Quantitative LVEF and qualitative regional function from gated thallium-201 perfusion SPECT

G Germano*, J Erel, H Kiat, PB Kavanagh, DS Berman

*Corresponding author for this work

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155 Citations (Scopus)

Abstract

This study investigates the feasibility of routine clinical Tl-201 gated perfusion SPECT (gated Tl), and compares quantitative left ventricular ejection fraction (LVEF) and visually-assessed regional wall motion and thickening to analogous values obtained from Tc-99m-sestamibi gated perfusion SPECT (gated MIBI). Methods: We studied 121 patients with a rest gated Tl (3-3.5 mCi, 35 sec/projection)/poststress gated MIBI (25-30 mCi, 25 sec/projection) separate dual-isotope protocol on a 90 degrees dual-detector camera. Automatic quantitation of LVEFs was accomplished using previously developed and validated software, while visual scoring of motion and thickening was performed using four-point scales, Results: Average myocardial counts were lower in gated Tl images (306 +/- 81 counts/pixel) compared to gated MIBI images (789 +/- 237 counts/pixel). The quality of gated Tl images was ranked as excellent, good, fair and poor in 24.0%, 42.1%, 24.8% and 9.1%, respectively, of the patients, compared to 43.0%, 43.8%, 9.1% and 4.1%, respectively, for gated MIBI images. Quantitative-gated Tl and gated MIBI LVEFs correlated well (y = 0.11 + 1.05x, r = 0.918, SEE = 6.35). Possible poststress myocardial stunning may have caused gated Tl LVEFs to overestimate gated MIBI LVEFs by a larger (p = 0.03) amount in ischemic patients (n = 47, y = -0.69 + 1.09x, r = 0.914, s.e.e. = 6.44) compared to nonischemic patients (n = 64, y = -1.58 + 1.05x, r = 0.919, s.e.e. = 5.93), the residual difference in LVEFs for this latter group being likely due to different isotope resolution in conjunction with small left ventricles. Exact agreement between gated Tl and gated MIBI segmental myocardial function in 41 nonischemic patients was 92.2% (kappa = 0.619) and 95.4% (kappa = 0.586) for motion and thickening scores, respectively. Conclusion: Thallium-201 gated SPECT imaging can be effectively performed on the majority of patients in our clinical environment and offers the opportunity to assess both myocardial perfusion and function using one injection and one imaging sequence, similarly to what is done with Tc-99m-based agents.

Original languageEnglish
Pages (from-to)749-754
Number of pages6
JournalJournal of Nuclear Medicine
Volume38
Issue number5
Publication statusPublished - May 1997
Externally publishedYes

Keywords

  • gated myocardial perfusion SPECT
  • thallium-201
  • automatic quantitative LVEF
  • EMISSION COMPUTED-TOMOGRAPHY
  • MYOCARDIAL PERFUSION
  • VENTRICULAR-FUNCTION
  • TL-201 SCINTIGRAPHY
  • LATE REVERSIBILITY
  • EJECTION FRACTION
  • TC-99M SESTAMIBI
  • TECHNETIUM-99M-SESTAMIBI
  • VIABILITY
  • SEPARATE

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