Intravenous left ventriculography utilizing digital subtraction technique

To detect the left ventricular boundary in the intravenous ventriculography, we used a subtraction technique for background suppression. Images containing contrast medium and reference mask images were transferred to a computer through a flying spot scanner and stored on the digital disc. Stored reference mask images were subtracted from the digitized contrast images. The resulting images were then electronically enhanced to extract the left ventricular (LV) image. The LV boundary was delineated with an algorithm we have developed and the volume of the LV cavity was calculated automatically. The validity of this method was compared with data obtained from conventional left ventriculogram (LVG). In 11 patients, values for end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) calculated from the intravenous LVG were correlated closely with those from the conventional LVG (128 +/- 38 (SD) vs 133 +/- 39 ml, r = 0.95; 50 +/- 28 vs 53 +/- 30 ml, r = 0.98; 63 +/- 10 vs 62 +/- 12%, r = 0.96, respectively). Nine patients with valvular regurgitation were followed up serially after valve replacement. EDV index fell significantly after corrective surgery (145 +/- 50 to 81 +/- 33 ml/m2, p less than 0.02), whereas, EF was affected variably depending upon the preoperative state (58 +/- 13 to 61 +/- 11%, not significant). Thus, this method is less invasive than conventional LVG and has successfully allowed for sequential determination of ventricular function on an outpatient basis.