Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France.
PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France.
J Nucl Cardiol. 2021 Apr;28(2):594-603. doi: 10.1007/s12350-019-01731-x. Epub 2019 May 1.
We appraised the feasibility of left ventricle (LV) function assessment using gated first-pass F-FDG PET, and assessed the concordance of the produced measurements with equilibrium radionuclide angiography (ERNA).
Twenty-four oncologic patients benefited from Tc-labeled red-blood-cell ERNA, in planar mode (all patients) and using SPECT (22 patients). All patients underwent gated first-pass F-FDG cardiac PET. Gated dynamic PET images were reconstructed over 1 minute during tracer first-pass inside the LV and post-processed using in-house software (TomPool). After re-orientation into cardiac canonical axes and adjustment of the valves plane using a phase image, pseudo-planar PET images obtained by re-projection were automatically segmented using thresholded region growing and gradient-based delineation to produce an LV ejection fraction (EF) estimate. PET images were also post-processed in fully-tomographic mode to produce LV end diastole volume (EDV), end systole volume (ESV), and EF estimates. Concordance was assessed using Lin's concordance (ccc) and Bland-Altman analysis. Reproducibility was assessed using the coefficient of variation (CoV) and intra-class correlation (ICC).
Pseudo-planar PET EF estimates were concordant with planar ERNA (ccc = 0.81, P < .001) with a bias of 0% (95% CI [- 2%; 3%], limits of agreement [- 11%; 12%]). Reproducibility was excellent and similar for both methods (CoV = 2 ± 1% and 3 ± 2%, P = NS; ICC = 0.97 and 0.92, for PET and ERNA, respectively). Measurements obtained in fully-tomographic mode were concordant with SPECT ERNA: ccc = 0.83 and bias = - 3 mL for LV EDV, ccc = 0.92 and bias = 0 mL for LV ESV, ccc = 0.89 and bias = - 1% for LV EF (all P values < .001 for ccc, all biases not significant).
Gated first-pass F-FDG PET might stand as a relevant alternative to ERNA for LV function assessment, enabling a joint evaluation of both therapeutic response and cardiac toxicity in oncologic patients receiving cardiotoxic chemotherapy.
我们评估了门控首过 F-FDG PET 用于左心室 (LV) 功能评估的可行性，并评估了所产生的测量结果与平衡放射性核素血管造影 (ERNA) 的一致性。
24 例肿瘤患者接受了 Tc 标记的红细胞 ERNA 平面模式（所有患者）和 SPECT（22 例患者）检查。所有患者均接受了门控首过 F-FDG 心脏 PET 检查。在示踪剂首次通过 LV 期间，在 1 分钟内重建门控动态 PET 图像，并使用内部软件 (TomPool) 进行后处理。在使用相位图像重新定向到心脏标准轴和调整瓣膜平面后，通过阈值区域生长和基于梯度的描绘获得的伪平面 PET 图像自动分段，以产生 LV 射血分数 (EF) 估计值。还以全断层扫描模式对 PET 图像进行后处理，以产生 LV 舒张末期容积 (EDV)、收缩末期容积 (ESV) 和 EF 估计值。使用 Lin 的一致性 (ccc) 和 Bland-Altman 分析评估一致性。使用变异系数 (CoV) 和组内相关系数 (ICC) 评估可重复性。
伪平面 PET EF 估计值与平面 ERNA 一致 (ccc = 0.81，P <.001)，偏差为 0%（95%CI [-2%；3%]，一致性界限 [-11%；12%]）。两种方法的可重复性均较好且相似（CoV = 2 ± 1% 和 3 ± 2%，P = NS；ICC = 0.97 和 0.92，分别为 PET 和 ERNA）。全断层扫描模式获得的测量值与 SPECT ERNA 一致：LV EDV 的 ccc = 0.83，偏差 = -3 mL，LV ESV 的 ccc = 0.92，偏差 = 0 mL，LV EF 的 ccc = 0.89，偏差 = -1%（所有 P 值 <.001 用于 ccc，所有偏差均无统计学意义）。
门控首过 F-FDG PET 可能成为 LV 功能评估的 ERNA 相关替代方法，使接受心脏毒性化疗的肿瘤患者能够联合评估治疗反应和心脏毒性。
