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Potential added value of three-dimensional reconstruction and display of single photon emission computed tomographic
E H Botvinick1, J W O'Connell, P P Kadkade
1Department of Medicine, Cardiovascular Research Institute of the University of California San Francisco, USA. eli@itsa.ucsf.edu
Background:
Single photon emission computed tomographic (SPECT) acquisition provides potential advantages for blood pool imaging. However, the method has been little applied.
Methods:
An improved method of three-dimensional (3-D) reconstruction and display of SPECT equilibrium blood pool scintigrams and related phase data was developed. Dynamic slices and volume-rendered dynamic 3-D images were displayed. Images were viewed from each of 34 solid angles referenced to a sphere surrounding the reconstruction field. Each image pixel was "painted" with intensity-coded regional amplitude and color-coded for its phase angle. The method was applied to evaluate the cardiac anatomy, regional contraction, and related conduction sequence at rest in 17 patients. Twelve had normal left ventricular function including 7 patients with minimal septal preexcitation. Five patients had abnormal left ventricular function, including 2 with left bundle branch block.
Results:
Slices contained all of the functional information, but necessary data integration was time-consuming and evaluation of chamber size and anatomy was difficult. Three-dimensional projection images condensed and integrated the data, presenting new vantage points on anatomy, contraction, and conduction not otherwise available in the clinically limited angulations of planar images. This provided excellent visual separation of cardiac chambers with full and increased visualization of right and left ventricular wall motion in all segments compared with the conventional projections acquired clinically (p < 0.05). Atria and great vessels were well separated with evident size and function. Phase-angle progression paralleled the electrocardiogram, permitting bypass pathway localization and the direct noninvasive localization of posteroseptal pathways.
Conclusions:
The 3-D method permits greater access to and utilization of SPECT blood pool image data. It suggests specific advantages for clinical use.