Skip to main content
SpringerLink
Log in

Automatic quantification of left ventricular ejection fraction from gated blood pool SPECT

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

Abstract

Background

Cardiac gated blood pool single photon emission computed tomography (GBPS) better separates cardiac chambers compared with planar radionuclide ventriculography (PRNV). We have developed a completely automatic algorithm to measure quantitatively the left ventricular ejection fraction (LVEF) from gated technetium 99m-red blood cells (RBC) GBPS short-axis 3-dimensional image volumes.

Methods and Results

The algorithm determines an ellipsoidal coordinate system for the left ventricle and then computes a static estimate of the endocardial surface by use of counts and count gradients. A dynamic surface representing the endocardium is computed for each interval of the cardiac cycle by use of additional information from the temporal Fourier transform of the image data sets. The algorithm then calculates the left ventricular volume for each interval and computes LVEF from the end-diastolic and end-systolic volumes. The algorithm was developed in a pilot group (N=45) and validated in a second group (N=89) of patients who underwent PRNV and 8-interval GBPS. Technically inadequate studies (N=38) were rejected before grouping and processing. Automatic identification and contouring of the left ventricle was successful in 121/172 patients (70%) globally and in 76/89 patients (85%) in the validation group. Correlation between LVEFs measured from GBPS and PRNV was high (y=2.00+1.01x, r=0.89), with GBPS LVEF significantly higher than PRNV LVEF (average difference=2.8% P<.004).

Conclusions

Our automatic algorithm agrees with conventional radionuclide measurements of LVEF and provides the basis for 3-dimensional analysis of wall motion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Shah PK, Pichler M, Berman DS, Singh BN, Swan HJ. Left ventricular ejection fraction determined by radionuclide ventriculography in early stages of first transmural myocardial infarction: relation to short-term prognosis. Am J Cardiol 1980;45:542–6.

    Article  PubMed  CAS  Google Scholar 

  2. CASS Principal Investigators and Associates. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery—comparability of entry characteristics and survival in randomized patients and nonrandomized patients meeting randomization criteria. J Am Coll Cardiol 1984;3:114–28.

    Google Scholar 

  3. The Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med 1983;309:331–6.

    Google Scholar 

  4. Lee KL, Pryor DB, Pieper KS, Harrell FE, Jr, Califf RM, Mark DB, et al. Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease: a comparison of clinical and catheterization variables. Circulation 1990;82:1705–17.

    PubMed  CAS  Google Scholar 

  5. Strauss HW, Zaret BL, Hurley PJ, Natarajan TK, Pitt B. A scintigraphic method for measuring left ventricular ejection fraction in man without cardiac catheterization. Am J Cardiol 1971;28:575–80.

    Article  PubMed  CAS  Google Scholar 

  6. Berman DS, Salel A, DeNardo G, Bogren H, Mason D. Clinical assessment of left ventricular regional contraction patterns and ejection fraction by high-resolution gated scintigraphy. J Nucl Med 1974;16:865–74.

    Google Scholar 

  7. Bacharach SL, Green MV, Borer JS. Instrumentation and data processing in cardiovascular nuclear medicine: evaluation of ventricular function. Semin Nucl Med 1979;9:257–74.

    Article  PubMed  CAS  Google Scholar 

  8. Borer JS, Bacharach SL, Green MV, Kent KM, Epstein SE, Johnston GS. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. N Engl J Med 1977;296:839–44.

    PubMed  CAS  Google Scholar 

  9. Maddahi J, Berman DS, Matsuoka DT, Waxman AD, Stankus KE, Forrester JS, et al. A new technique for assessing right ventricular ejection fraction using rapid multiple-gated equilibrium cardiac blood pool scintigraphy: description, validation and findings in chronic coronary artery disease. Circulation 1979;60:581–9.

    PubMed  CAS  Google Scholar 

  10. Moore ML, Murphy PH, Burdine JA. ECG-gated emission computed tomography of the cardiac blood pool. Radiology 1980;13:233–5.

    Google Scholar 

  11. Chang W, Henkin RE. Seven-pinhole multigated tomography and its application to blood-pool imaging: technical parameters. J Nucl Med 1980;21:682–8.

    PubMed  CAS  Google Scholar 

  12. Gill JB, Moore RH, Tamaki N, Miller DD, Barlai-Kovach M, Yasuda T, et al. Multigated blood pool tomography: new method for the assessment of left ventricular function. J Nucl Med 1986;12:1916–24.

    Google Scholar 

  13. Bartlett M, Bacharach SL, Barker C, et al. SPECT gated blood pool imaging—potentials and problems. In: Computers in Cardiology 1994. Los Alamitos, CA, USA: IEEE Comput Soc Press 1995. p. 197–200.

    Chapter  Google Scholar 

  14. Massie BM, Kramer BL, Gertz EW, Henderson SG. Radionuclide measurement of left ventricular volume: comparison of geometric and counts-based methods. Circulation 1982;65:725–30.

    PubMed  CAS  Google Scholar 

  15. Slutsky R, Karliner J, Ricci D, Kaiser R, Pfisterer M, Gordon D, et al. Left ventricular volumes by gated equilibrium radionuclide angiography: a new method. Circulation 1979;60:556–64.

    PubMed  CAS  Google Scholar 

  16. Dehmer GJ, Firth BG, Hillis LD, Nicod P, Willerson JT, Lewis SE. Nongeometric determination of right ventricular volumes from equilibrium blood pool scans. Am J Cardiol 1982;49:78–84.

    Article  PubMed  CAS  Google Scholar 

  17. Uren RF, Newman HN, Hutton BF, Cormack J, Bernstein L, Allen L, et al. Geometric determination of left ventricular volume from gated blood pool studies using a slant-hole collimator. Radiology 1983;147:541–5.

    PubMed  CAS  Google Scholar 

  18. Caputo GR, Graham MM, Brust KD, Kennedy JW, Nelp WB. Measurement of left ventricular volume using single-photon emission computed tomography. Am J Cardiol 1985;56:781–6.

    Article  PubMed  CAS  Google Scholar 

  19. Underwood SR, Walton S, Laming PJ, Jarritt PH, Ell PJ, Emanuel RW, et al. Left ventricular volume and ejection fraction determined by gated blood pool emission tomography. Br Heart J 1985;53:216–22.

    Article  PubMed  CAS  Google Scholar 

  20. Bunker SR, Hartshorne MF, Schmidt WP, Cawthon MA, Karl RD Jr, Bauman JM, et al. Left ventricular volume determination from single-photon emission computed tomography. Am J Roentgenol 1985;144:295–8.

    CAS  Google Scholar 

  21. Stadius ML, Williams DL, Harp G, Cerqueira M, Caldwell JH, Stratton JR, et al. Left ventricular volume determination using single-photon emission computed tomography. Am J Cardiol 1985;55:1185–91.

    Article  PubMed  CAS  Google Scholar 

  22. McKiddie FI, Gemmell HG, Redpath TW, Trent RJ, Philip WJ, Norton MY, et al. A variable threshold edge-detector for improved quantitation of gated tomographic imaging of the left ventricular blood pool. Nucl Med Commun 1996;17:410–7.

    Article  PubMed  CAS  Google Scholar 

  23. Chin BB, Bloomgarden DC, Xia W, Kim HJ, Fayad ZA, Ferrari VA, et al. Right and left ventricular volume and ejection fraction by tomographic gated blood-pool scintigraphy. J Nucl Med 1997;38:942–8.

    PubMed  CAS  Google Scholar 

  24. Cerqueira MD, Harp GD, Ritchie JL. Quantitative gated blood pool tomographic assessment of regional ejection fraction: definition of normal limits. J Am Coll Cardiol 1992;20:934–41.

    PubMed  CAS  Google Scholar 

  25. Faber TL, Stokely EM, Templeton GH, Akers MS, Parkey RW, Corbett JR. Quantification of three-dimensional left ventricular segmental wall motion and volumes from gated tomographic radionuclide ventriculograms. J Nucl Med 1989;30:638–49.

    PubMed  CAS  Google Scholar 

  26. Corbett JR, Jansen DE, Lewis SE, Gabliani GI, Nicod P, Filipchuk NG, et al. Tomographic gated blood-pool radionuclide ventriculography: analysis of wall motion and left ventricular volumes in patients with coronary artery disease. J Am Coll Cardiol 1985;6:349–58.

    Article  PubMed  CAS  Google Scholar 

  27. Barat JL, Brendel AJ, Colle JP, Magimel-Pelonnier V, Ohayon J, Wynchank S, et al. Quantitative analysis of left-ventricular function using gated single-photon emission tomography. J Nucl Med 1984;25:1167–74.

    PubMed  CAS  Google Scholar 

  28. Boudraa AE, Mallet J, Besson J, Bouyoucef S, Champier J. Left ventricle automated detection method in gated isotopic ventriculography using fuzzy clustering. IEEE Trans Med Imag 1993;12:451–65.

    Article  CAS  Google Scholar 

  29. Levy WC, Jacobson AF, Cerqueira MD, Matsuoka DT, Sheehan FH, Stratton JR. Radionuclide cardiac volumes: effects of region of interest selection and correction for Compton scatter using a buildup factor. J Nucl Med 1992;33:1642–7.

    PubMed  CAS  Google Scholar 

  30. Levy WC, Cerqueira MD, Matsuoka DT, Harp GD, Sheehan FH, Stratton JR. Four radionuclide methods for left ventricular volume determination: comparison of a manual and an automated technique. J Nucl Med 1992;33:763–70.

    PubMed  CAS  Google Scholar 

  31. Duncan J. Knowledge directed left ventricular boundary detection in equilibrium radionuclide angiocardiography. IEEE Trans Med Imag 1987;6:325–36.

    Article  CAS  Google Scholar 

  32. Nelson A, Muswick G, Muzic R, Descamps X. A robust edge detection method for gated radionuclide ventriculograms. J Nucl Med 1996;37:685–9.

    PubMed  CAS  Google Scholar 

  33. Bartlett ML, Srinivasan G, Barker WC, Kitsiou AN, Dilsizian V, Bacharach SL. Left ventricular ejection fraction: comparison of results from planar and SPECT gated blood-pool studies. J Nucl Med 1996;37:1795–9.

    PubMed  CAS  Google Scholar 

  34. Faber TL, Folks RD. Computer processing methods for nuclear medicine images. J Nucl Med Technol 1994;22:145–62.

    Google Scholar 

  35. Gambhir S, Huang S, Digby W, Schelbert H, Phelps M. A new method for partial volume and spillover correction in cardiac PET scans. J Nucl Med 1989;30:824–5.

    Google Scholar 

  36. Germano G, Kavanagh PB, Su HT, Mazzanti M, Kiat H, Hachamovitch R, et al. Automatic reorientation of 3-dimensional, transaxial myocardial perfusion SPECT images. J Nucl Med 1995;36:1107–14.

    PubMed  CAS  Google Scholar 

  37. Green MV, Bacharach SL. Functional imaging of the heart: methods, limitations, and examples from gated blood pool scintigraphy. Prog Cardiovasc Dis 1986;28:319–48.

    Article  PubMed  CAS  Google Scholar 

  38. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–47.

    PubMed  CAS  Google Scholar 

  39. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;1(8476):307–10.

    PubMed  CAS  Google Scholar 

  40. Mariano-Goulart D, Collet H, Kotzki PO, Zanca M, Rossi M. Semi-automatic segmentation of gated blood pool emission tomographic images by watersheds: application to the determination of left and right ejection fractions. Eur J Nucl Med 1998;25:1300–7.

    Article  PubMed  CAS  Google Scholar 

  41. Koenderink, JJ The structure of images. Biol Cybern 1984;50:363–70.

    Article  PubMed  CAS  Google Scholar 

  42. Hoffman E, Huang S, Phelps M. Quantitation in positron emission tomography: 1. Effect of object size. J Comput Assist Tomogr 1979;3:299–308.

    Article  PubMed  CAS  Google Scholar 

  43. Shepp LA, Vardi Y. Maximum likelihood reconstruction for emission tomography. IEEE Trans Med Imaging 1982;MI-1:113–22.

    Article  Google Scholar 

  44. Diaz RA, Obasohan A, Oakley CM. Prediction of outcome in dilated cardiomyopathy. Br Heart J 1987;58:393–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Medical Physics and Imaging, Department of Medicine, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.

    Serge D. Van Kriekinge & Guido Germano

  2. Division of Nuclear Medicine, Department of Imaging, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.

    Daniel S. Berman

  3. The Department of Computer Science, UCLA School of Engineering and Applied Science, Los Angeles, Calif.

    Serge D. Van Kriekinge

  4. The Division of Nuclear Medicine and Biophysics, Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, Calif.

    Guido Germano

  5. the Department of Medicine, UCLA School of Medicine, Los Angeles, Calif.

    Daniel S. Berman

Authors
  1. Serge D. Van Kriekinge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel S. Berman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guido Germano
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van Kriekinge, S.D., Berman, D.S. & Germano, G. Automatic quantification of left ventricular ejection fraction from gated blood pool SPECT. J Nucl Cardiol 6, 498–506 (1999). https://doi.org/10.1016/S1071-3581(99)90022-3

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1016/S1071-3581(99)90022-3

Key Words

Search

Navigation