Journal of Nuclear Cardiology

, Volume 24, Issue 4, pp 1378–1388 | Cite as

Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography

  • Hiroto YoneyamaEmail author
  • Kenichi Nakajima
  • Koichi Okuda
  • Shinro Matsuo
  • Masahisa Onoguchi
  • Seigo Kinuya
  • Lars Edenbrandt
Original Article



We compared two reconstruction algorisms and two cardiac functional evaluation software programs in terms of their accuracy for estimating ejection fraction (EF) of small hearts (SH).


The study group consisted of 66 pediatric patients. Data were reconstructed using a filtered back projection (FBP) method without the resolution correction (RC) and an iterative method based on an ordered subset expectation maximization (OSEM) algorithm with the RC. EF was evaluated using two software programs of quantitative gated single-photon emission computed tomography (SPECT) (QGS) and cardioREPO. We compared the EF of gated myocardial perfusion SPECT to echocardiographic measurement (Echo).


Forty-eight of 66 patients had an end-systolic volume < 20 mL which was used as the criterion for being included in the SH group, and the SH effect led to an overestimation of EF. While significant differences were observed between Echo (66.9 ± 5.0%) and QGS-FBP without RC (76.9 ± 8.4%, P < .0001), QGS-OSEM with RC (76.6 ± 8.6%, P < .0001), and cardioREPO-FBP without RC (72.1 ± 10.0%, P = .0011), no significant difference was observed between Echo and cardioREPO-OSEM with RC (67.4 ± 6.1%) in SH group.


In pediatric gated myocardial perfusion SPECT, the SH effect can be significantly reduced when an OSEM algorithm is used with RC in combination with the specific cardioREPO algorithm.


Ejection fraction small-heart effect resolution correction quantitative gated SPECT cardioREPO 



Echocardiographic measurement


End-diastolic volume


Ejection fraction


End-systolic volume


Filtered back projection


Left ventricle


Ordered subset expectation maximization


Quantitative gated SPECT


Resolution correction


Small heart



The authors thank all the nuclear medicine physicians at Kanazawa University Hospital for their interpretation of gated myocardial perfusion SPECT images. We are grateful to M. Tobisaka, M. Kawamura, T. Konishi, S. Hanaoka, T. Shibutani, and all the radiological technologists at Kanazawa University Hospital for providing technical support.

Compliance with ethical standards

Ethical approval

The study protocol was approved by the ethical committee of Kanazawa University Hospital.


Kenichi Nakajima has done a collaborative research work with FIJIFILM RI Pharma Co Ltd. (Tokyo, Japan) for the development of software programs. Lars Edenbrandt is employed by and is a shareholder of EXINI Diagnostics AB (Lund, Sweden).

Supplementary material

12350_2016_518_MOESM1_ESM.pptx (285 kb)
Supplementary Material 1 (PPTX 285 kb)


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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Hiroto Yoneyama
    • 1
    Email author
  • Kenichi Nakajima
    • 2
  • Koichi Okuda
    • 3
  • Shinro Matsuo
    • 2
  • Masahisa Onoguchi
    • 4
  • Seigo Kinuya
    • 2
  • Lars Edenbrandt
    • 5
  1. 1.Department of Radiological TechnologyKanazawa University HospitalKanazawaJapan
  2. 2.Department of Nuclear MedicineKanazawa University HospitalKanazawaJapan
  3. 3.Department of PhysicsKanazawa Medical UniversityKanazawaJapan
  4. 4.Department of Health Science, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
  5. 5.Department of Molecular and Clinical MedicineUniversity of GothenburgGothenburgSweden

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