"Motion-frozen" display and quantification of myocardial perfusion.
Gated myocadial perfusion SPECT (MPS) incorporates functional and perfusion information of the left ventricle (LV). To improve the image quality and accuracy of gated MPS we propose to eliminate the influence of cardiac LV motion in the display and quantification by a novel "motion-frozen" (MF) technique.


METHODS
Three-dimensional LV contours were identified on images of the individual time phases. Three-dimensional phase-to-phase motion vectors were derived by sampling of the epi- and endocardial surfaces. A nonlinear image warping (thin-plate spline) was applied to warp all image phases to fit the end-diastolic (ED) phase. Warped images were created to provide the LV image in the ED phase but containing counts from an arbitrary number of time intervals. MF quantification has been performed using the same phase-to-phase motion vectors. MF normal perfusion limits were created from (99m)Tc sestamibi gated MPS studies of 40 females and 40 males with low likelihood (<5%) of coronary artery disease. All MF processing was completely automated. In the initial evaluation, we assessed the display quality and quantification of stress images using MF processing in 51 consecutive patients with 16-frame electrocardiographic gating and available coronary angiography.


RESULTS
The display quality was significantly better for MF images as assessed visually. The MF images had the appearance of ED frames but were less noisy and of higher resolution than the summed images. MF images had higher maximum count values in the LV (116% +/- 6%) and higher contrast (12.5 +/- 7.7 vs. 9.5 +/- 3.2) than the corresponding summed images. The area under the receiver operator characteristic curve for prediction of stenoses > or = 70% by the MF method was 0.92 +/- 0.04 versus 0.89 +/- 0.04 by standard quantification (P = not significant). The computation time for automated MF quantification and warping was <25 s for each case.


CONCLUSIONS
We have developed a novel technique for display and quantification of gated myocardial perfusion images, which retrospectively eliminates blur due to cardiac motion. Such processing of gated MPS appears to improve the effective resolution of images. Initial evaluation indicates that it may improve the accuracy of gated MPS in detection of coronary artery disease.
Slomka
Piotr J
PJ
Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA. Piotr.Slomka@cshs.org
Nishina
Hidetaka
H
Berman
Daniel S
DS
Kang
Xingping
X
Akincioglu
Cigdem
C
Friedman
John D
JD
Hayes
Sean W
SW
Aladl
Usaf E
UE
Germano
Guido
G
D000368:Aged; D000465:Algorithms; D016477:Artifacts; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D009068:Movement; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity