Journal of Nuclear Cardiology

, Volume 25, Issue 4, pp 1156–1163 | Cite as

Count density curves for gated SPECT myocardial perfusion imaging studies: An overview of technical considerations, patterns in various arrhythmia-related artifacts, and a technologist’s guide for curve plotting

  • Mohsen Qutbi
Technical Corner


Gated SPECT myocardial perfusion imaging (MPI) is among the most widely used diagnostic procedures in nuclear medicine. Complexity of the acquisition procedure and its dependence on the status and regularity of the patient’s electrocardiographic signal during image acquisition make this procedure susceptible to technical errors and a variety of artifacts. Thus, a number of tools have been developed to control the quality of images. A qualified technologist or physician should have a substantial knowledge of various artifacts and be familiar with using the available state-of-the-art software packages for advanced processing and appropriate quality control tools, including count density curves, and how to plot them. In the present technical note, we intended to provide an overview of technical considerations regarding some of the most important arrhythmia-related artifacts in gated SPECT MPI and available quality control tools, primarily focused on count density curves, and...



No conflict of interests is declared. No fund or financial support was assigned to this project.


  1. 1.
    Abidov A, Germano G, Hachamovitch R, Slomka P, Berman DS. Gated SPECT in assessment of regional and global left ventricular function: an update. J Nucl Cardiol 2013;20:1118-43.CrossRefPubMedGoogle Scholar
  2. 2.
    Holly TA, Abbott BG, Al-Mallah M, Calnon DA, Cohen MC, DiFilippo FP, et al. Single photon-emission computed tomography. J Nucl Cardiol 2010;17:941-73.CrossRefPubMedGoogle Scholar
  3. 3.
    Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.CrossRefPubMedGoogle Scholar
  4. 4.
    Hesse B, Lindhardt TB, Acampa W, Anagnostopoulos C, Ballinger J, Bax JJ, et al. EANM/ESC guidelines for radionuclide imaging of cardiac function. Eur J Nucl Med Mol Imaging 2008;35:851-85.CrossRefPubMedGoogle Scholar
  5. 5.
    Verberne HJ, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P, et al. EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging 2015;42:1929-40.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Germano G, Berman DS. Physics and technical aspects of gated myocardial perfusion SPECT. In: Germano G, Berman DS, editors. Clinical gated cardiac SPECT. Oxford: Blackwell; 2006. p. 27-45.CrossRefGoogle Scholar
  7. 7.
    Germano G, Van Kriekinge SD, Berman DS. Regional and global ventricular function and volumes from SPECT perfusion imaging. In: Zaret BL, Beller GA, editors. Clinical nuclear cardiology: state of the art and future directions. Philadelphia: Mosby Elsevier; 2010. p. 194-222.CrossRefGoogle Scholar
  8. 8.
    Corbett JR, Akinboboye OO, Bacharach SL, Borer JS, Botvinick EH, DePuey EG, et al. Equilibrium radionuclide angiocardiography. J Nucl Cardiol 2006;13:e56-79.CrossRefPubMedGoogle Scholar
  9. 9.
    Mirvis DM, Goldberger AL. Electrocardiography. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine. Philadelphia: Elsevier; 2019. p. 117-53.Google Scholar
  10. 10.
    Nichols K, Dorbala S, DePuey EG, Yao SS, Sharma A, Rozanski A. Influence of arrhythmias on gated SPECT myocardial perfusion and function quantification. J Nucl Med 1999;40:924-34.PubMedGoogle Scholar
  11. 11.
    Nichols K, Yao SS, Kamran M, Faber TL, Cooke CD, DePuey EG. Clinical impact of arrhythmias on gated SPECT cardiac myocardial perfusion and function assessment. J Nucl Cardiol 2001;8:19-30.CrossRefPubMedGoogle Scholar
  12. 12.
    Kasai T, DePuey EG, Sponder I. “W-shaped” volume curve with gated myocardial perfusion single photon emission computed tomography. Ann Nucl Med 2005;19:59-64.CrossRefPubMedGoogle Scholar
  13. 13.
    Kasai T, Depuey EG, Shah AA, Merla VC. Impact of gating errors with electrocardiography gated myocardial perfusion SPECT. J Nucl Cardiol 2003;10:709-11.CrossRefPubMedGoogle Scholar
  14. 14.
    Kim DW, Park SA, Kim CG. Gating error because of prominent T waves with ECG-gated myocardial SPECT. Clin Nucl Med 2008;33:278-9.CrossRefPubMedGoogle Scholar
  15. 15.
    Cullom SJ, Case JA, Bateman TM. Electrocardiographically gated myocardial perfusion SPECT: technical principles and quality control considerations. J Nucl Cardiol 1998;5:418-25.CrossRefPubMedGoogle Scholar
  16. 16.
    Ibrahim DY, DiFilippo FP, Steed JE, Cerqueira MD. Optimal SPECT processing and display: making bad studies look good to get the right answer. J Nucl Cardiol 2006;13:855-66.CrossRefPubMedGoogle Scholar
  17. 17.
    Germano G, Kavanagh PB, Slomka PJ, Van Kriekinge SD, Pollard G, Berman DS. Quantitation in gated perfusion SPECT imaging: the Cedars-Sinai approach. J Nucl Cardiol 2007;14:433-54.CrossRefPubMedGoogle Scholar
  18. 18.
    Garcia EV, Faber TL, Cooke CD, Folks RD, Chen J, Santana C. The increasing role of quantification in clinical nuclear cardiology: the Emory approach. J Nucl Cardiol 2007;14:420-32.CrossRefPubMedGoogle Scholar
  19. 19.
    Liu YH. Quantification of nuclear cardiac images: the Yale approach. J Nucl Cardiol 2007;14:483-91.CrossRefPubMedGoogle Scholar
  20. 20.
    Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor4DM: the Michigan method for quantitative nuclear cardiology. J Nucl Cardiol 2007;14:455-65.CrossRefPubMedGoogle Scholar
  21. 21.
    Khalil MM. Quantitative cardiac SPECT imaging. In: Khalil MM, editor. Basic sciences of nuclear medicine. Berlin: Springer; 2011. p. 311-31.CrossRefGoogle Scholar
  22. 22.
    Germano G, Kavanagh PB, Berman DS. An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images. Int J Card Imaging 1997;13:337-46.CrossRefPubMedGoogle Scholar
  23. 23.
    Paul AK, Nabi HA. Gated myocardial perfusion SPECT: basic principles, technical aspects, and clinical applications. J Nucl Med Technol 2004;32:179-87.PubMedGoogle Scholar
  24. 24.
    Depeuy EG. Artifacts caused by and clarified by gated myocardial perfusion SPECT. In: Germano G, Berman DS, editors. Clinical gated cardiac SPECT. Oxford: Blackwell; 2006. p. 173-86.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  1. 1.Department of Nuclear Medicine, Taleghani Educational Hospital, School of MedicineShahid Beheshti University of Medical SciencesTehranIran

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