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Left ventricle function assessment using gated first-pass 18F-FDG PET: Validation against equilibrium radionuclide angiography

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Journal of Nuclear Cardiology Aims and scope

Abstract

Purpose

We appraised the feasibility of left ventricle (LV) function assessment using gated first-pass 18F-FDG PET, and assessed the concordance of the produced measurements with equilibrium radionuclide angiography (ERNA).

Materials and Methods

Twenty-four oncologic patients benefited from 99mTc-labeled red-blood-cell ERNA, in planar mode (all patients) and using SPECT (22 patients). All patients underwent gated first-pass 18F-FDG cardiac PET. Gated dynamic PET images were reconstructed over 1 minute during tracer first-pass inside the LV and post-processed using in-house software (TomPool). After re-orientation into cardiac canonical axes and adjustment of the valves plane using a phase image, pseudo-planar PET images obtained by re-projection were automatically segmented using thresholded region growing and gradient-based delineation to produce an LV ejection fraction (EF) estimate. PET images were also post-processed in fully-tomographic mode to produce LV end diastole volume (EDV), end systole volume (ESV), and EF estimates. Concordance was assessed using Lin’s concordance (ccc) and Bland-Altman analysis. Reproducibility was assessed using the coefficient of variation (CoV) and intra-class correlation (ICC).

Results

Pseudo-planar PET EF estimates were concordant with planar ERNA (ccc = 0.81, P < .001) with a bias of 0% (95% CI [− 2%; 3%], limits of agreement [− 11%; 12%]). Reproducibility was excellent and similar for both methods (CoV = 2 ± 1% and 3 ± 2%, P = NS; ICC = 0.97 and 0.92, for PET and ERNA, respectively). Measurements obtained in fully-tomographic mode were concordant with SPECT ERNA: ccc = 0.83 and bias = − 3 mL for LV EDV, ccc = 0.92 and bias = 0 mL for LV ESV, ccc = 0.89 and bias = − 1% for LV EF (all P values < .001 for ccc, all biases not significant).

Conclusions

Gated first-pass 18F-FDG PET might stand as a relevant alternative to ERNA for LV function assessment, enabling a joint evaluation of both therapeutic response and cardiac toxicity in oncologic patients receiving cardiotoxic chemotherapy.

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Abbreviations

LV:

Left ventricle

RV:

Right ventricle

EDV:

End-diastole volume

ESV:

End-systole volume

EF:

Ejection fraction

ERNA:

Equilibrium radionuclide angiography

SPECT:

Single photon emission computerized tomography

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The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France

    Fayçal Ben Bouallègue MD, PhD, Laurent Maïmoun PhD, Pierre Le Fur D Pharm, Fabien Vauchot MD, PhD, Boramy Hay MD & Denis Mariano-Goulart MD, PhD

  2. PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France

    Fayçal Ben Bouallègue MD, PhD, Laurent Maïmoun PhD & Denis Mariano-Goulart MD, PhD

  3. LIRMM, Montpellier University, CNRS, Montpellier, France

    Florentin Kucharczak PhD

  4. UMR QualiSud, Montpellier University, Montpellier, France

    Eric Rondet PhD

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  1. Fayçal Ben Bouallègue MD, PhD
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  2. Laurent Maïmoun PhD
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Correspondence to Fayçal Ben Bouallègue MD, PhD.

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Ben Bouallègue, F., Maïmoun, L., Kucharczak, F. et al. Left ventricle function assessment using gated first-pass 18F-FDG PET: Validation against equilibrium radionuclide angiography. J. Nucl. Cardiol. 28, 594–603 (2021). https://doi.org/10.1007/s12350-019-01731-x

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