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Influence of ROI definition on the heart-to-mediastinum ratio in planar 123I-MIBG imaging

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Iodine-123-metaiodobenzylguanidine (123I-MIBG) imaging with estimation of the heart-to-mediastinum ratio (HMR) has been established for risk assessment in patients with chronic heart failure. Our aim was to evaluate the effect of different methods of ROI definition on the renderability of HMR to normal or decreased sympathetic innervation.

Methods and Results

The results of three different methods of ROI definition (clinical routine (CLI), simple standardization (STA), and semi-automated (AUT) were compared. Ranges of 95% limits of agreement (LoA) of inter-observer variabilities were 0.28 and 0.13 for STA and AUT, respectively. Considering a HMR of 1.60 as the lower limit of normal, 13 of 32 (41%) for method STA and 5 of 32 (16%) for method AUT of all HMR measurements could not be classified to normal or pathologic. Ranges of 95% LoA of inter-method variabilities were 0.72 for CLI vs AUT, 0.65 for CLI vs STA, and 0.31 for STA vs AUT.

Conclusion

Different methods of ROI definition result in different ranges of the LoA of the measured HMR with relevance for rendering the results to normal or pathological innervation. We could demonstrate that standardized protocols can help keep methodological variabilities limited, narrowing the gray zone of renderability.

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Abbreviations

ANOVA:

Analysis of variance

AUT:

Evaluation with semi-automated software

CI:

Confidence interval

CLI:

Manual evaluation in daily clinical routine

HMR:

Heart-to-mediastinum activity ratio

123I-MIBG:

Iodine-123-metaiodobenzylguanidine

LoA:

Limits of agreement

ROI:

Region of interest

SD:

Standard deviation

STA:

Manual standardized evaluation

WR:

Washout rate

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Disclosure

KN has a collaborative research work for creating ROI setting software in this study with FUJIFILM RI Pharma, Co. Ltd, Tokyo, Japan. CM received support from the German Centre for Cardiovascular Research (DZHK) (grant number 81Z4710141) and from the Förderverein des Universitären Herzzentrums Hamburg e.V. The other authors have no conflict of interest to disclose.

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Author notes

    Authors and Affiliations

    1. Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      Christiane Klene MD, Yuske Kobayashi MSc, Annabelle Helberg BA & Janos Mester PhD

    2. Department of Cardiology – Electrophysiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

      Christiane Jungen MD & Christian Meyer MD

    3. DZHK (German Centre for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Germany), Berlin, Germany

      Christiane Jungen MD & Christian Meyer MD

    4. Department of Physics, Kanazawa Medical University, Uchinada, Kahoku, Japan

      Koichi Okuda PhD

    5. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan

      Kenichi Nakajima MD

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    1. Christiane Klene MD
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    Correspondence to Christiane Klene MD.

    Additional information

    Christiane Klene and Christiane Jungen have contributed equally.

    All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Nagara Tamaki, MD.

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    Klene, C., Jungen, C., Okuda, K. et al. Influence of ROI definition on the heart-to-mediastinum ratio in planar 123I-MIBG imaging. J. Nucl. Cardiol. 25, 208–216 (2018). https://doi.org/10.1007/s12350-016-0708-8

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    • DOI: https://doi.org/10.1007/s12350-016-0708-8

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