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Nakajima, Kenichi ; Higuchi, Takahiro ; Taki, Junichi ; Kawano, Masaya ; Tonami, Norihisa
概要:
金沢大学大学院医学系研究科<br />Gated myocardial perfusion SPECT has been used to calculate ejection fraction (EF) and end-diastolic
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volume (EDV) and has correlated well with conventional methods. However, the comparative accuracy of and correlations across various types of gated SPECT software are not well understood. Methods: Mathematic phantoms of cylindric-hemispheric hybrid models, ranging in volume from 34 to 266 mL, were generated. The clinical cases consisted of 30 patients who participated in a radionuclide angiography and gated blood-pool (GBP) study in addition to undergoing 99mTc-sestamibi gated SPECT. Four kinds of software, Quantitative Gated SPECT (QGS), the Emory Cardiac Toolbox (ECT), 4D-MSPECT, and Perfusion and Functional Analysis for Gated SPECT (pFAST) were used to compute EF and EDV, and the results were analyzed by multiple comparisons tests. Patients were classified into 4 groups (i.e., no defect, small defect, large defect, and small heart) so that factors affecting variation could be analyzed. Results: In mathematic models ≥74 mL, volume error was within ±15%, whereas for a small volume (34 mL), QGS and 4D-MSPECT underestimated the volume and pFAST overestimated it. The respective intra- and interobserver reproducibility of the results was good for QGS (r=0.99 and 1.00), ECT (r=0.98 and 0.98), and 4D-MSPECT (r=0.98 and 0.98) and fair for pFAST (r=0.88 and 0.85). The correlation coefficient for EF between gated SPECT and the GBP study was 0.82, 0.78, 0.69, and 0.84 for QGS, ECT, 4D-MSPECT, and pFAST, respectively. The correlation coefficient for EDV between gated SPECT and the GBP study was 0.88, 0.89, 0.85, and 0.90, respectively. Although good correlation was observed among the 4 software packages, QGS, ECT, and 4D-MSPECT overestimated EF in patients with small hearts, and pFAST overestimated the true volume in patients with large perfusion defects. Correlation coefficients among the 4 kinds of software were 0.80-0.95 for EF and 0.89-0.98 for EDV. Conclusion: All 4 software programs showed good correlation between EF or EDV and the GBP study. Good correlation was observed also between each pair of quantification methods. However, because each method has unique characteristics that depend on its specific algorithm and thus behaves differently in the various patient subgroups, the methods should not be used interchangeably.
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| 2.
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Taki, Junichi ; Higuchi, Takahiro ; Nakajima, Kenichi ; Matsunari, Ichiro ; Hwang, Eui-Hyo ; Bunko, Hisashi ; Kawasuji, Michio ; Watanabe, Go ; Tonami, Norihisa
概要:
金沢大学大学院医学系研究科<br />Abnormal septal motion after coronary artery bypass graft surgery (CABG) is a common finding. This st
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udy was undertaken to investigate the change in various global and regional ventricular function parameters measured by gated myocardial perfusion SPECT after surgery and to determine which quantitative parameter of WT and WM is more appropriate for the evaluation of regional cardiac function, especially in the septum of patients with CABG. Methods: Before and 3 to 5 wk after CABG (all patients underwent at least 1 bypass grafting to the left anterior descending coronary artery), 35 patients (28 men, 7 women) underwent gated SPECT using 99mTc-methoxyisobutylisonitrile. Quantitative global and regional ventricular functional analysis was performed using quantitative gated SPECT software. Results: Global ejection fraction did not change (59.3% ± 16.0% to 60.5% ± 14.5%, P = 0.24). However, end-diastolic and end-systolic volumes lessened significantly after CABG (81.4 ± 37.3 mL to 68.9 ± 28.9 mL, P < 0.0001, and 38.1 ± 33.1 mL to 30.4 ± 23.0 mL, P < 0.005, respectively). As global function parameters, the changes in both total WM (r = 0.88) and WT (r = 0.86) correlated well with the change in ejection fraction after surgery. Segmental analysis showed a significant postoperative increase in relative tracer uptake in the anterior, anteroseptal, inferoseptal, and inferior walls and in the apex. Segmental wall motion (WM) deteriorated in the anteroseptal, inferoseptal, and mid anterior walls. On the other hand, anterolateral, inferolateral, and inferior WM increased. As a whole, these WM changes showed a reduction in septal motion associated with a concomitant increase in lateral motion after surgery. Segmental wall thickening, however, did not decrease in septal areas and did not increase in the lateral wall and correlated with percentage tracer uptake (r = 0.69) better than WM did (r = 0.30) after CABG. Conclusion: In patients with CABG, postoperative WM analysis by gated SPECT underestimated septal motion and overestimated lateral motion because of exaggerated systolic anteromedial cardiac translation. Therefore, wall thickening analysis would be recommended for the evaluation of postoperative cardiac function
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| 3.
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Nakajima, Kenichi ; Taki, Junichi ; Kawano, Masaya ; Higuchi, Takahiro ; Sato, Shinichi ; Nishijima, Chihiro ; Takehara, Kazuhiko ; Tonami, Norihisa
概要:
金沢大学大学院<br />Diagnosis of cardiac involvement is important for the management of patients with systemic sclerosis (SSc).
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This study was undertaken to determine the significance of gated myocardial perfusion SPECT in patients with SSc and whether diastolic function measured by gated SPECT is an early sign of cardiac complications. Methods: Thirty-four patients with SSc and 16 control patients were studied using exercise nongated and resting gated myocardial perfusion SPECT. The SSc was classified by the modified Rodnan total skin score (TSS) into high-TSS (score ≥ 10; n = 18) and low-TSS (score < 10; n = 16) groups. Gated SPECT was performed using 99mTc-methoxyisobutyl-isonitrile with 16 frames per cardiac cycle and quantitatively analyzed by QGS software and Fourier filtering of the volume curve. The parameters of ejection fraction (EF), peak filling rate (PFR), one-third mean filling rate, and time to PFR (TPFR) were calculated. Results: A slight perfusion abnormality was observed in four and five patients in the low-TSS and high-TSS groups, respectively (not statistically significant). A decreased resting EF less than 55% was found in no and two patients in the low-TSS and high-TSS groups, respectively. TPFR was 166 ± 22, 168 ± 38, and 216 ± 82 ms (P = 0.05, high-TSS group versus low-TSS group; P = 0.04, control group versus high-TSS group) and TPFR/R-R interval was 0.18 ± 0.02, 0.19 ± 0.04, and 0.26 ± 0.09 (P = 0.01, high-TSS group versus low-TSS group; P = 0.005, control group versus high-TSS group) for the control, low-TSS, and high-TSS groups, respectively. Conclusion: Diastolic function can be evaluated by gated myocardial perfusion SPECT. Significant diastolic abnormalities were shown even in patients with normal perfusion and systolic function and were related to the severity of SSc.
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Nakajima, Kenichi ; Kusuoka, Hideo ; Nishimura, Shigeyuki ; Yamashina, Akira ; Nishimura, Tsunehiko
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金沢大学大学院医学系研究科がん制御学<br />Purpose: Quantitative gated single-photon emission computed tomography (SPECT) is known to have
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high accuracy and precision for measurement of the principal cardiac functional parameters. We hypothesised that normal values for EF and LV volumes may differ among nationalities, and that optimal threshold values specific to the study population are required. Methods: Among 4,670 consecutively registered patients for a J-ACCESS (Japanese investigation regarding prognosis based on gated SPECT) study from 117 hospitals, a total of 268 (149 women, 119 men) were selected who had no baseline cardiac diseases and had experienced no cardiac events during the preceding 3-year period. A gated SPECT study was performed with 99mTc-tetrofosmin and analysed with Cedars Sinai Medical Center's quantitative gated SPECT (QGS) software. The results in respect of ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV) and stroke volume (SV), and EDV, ESV and SV normalised by body surface area (EDVI, ESVI and SVI), were calculated and summarised to obtain normal limits. Results: EF for women and men was 74 ± 9% and 63 ± 7%, respectively (p < 0.0001). EDV, ESV and SV were significantly smaller in women than in men. Based on multiple regressions for linear models, the primary and secondary predictors of EF, EDVI, ESVI were gender and age. By stepwise multiple regression analysis, a statistically significant third predictor for EDV, ESV, SV and SVI was body weight. No colinearity was found between age and body weight. Important factors for the studied Japanese population included a high incidence of small hearts in women and the relatively advanced age of the population (the mean age ±SD was 64.1 ± 10.0 years for women and 60.9 ± 11.7 years for men). Conclusion: EF and volumes determined by gated SPECT with QGS were significantly affected by gender and age, with body weight as a third predictor for volumes. Moreover, the normal limits were so specific for the population studied that standards appropriate for the study in question should be utilised. © 2007 Springer-Verlag.
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Nakajima, Kenichi ; Kusuoka, Hideo ; Nishimura, Shigeyuki ; Yamashina, Akira ; Nishimura, Tsunehiko
概要:
金沢大学医薬保健研究域医学系<br />Objective: To determine the prognostic value of myocardial ischemia, function and coronary risk fact
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ors on total and hard cardiac events using myocardial perfusion imaging in a Japanese population. Methods: A prospective cohort study was performed in 117 Japanese hospitals, each with a nuclear cardiology facility. A total of 4,031 patients with suspected or confirmed ischemic heart disease were registered. The patients were followed up for a year to investigate total and hard events, and those who had any events were followed up for 3 years to evaluate subsequent hard events. A stress-rest gated myocardial perfusion study was performed with 99mTc-tetrofosmin using gated single-photon emission computed tomography (SPECT) and analyzed by semi-quantitative scores. Results: During the 1-year follow-up period, 263 (6.5%) patients had total events comprising all-cause death, non-fatal myocardial infarction (MI), heart failure, unstable angina, angina pectoris and coronary revascularization. Cardiac death occurred in 23 patients (0.6%) and non-fatal MI in 11 (0.3%). Among patients with ejection fraction (EF) of <45% and a summed difference score (SDS) of ≥2, 18.7% (2.4% for cardiac death and 0.6% for non-fatal MI) experienced total events compared with 3.9% (0.3% for cardiac death and 0.2% for non-fatal MI; P < 0.0001) of those with EF ≥ 45% and SDS < 2. Multivariate analysis identified EF, SDS, age, history of revascularization and diabetes as significant predictors of all events, while the significant predictors were age and EF for hard events. When the patients who had heart failure in the first year were followed up, 9 of 41 (22.0%) experienced cardiac death in the subsequent 3-year follow-up period. Conclusions: Myocardial ischemia defined by SDS and ventricular function were the main predictors of total events despite the relatively low incidence of hard events in this Japanese population. In patients with cardiac events in a year, closer attention should be paid to subsequent hard events particularly in patients with heart failure. © 2009 The Japanese Society of Nuclear Medicine.
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| 6.
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Nakajima, Kenichi ; Nishimura, Tsunehiko
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Purpose Inter-institution reproducibility of gated SPECT quantification based on institutional preferences was evaluated
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. This sort of variability is crucial for a multicentre study when many hospitals are involved. Methods A total of 106 institutes participated in this study and were grouped according to their use of five workstation types. Fifteen sets of 99mTc-tetrofosmin gated projection images with normal ejection fraction (EF) (70%, group A, n=5), borderline low EF (50%, group B, n=5) and low EF with large perfusion defects (30%, group C, n=5) were prepared. The projection images were processed by QGS software in each institute based on its own routine settings. Based on 318 QGS results, the reproducibility of EF and volumes was analysed for each group and workstation. Results The reproducibility of EF was good in 14 of 15 cases, showing a standard deviation (SD) of <3.6%, and the coefficient of variance of the end-diastolic volume (EDV) was <9.3% in all cases. When the deviation from the average value was analysed, the difference between EF at each institute and the average EF of the workstation (dEF) showed an SD of 2.2–3.7% for each group. The ratio of the EDV divided by the average EDV (rEDV) showed an SD of 0.061–0.069 for each group. One case in group C that had a large anterior defect with low EF showed bimodal EF distribution in one of the five workstations. The SD of EF was workstation dependent, owing to the SPECT reconstruction conditions. Conclusion The reproducibility in EF and volumes within a workstation was good, even though the gated SPECT preferences varied. This reproducibility study supports the use of gated SPECT as a standard of ventricular function in multicentre studies.© Springer-Verlag 1999.
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| 7.
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Nakajima, Kenichi ; Kawano, Masaya ; Hasegawa, Minoru ; Taki, Junichi ; Fujimoto, Manabu ; Takehara, Kazuhiko ; Tonami, Norihisa
概要:
金沢大学医学部附属病院核医学診療科<br />Background: Cardiac involvement is an important factor for the appropriate management of systemic
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sclerosis (SSc). The possibility for detecting early myocardial damage was investigated using 99mTc methoxyisobutyliso- nitrile (MIBI) gated perfusion single photon emission computed tomography (SPECT) and 123I metaiodobenzyl-guanidine (MIBG) sympathetic imaging. Methods and Results: Twenty-three patients with SSc and 14 control subjects were studied. The severity of SSc was defined by disease type and semi-quantitative skin thickness scores. A myocardial perfusion study was performed using 99mTc MIBI exercise-rest study, and systolic and diastolic parameters were calculated from the volume curve of the gated SPECT. 123I MIBG was evaluated by segmental defects, a heart-to-mediastinum ratio and washout rate (WR). No significant exercise-induced ischemia was observed and the left ventricular ejection fraction was within normal range in patients with SSc. However, diastolic function calculated by time to peak filling (TPF) in the early diastole was significantly prolonged in SSc compared with the control group (184±35 ms, 160±25 ms, p=0.030) and more rapid MIBG WR from the myocardium (18.2±7.0% vs 11.1±4.3%, p=0.0015). Compared with the control group, the severe group with either diffuse SSc or a skin thickness score ≥10 had more prolonged TPF/RR interval than the less severe group. Both diastolic and sympathetic abnormali-ties were observed in 7 (30%) patients, and 1 abnormality in 17 (74%) patients with SSc. Conclusions: In patients with SSc, either diastolic dysfunction or sympathetic derangement, or both were observed even without induced ischemia and normal ventricular contractility. Based on these subclinical early findings, further follow-up studies are recommended.
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