Left ventricular ejection fraction and volumes from gated blood-pool SPECT: comparison with planar gated blood-pool imaging and assessment of repeatability in patients with heart failure.
Gated blood-pool SPECT (GBPS) has several potential advantages over planar radionuclide ventriculography (PRNV), including the possibility of greater repeatability of left ventricular ejection fraction (LVEF) and the noninvasive calculation of left ventricular end-systolic volume and left ventricular end-diastolic volume (LVEDV). The aim of this study was to assess the repeatability of LVEF and LVEDV from GBPS and to compare LVEF with those from PRNV.


METHODS
Fifty patients underwent PRNV and GBPS, 23 of whom also had repeated studies in the same session. GPBS studies were processed using the Cedars Sinai Quantitative Blood-Pool SPECT (QBS) software that automatically calculates LVEF and LVEDV. Automatic processing with QBS was successful in 70% of the GBPS studies, with the remaining studies processed using the manual option in QBS. All PRNV studies were processed using a manual processing technique.


RESULTS
Comparison of LVEF from PRNV and GBPS yielded a correlation coefficient of 0.80. Bland-Altman analysis demonstrated a mean difference of 0.74% +/- 7.62% (mean +/- SD) between LVEF from the 2 techniques. The 95% limits of agreement are therefore -14.50% to +15.98%. The correlation between repeated measurements was 0.87 for GBPS and 0.95 for PRNV. Bland-Altman analysis revealed poorer repeatability for GBPS (95% limits of agreement, -9.63% to +14.97% vs. -4.66% to +5.92%; P = 0.003). The mean LVEDV was 198 +/- 94 mL, with a mean difference of 9 +/- 47 mL between repeated measurements. The 95% limits of agreement are therefore -85 to +103 mL.


CONCLUSIONS
GBPS provides a less repeatable measurement of LVEF than PRNV. Repeatability of LVEDV measurements from GBPS is poor.
Wright
Graham A
GA
Department of Nuclear Medicine, Hull Royal Infirmary, Anlaby Road, Kingston Upon Hull, UK. graham@physicist.net
Thackray
Simon
S
Howey
Syd
S
Cleland
John G
JG
D002302:Cardiac Output; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D012044:Regression Analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*