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Influence of CT-based attenuation correction in assessment of left and right ventricular functions with count-based
Louis Sibille1, Fayçal Ben Bouallegue, Aurélie Bourdon
1Department of Nuclear Medicine, CHRU Lapeyronie, 371 Av. du Doyen Gaston Giraud, 34295, Montpellier, France. louis.sibille@gmail.com
Insights
CT-based attenuation correction in gated blood-pool SPECT (GBPS) for ventricular function assessment results in slightly lower ejection fractions and higher volumes. These differences are minor, particularly within normal ranges.
Area of Science:
- Nuclear Cardiology
- Cardiovascular Imaging
- Medical Physics
Background:
- Gated blood-pool SPECT (GBPS) is a standard technique for assessing left and right ventricular function.
- CT-based attenuation correction (CT-AC) can potentially improve image quality and quantitative accuracy in SPECT.
- The impact of CT-AC on ventricular function assessment using count-based GBPS requires detailed evaluation.
Purpose of the Study:
- To evaluate the influence of CT-based attenuation correction (CT-AC) on the assessment of left and right ventricular functions using count-based gated blood-pool SPECT (GBPS).
- To compare ventricular ejection fractions (EF) and volumes derived from GBPS with and without CT-AC.
- To determine the clinical significance of differences observed with CT-AC in a mixed patient population.
Main Methods:
- Thirty-two patients underwent prospective GBPS imaging.
- GBPS data were reconstructed using an iterative algorithm with (IRAC) and without (IRNC) CT-AC.
- Left and right ventricular ejection fractions (LV EF, RV EF) and volumes (LV EDV, LV ESV, RV EDV, RV ESV) were assessed using watershed algorithm-based segmentation software.
Main Results:
- A strong correlation was observed between parameters assessed with and without CT-AC (r = 0.96-0.98, P < .001).
- CT-AC resulted in significantly lower mean EF (LV EF: 49% vs 51%; RV EF: 50% vs 54%) and higher mean volumes (LV EDV: 142 vs 133 mL; RV EDV: 91 vs 86 mL).
- Limits of agreement indicated slight but noticeable differences, particularly for LV volumes.
Conclusions:
- Count-based GBPS with CT-AC demonstrates a trend towards lower ventricular ejection fractions and higher ventricular volumes compared to non-corrected data.
- The observed differences, while statistically significant, were generally slight, especially for ventricular volumes within the normal to subnormal range.
- CT-AC influences quantitative assessment of ventricular function by GBPS, necessitating careful interpretation of results.
Objective:
Influence of CT-based attenuation correction (CT-AC) in assessment of left and right ventricular functions with count-based gated blood-pool SPECT (GBPS) was evaluated in a mixed population.
Methods:
Thirty-two patients (81% male; mean age 56 ± 12) referred for various symptoms or heart diseases were prospectively included. Data from 32 GBPS acquisitions were reconstructed using an iterative algorithm with (IRAC) and without (IRNC) CT-AC and analyzed using previously described segmentation software based on the watershed algorithm. LV and RV EF and volumes were assessed with and without CT-AC and compared.
Results:
EF and volumes were correlated (P < .001 for all parameters with r = 0.97 for LV and RV EF; r = 0.96 for LV EDV; r = 0.98 for LV ESV; r = 0.96 for RV EDV and ESV). The mean values using IRAC and IRNC were different for all parameters with lower EF (respectively, 49% ± 19% vs 51 %± 18%; P = .002 for LV EF and 50% ± 14% vs 54%±15%; P < .001 for RV EF) and higher volumes (respectively, 142 ± 41 mL vs 133 ± 40 mL; P < .001 and 79 ± 45 mL vs 71 ± 42 mL; P < .001 for LV EDV and ESV; 91 ± 32 mL vs 86 ± 31 mL; P = .003 and 48 ± 28 mL vs 43 ± 26 mL; P < .001 for RV EDV and ESV). Limits of agreement were -11% to 6% and -11% to 4% for LV and RV EF. We found wider limits of agreement for LV volumes (-13 to 32 mL for EDV and -10 to 27 mL for ESV) than for RV volumes (-13 to 23 mL for EDV and -9 to 20 mL for ESV). Taking into account all volumes, we found a trend with a significant positive correlation between means and differences in volumes assessed with and without CT-AC.
Conclusion:
Assessment of both left and right ventricular functions by count-based GBPS with CT-AC showed higher volumes and lower EF. Differences were slight, especially for the range of normal to subnormal ventricular volumes.
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