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. 2023;11(1):55-70.
doi: 10.22038/AOJNMB.2022.60392.1424.

Left ventricular ejection fraction by multigated acquisition scan using planar sodium iodide and cadmium-zinc-telluride cameras: a comparison with two-dimensional echocardiography

Gouri Kumar Das  1 , Chen Siew Ng  1 , Mahayuddin Abdul Manap  2
Affiliations

Left ventricular ejection fraction by multigated acquisition scan using planar sodium iodide and cadmium-zinc-telluride cameras: a comparison with two-dimensional echocardiography

Gouri Kumar Das et al. Asia Ocean J Nucl Med Biol. 2023.

Abstract

Objectives: This study was undertaken to compare the correlation and agreement between Modified Simpson's method two-dimensional-echocardio-graphy (2D-echo) and rest multigated acquisition scan (MUGA) using both planar sodium iodide (pNaI) and cadmium-zinc-telluride (CZT) cameras to measure left ventricular ejection fraction (LVEF).

Methods: One hundred and nine breast cancer patients monitored for cardiotoxicity underwent 2D-echo, followed by pNaI and CZT MUGA scans on the same day. LVEF for CZT camera was processed using both automatic and manual processing methods, thus yielding four methods for the LVEF analysis.

Results: Significant correlation (p<0.01) was seen among all four methods, with varied correlation strengths. Moderate correlation was seen between 2D-echo and both pNaI (r=0.56) and CZT cameras (automatic r=0.54, manual r=0.56). Strong correlation was registered between pNaI and CZT camera (automatic r=0.72, manual r=0.71). Bland-Altman limits of agreement among the three scans were wide and suboptimal. The widest limits were -21.1 to +16.2 (37%) between 2D-echo and CZT auto-processing.

Conclusion: Any one of the modalities can be used to measure LVEF, however, their results should not be used interchangeably. The same method of measurement is advised for serial scans.

Keywords: 2D-echocardiography; Breast cancer; CZT camera; LVEF; MUGA; Planar NaI camera.

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Figures

Figure 1
Figure 1
Modified Simpson's biplane method for measurement of ejection fraction in the apical two-chamber and four-chamber view
Figure 2
Figure 2
Semiautomatic region of interest (ROI) determination around the left ventricle and results of LVEF measurements by planar-NaI camera depicting both global and regional LVEF values
Figure 3
Figure 3
LVEF and RVEF measured by the 3D-CZT camera using QBS software with automatic processing(Top image) and manual processing (Bottom image)
Figure 4
Figure 4
(a- f). Linear correlation plots of LVEF with (a) 2D-echo vs CZT-auto, (b) 2D-echo vs CZT- manual, (c) planar-NaI vs CZT- auto, (d) planar-NaI vs CZT- manual, (e) planar-NaI vs 2D-echo, (f) CZT- auto vs CZT- manual
Figure5 (a-f)
Figure5 (a-f)
Bland-Altman plots with linear regression analysis of the agreement between cameras regarding LVEF for (a) 2D-echo vs CZT-auto, (b) 2D-echo vs CZT- manual, (c) planar-NaI vs CZT- auto, (d) planar-NaI vs CZT- manual, (e) planar-NaI vs 2D-echo, (f) CZT- auto vs CZT- manual
Figure 6
Figure 6
CZT automatic processing results in QBPS software of a patient with ESV value <20mL (2mL in this image) showing overestimated LVEF value of 95% and with regional wall motion detection error (blue arrow). The patient had no cardiac rhythm abnormality, and clinically no left chest wall lesion obscuring or causing attenuation artifacts. ECG showed no left ventricular hypertrophy; radiolabelling efficiency was >90%
Figure 7
Figure 7
CZT camera QBPS software showing overestimation of LVEF (>80%) in small heart volumes (ESV<20mL) with no regional wall motion error
See this image and copyright information in PMC

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