- Email: [email protected]
Reliability of gated SPECT in assessing left ventricular ejection fraction in ventricles with scarred myocardium
$26
Abstracts Monday afternoon, April 19; 1999
15.16 M O N D A Y P M A P R I L 19
LOCALISATION OF THE ACCESSORY PATHWAY IN WOLFF PARKINSON WHITE SYNDROME: A COMPARISON OF ECG AND RADIONUCLIDE VENTRICULOGRAPHY J Prosser, A Ng, W Martin, A Rankin, I Hutton. Dept.ofMedical Cardiology, Royal Infa-mary, Glasgow, Scotland The site of the accessory conduction pathway in Wolff-ParkinsonWhite syndrome is determined by an electrophysiology study (EPS), prior to radio-frequency ablation (RFA). EPS time could be reduced if non-invasive localisation of the pathway was accurate. 22 patients for rf-ablation underwent gated radionuclide ventriculography (RNVG). Fourier phase images were generated and analysis, by continuous cine loop display of phase masks, was performed by two independent observers to localise the site. A full 12 lead ECG was analysed by a single experienced observer and again, the site determined. Reported pathway sites were expressed in terms of the number of segments away from the actual location, determined by EPS (n=15 segments). Mean values were 0.91 segments for the ECG, 1.27 and 0.95 for the phase images (Observerl and Observer2), respectively. No significant difference was found between phase image and ECG localisation. Lateral sites were identified more reliably by the phase images while right and septal pathways were poorly identified. The ECG was most inaccurate in lateral and posterior sites. Identification of ACP sites from Fourier phase images is a useful adjunct to the standard ECG and may allow identification of multiple pathways.
Journal of Nuclear Cardiology January/February 1999, Part 2
15.18 EASY NUCLEAR DATABASE: A UNIFIED DATABASE ENTRY AND REPORT GENERATION PROGRAM FOR NUCLEAR PERFUSION IMAGING, Renee Fabrizi, Haresh Majmundar, Gregory S. Thomas Mission Internal Medical Group, Mission Viejo CA, USA Methods: A database application using Microsoft Access 97 was developed which allows simultaneous database entry and production of the official report of a nuclear perfusion study. Demographic and procedural information are entered by the technical staff followed by the physician entering the interpretation of the perfusion images. Advanced word processing technology now incorporated into database software facilitates rapid report typing. The report can then be instantly printed or faxed from the computer for immediate use by referring physicians, simultaneously becoming part of the lab database. Results: To date, 2900 patients have been entered into the database using the unified database entry and report form. The database has facilitated the correlation of perfusion scan results with the results of coronary angiography in patients who go on to cardiac cath. Such continuous cath feedback has been shown to enhance the accuracy of test interpretation. The database has also allowed the development of a lab Report Card for referring physicians. Positive and negative predictive accuracy are highlighted in the Report Card as well as other indices such as the gatekeeper function of nuclear cardiology--the rate of cardiac cath in patients with normal scans. Conclusion: A combined database entry and report generation form was developed using off-the-shelf software which eases database development and eliminates the need for preliminary reports and the delays resulting from transcription services.
15.17
15.19
RESTJAE;CARDIACSFBCI'W1Ttt INF[M)GD~J~ ATIENUATION O O R R ~ O N IN P A T I ~ WITH PRIOR INF~IOR MYOCARDIAL INFARCTION
RELIABILITY OF GATED SPECT IN ASSESSING LEFT VENTRICULAR EJECTION FRACTION IN VENTRICLES WITH SCARRED MYOCARDIUM, F. A1-Khori, P. M. McNelis, W.A. Van Decker. Allegheny University of the Health Sciences, Philadelphia, PA.
C .Decker,W.Teichronn*,T.Mmnde Dpts. of Nuclear Medicine and Cardiolog/:", Y~rtin-Luther-University }{~lle-Wittenberg, Germany Aim of the present study was to ~ the effect of inhomogeneous attenuation correction (AC) by simultaneous transndssion-~'on tomography regarding the inferior myocardial uptake in 20 patients with leftventriod~r inferior myocardial infarction (MI) (62,4+/-7,6y.) and 20 controls. After Thallium 201 rest injection a S P ~ was performed using a triple-~d canexa (Picker, 123 Gd line source) and an iterative image reconstruction with and without AC. Maltifactorial a n a l y s i s s h ~ d significant differences in inferior myocardial uptake (p
Background: Gated SPECT (GS) is an often utilized method of assessing global left ventrieular ejection fraction (EF). Theoretical concerns have been raised about the validity of the technique in images with large perfusien defectswhere artificial intelligence extrapolates ventrieular edge detection. Methods: To validate EF calculated by GS in grossly abnormal perfusion images, we comparedthe EF calculatedby GS to EF calculated by first pass method (FP). 42 patients (10 female and 32 male) with known previous myoeardial infarction and severe fixed perfusion defeets of greater than 20% ofmyocardiumby quantitative polar plots. GS EF on ADAC camera, Germano calculation (Germano et al. JNMI995;36:2138-47) with 8 frame/cycle. FP EF on same patients, same day with SIMMS first pass erystal. All tetrofosmin tracer. Results plotted to line of identity with regression analysis and T-testing results. Results:
. ] .
"~
.
.~
a
~
i ,~
//
(GSEF:29d: 8,
i
FPEF:30.4- 7; R=0.81; p = N S )
rP=r
Conclusions: EF can be reliably measured using a gated SPECT program despite severe large fixed perfusion defects on images.
Abstracts Monday afternoon, April 19; 1999
15.16 M O N D A Y P M A P R I L 19
LOCALISATION OF THE ACCESSORY PATHWAY IN WOLFF PARKINSON WHITE SYNDROME: A COMPARISON OF ECG AND RADIONUCLIDE VENTRICULOGRAPHY J Prosser, A Ng, W Martin, A Rankin, I Hutton. Dept.ofMedical Cardiology, Royal Infa-mary, Glasgow, Scotland The site of the accessory conduction pathway in Wolff-ParkinsonWhite syndrome is determined by an electrophysiology study (EPS), prior to radio-frequency ablation (RFA). EPS time could be reduced if non-invasive localisation of the pathway was accurate. 22 patients for rf-ablation underwent gated radionuclide ventriculography (RNVG). Fourier phase images were generated and analysis, by continuous cine loop display of phase masks, was performed by two independent observers to localise the site. A full 12 lead ECG was analysed by a single experienced observer and again, the site determined. Reported pathway sites were expressed in terms of the number of segments away from the actual location, determined by EPS (n=15 segments). Mean values were 0.91 segments for the ECG, 1.27 and 0.95 for the phase images (Observerl and Observer2), respectively. No significant difference was found between phase image and ECG localisation. Lateral sites were identified more reliably by the phase images while right and septal pathways were poorly identified. The ECG was most inaccurate in lateral and posterior sites. Identification of ACP sites from Fourier phase images is a useful adjunct to the standard ECG and may allow identification of multiple pathways.
Journal of Nuclear Cardiology January/February 1999, Part 2
15.18 EASY NUCLEAR DATABASE: A UNIFIED DATABASE ENTRY AND REPORT GENERATION PROGRAM FOR NUCLEAR PERFUSION IMAGING, Renee Fabrizi, Haresh Majmundar, Gregory S. Thomas Mission Internal Medical Group, Mission Viejo CA, USA Methods: A database application using Microsoft Access 97 was developed which allows simultaneous database entry and production of the official report of a nuclear perfusion study. Demographic and procedural information are entered by the technical staff followed by the physician entering the interpretation of the perfusion images. Advanced word processing technology now incorporated into database software facilitates rapid report typing. The report can then be instantly printed or faxed from the computer for immediate use by referring physicians, simultaneously becoming part of the lab database. Results: To date, 2900 patients have been entered into the database using the unified database entry and report form. The database has facilitated the correlation of perfusion scan results with the results of coronary angiography in patients who go on to cardiac cath. Such continuous cath feedback has been shown to enhance the accuracy of test interpretation. The database has also allowed the development of a lab Report Card for referring physicians. Positive and negative predictive accuracy are highlighted in the Report Card as well as other indices such as the gatekeeper function of nuclear cardiology--the rate of cardiac cath in patients with normal scans. Conclusion: A combined database entry and report generation form was developed using off-the-shelf software which eases database development and eliminates the need for preliminary reports and the delays resulting from transcription services.
15.17
15.19
RESTJAE;CARDIACSFBCI'W1Ttt INF[M)GD~J~ ATIENUATION O O R R ~ O N IN P A T I ~ WITH PRIOR INF~IOR MYOCARDIAL INFARCTION
RELIABILITY OF GATED SPECT IN ASSESSING LEFT VENTRICULAR EJECTION FRACTION IN VENTRICLES WITH SCARRED MYOCARDIUM, F. A1-Khori, P. M. McNelis, W.A. Van Decker. Allegheny University of the Health Sciences, Philadelphia, PA.
C .Decker,W.Teichronn*,T.Mmnde Dpts. of Nuclear Medicine and Cardiolog/:", Y~rtin-Luther-University }{~lle-Wittenberg, Germany Aim of the present study was to ~ the effect of inhomogeneous attenuation correction (AC) by simultaneous transndssion-~'on tomography regarding the inferior myocardial uptake in 20 patients with leftventriod~r inferior myocardial infarction (MI) (62,4+/-7,6y.) and 20 controls. After Thallium 201 rest injection a S P ~ was performed using a triple-~d canexa (Picker, 123 Gd line source) and an iterative image reconstruction with and without AC. Maltifactorial a n a l y s i s s h ~ d significant differences in inferior myocardial uptake (p
Background: Gated SPECT (GS) is an often utilized method of assessing global left ventrieular ejection fraction (EF). Theoretical concerns have been raised about the validity of the technique in images with large perfusien defectswhere artificial intelligence extrapolates ventrieular edge detection. Methods: To validate EF calculated by GS in grossly abnormal perfusion images, we comparedthe EF calculatedby GS to EF calculated by first pass method (FP). 42 patients (10 female and 32 male) with known previous myoeardial infarction and severe fixed perfusion defeets of greater than 20% ofmyocardiumby quantitative polar plots. GS EF on ADAC camera, Germano calculation (Germano et al. JNMI995;36:2138-47) with 8 frame/cycle. FP EF on same patients, same day with SIMMS first pass erystal. All tetrofosmin tracer. Results plotted to line of identity with regression analysis and T-testing results. Results:
. ] .
"~
.
.~
a
~
i ,~
//
(GSEF:29d: 8,
i
FPEF:30.4- 7; R=0.81; p = N S )
rP=r
Conclusions: EF can be reliably measured using a gated SPECT program despite severe large fixed perfusion defects on images.