a stress EF of <55%, a rest ESV of <28mL and patients with reversible perfusion defect showed statistically significant difference in ${\Delta}EF$. If performing $^{201}T$ myocardial perfusion SPECT to patients with abnormal cardiac function or reversible perfusion defect, consider this study results and apply it. We expect this study results could be useful predictors of ${\Delta}EF$ variability.

• Nuclear Medicine and Molecular Imaging
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• 제43권5호
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• pp.386-394
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• 2009

Purpose: We aimed to assess the myocardial velocity on gated myocardial perfusion SPECT (gated MPS), to compare myocardial velocity between patients without coronary artery disease (CAD) and CAD patients and to assess the correlation of myocardial velocity and perfusion and wall thickening on CAD group. Materials and Methods: Seventeen patients without CAD (M:F=9:8, mean age $61.8{\pm}11.1$ yrs: group A) and thirty-nine patients with CAD (M:F=18:21, mean age $66.9{\pm}8.1$ yrs : group B) had undergone one-day adenosine stress gated MPS. In twenty segment model, 12 segments (except apical and basal segments) of each patient were included. We obtained systolic and diastolic gate ratio in left ventricular volume curve by eight frames per cardiac cycle on gated MPS. Using the systolic and diastolic gate ratio and R-R time of each patient, we obtained systolic and diastolic time ratio. The myocardial velocity was defined as wall thickening over systolic or diastolic time. Results: We presented normal range of myocardial velocities according segments and territories of coronary artery. The myocardial velocity of group B was significantly lower than group A (p=0.00). There was no significant difference between the myocardial velocity of group B with preserved EF and group A. The stress systolic velocity significantly correlated with regional myocardial perfusion in group B with preserved EF (p=0.00) as well as decreased EF (p=0.01). In group B, stress perfusion of segments which had decreased wall thickening and decreased myocardial velocity was significantly lower than segments which had decreased wall thickening and preserved myocardial velocity (p=0.01). Conclusion: The new functional index of velocity will be used as an useful of gated MPS.

• Journal of Korea Multimedia Society
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• 제9권7호
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• pp.808-817
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• 2006

Although the generally used the velocity index of doppler effect is a very significant factor in the functional evaluation of the left ventricle, it depends on the subjective evaluation of an inspector. The objective data of the motility can be obtained from the gated myocardial SPECT images by quantitative analysis. However, it is difficult to image visual of the velocity of the motion. The aim of our study is to develop a new method for the imaging velocity using the gated myocardial SPECT images and use it as an evaluation index for analyzing motility. First we visualized left ventricle into 3 dimensions using the coordinates of the points which were obtained through a segmentation of myocardium. Each point was represented by the different colors, according to the velocity of each point. We performed a validation study using 7 normal subjects and 15 myocardial infarction patients. To analyze motility, we used the average of the moved distance and the velocity. In normal cases, the average of the moved distance was 4.3mm and the average of the velocity was 11.9mm. In patient cases, the average of the moved distance was 3.9mm and the average of the velocity was 10.5mm. These results show that the motility of normal subjects is higher than the abnormal subjects. We expect that our proposed method could become a way to improve the accuracy and reproducibility for the functional evaluation of myocardial wall.