Reducing the small-heart effect in pediatric gated myocardial perfusion single-photon emission computed tomography
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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.
KeywordsEjection fraction small-heart effect resolution correction quantitative gated SPECT cardioREPO
Filtered back projection
Ordered subset expectation maximization
Quantitative gated SPECT
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
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).
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