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Development and validation of an automatic method to detect the latest contracting viable left ventricular segments to assist guide CRT therapy from gated SPECT myocardial perfusion imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

The purpose of this study is to use ECG-gated SPECT MPI to detect the latest contracting viable left ventricular (LV) segments to help guide the LV probe placement used in CRT therapy and to validate segment selection against the visual integration method by experts.

Methods

For each patient, the resting ECG-gated SPECT MPI short-axis images were sampled in 3D to generate a polar map of the perfusion distribution used to determine LV myocardial viability, and to measure LV synchronicity using our phase analysis tool. In the visual integration method, two experts visually interpreted the LV viability and mechanical dyssynchrony from the short-axis images and polar maps of viability and phase, to determine the latest contracting viable segments using the 17-segment model. In the automatic method, the apical segments, septal segments, and segments with more than 50% scar were excluded as these are not candidates for CRT LV probe placement. Amongst the remaining viable segments, the segments, whose phase angles were within 10° of the latest phase angle (the most delayed contracting segment), were identified for potential CRT LV probe placement and ranked based on the phase angles of the segments. Both methods were tested in 36 pre-CRT patients who underwent ECG-gated SPECT MPI. The accuracy was determined as the percent agreement between the visual integration and automatic methods. The automatic method was performed by a second independent operator to evaluate the inter-operator processing reproducibility.

Results

In all the 36 patients, the LV lead positions of the 1st choices recommended by the automatic and visual integration methods were in the same segments in 35 patients, which achieved an agreement rate of 97.2%. In the inter-operator reproducibility test, the LV lead positions of the 1st choices recommended by the two operators were in the same segments in 25 patients, and were in the adjacent segments in 7 patients, which achieved an overall agreement of 88.8%.

Conclusions

An automatic method has been developed to detect the latest contracting viable LV segments to help guide the LV probe placement used in CRT therapy. The retrospective clinical study with 36 patients suggests that this method has high agreement against the visual integration method by experts and good inter-operator reproducibility. Consequently, this method is promising to be a clinical tool to recommend the CRT LV lead positions.

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Abbreviations

SPECT:

Single-photon emission computed tomography

MPI:

Myocardial perfusion imaging/images

LV:

Left ventricle/ventricular

CRT:

Cardiac resynchronization therapy

OSEM:

Ordered subset expectation maximization

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Acknowledgements

This research was supported by a grant from the American Heart Association (15POST22690035, PI: Weihua Zhou, Ph.D.) and a New Faculty startup grant from the University of Southern Mississippi (Project Number: DE01791). This research was also partly supported by a grant from National Natural Science Foundation of China (Project Number: 81470457, PI: Jiangang Zou, MD).

Disclosures

Dr. Garcia and Mr. Folks receive royalties from the sale of the Emory Cardiac Toolbox. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest practice. All other authors have nothing to declare.

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    Authors and Affiliations

    1. School of Computing, University of Southern Mississippi, Long Beach, MS, USA

      Weihua Zhou PhD

    2. Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China

      Ningchao Tao BS, Xiaofeng Hou MD, Yao Wang PhD & Jiangang Zou MD

    3. Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA

      Russell D. Folks BS, David C. Cooke MSEE, Valeria M. Moncayo MD & Ernest V. Garcia PhD

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    1. Weihua Zhou PhD
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    Correspondence to Ernest V. Garcia PhD or Jiangang Zou MD.

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    The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

    Dr. Zhou, conducted the technical development. Mr. Tao, enrolled the patients and performed the clinical studies.

    Weihua Zhou and Ningchao Tao have contributed equally to this article.

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    Zhou, W., Tao, N., Hou, X. et al. Development and validation of an automatic method to detect the latest contracting viable left ventricular segments to assist guide CRT therapy from gated SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 25, 1948–1957 (2018). https://doi.org/10.1007/s12350-017-0853-8

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