Nichols Kenneth J, Van Tosh Andrew, Wang Yi, Chen Ji, Garcia Ernest V, Palestro Christopher J, Reichek Nathaniel
Division of Nuclear Medicine and Molecular Imaging, North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
Nucl Med Commun. 2009 Apr;30(4):292-9. doi: 10.1097/MNM.0b013e3283296194.
Algorithms have been developed to quantify global and regional left ventricular (LV) function and asynchrony from myocardial perfusion (MP) and blood pool (BP)-gated single-photon emission computer-assisted tomography, but relationships between measurements from these two imaging modalities have not been documented. The objective of this investigation was to determine the degree to which automated BP and MP measurements agree with each other and are accurate, using cardiac magnetic resonance (CMR) as the reference standard. We also sought to determine the extent to which regions of abnormal phase correspond to segments exhibiting abnormal wall motion.
We studied 20 patients with prior myocardial infarction (age 60+/-11 years; 95% males) who had BP, MP, and ECG-gated CMR data acquisitions. MP and BP measured parameters included global ejection fraction (EF) and volumes, regional contraction phases, and standard deviations and bandwidths of phase versus R-R histograms. CMR algorithms used manually drawn endocardial and epicardial contours to measure global and regional wall motion and wall thickening. Regional measurements were resampled for all three imaging modalities into 17 conventional LV territories.
BP LV counts significantly exceeded MP counts with a ratio of 5.2 : 1. There were no differences among the three methods for global EFs or volumes (analysis of variance P=0.86 and 0.94). MP and BP correlated equally well (P=0.15) versus CMR for global EFs (MP: r=0.87 and BP: r=0.95) and volumes (r=0.91 for both). Phase histogram parameters correlated significantly for MP versus BP for phase standard deviation (r=0.79) and phase bandwidth (r=0.93). Detection of five patients with significantly extended phase bandwidth, indicative of asynchrony, showed 'good agreement' between MP and BP (kappa=0.73; McNemar's difference=0%, P=0.48). Abnormal regional BP EF predicted abnormal wall motion of specific LV segments (receiver-operating characteristic area=85+/-2%), and abnormal regional MP wall thickening predicted abnormal CMR wall thickening (receiver-operating characteristic area=87+/-3%). Abnormal MP phase was present in 25% of 67 dyssynergic segments and 64% of segments adjacent to dyssynergic segments, indicating that locations of phase abnormalities were more widely distributed in the LV than sites of depressed wall motion.
MP and BP measures of LV global and regional function agreed well with each other and with independent CMR measurements. MP and BP phase measurements suggested that phase abnormalities were more widespread than localized wall motion abnormalities.
已开发出算法，用于从心肌灌注（MP）和血池（BP）门控单光子发射计算机断层扫描中量化左心室（LV）整体和局部功能及不同步性，但这两种成像方式测量结果之间的关系尚未见报道。本研究的目的是使用心脏磁共振成像（CMR）作为参考标准，确定自动BP和MP测量结果相互之间的一致程度及准确性。我们还试图确定异常相位区域与表现出异常壁运动的节段的对应程度。
我们研究了20例既往有心肌梗死的患者（年龄60±11岁；95%为男性），这些患者均进行了BP、MP及心电图门控CMR数据采集。MP和BP测量的参数包括整体射血分数（EF）和容积、局部收缩期以及相位与RR直方图的标准差和带宽。CMR算法使用手动绘制的心内膜和心外膜轮廓来测量整体和局部壁运动及壁增厚。对所有三种成像方式的局部测量结果重新采样，分为常规的17个左心室区域。
BP左心室计数显著超过MP计数，比例为5.2:1。三种方法在整体EF或容积方面无差异（方差分析P = 0.86和0.94）。MP和BP与CMR在整体EF（MP: r = 0.87；BP: r = 0.95）和容积（两者r = 0.91）方面的相关性相同（P = 0.15）。MP与BP在相位标准差（r = 0.79）和相位带宽（r = 0.93）方面的相位直方图参数显著相关。检测出5例相位带宽显著延长（提示不同步）的患者，结果显示MP和BP之间“一致性良好 ”（kappa = 0.73；McNemar差异 = 0%，P = 0.48）。异常的局部BP EF可预测特定左心室节段的异常壁运动（受试者操作特征面积 = 85±2%），异常的局部MP壁增厚可预测异常的CMR壁增厚（受试者操作特征面积 = 87±3%）。67个运动不协调节段中有25%以及与运动不协调节段相邻的节段中有64%存在异常MP相位，这表明相位异常在左心室中的分布比壁运动减弱的部位更广泛。
MP和BP对左心室整体和局部功能的测量结果相互之间以及与独立的CMR测量结果一致性良好。MP和BP相位测量结果表明，相位异常比局限性壁运动异常更为广泛。
