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Gelbart E, Krakovich A, Sherm Y, Rabin G, Ratner H, Scheinowitz M, Goldkorn R. Validation of advanced hybrid SPECT/CT system using dynamic anthropomorphic cardiac phantom. Ann Nucl Med 2024:10.1007/s12149-024-01966-w. [PMID: 39210201 DOI: 10.1007/s12149-024-01966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Myocardial blood flow (MBF) assessment can provide incremental diagnostic and prognostic information and thus the validation of dynamic SPECT is of high importance. We recently developed a novel cardiac phantom for dynamic SPECT validation and compared its performance against the GE Discovery NM 530c. We now report its use for validation of a new hybrid SPECT/CT System featuring advanced cadmium zinc telluride (CZT) technology in a ring array detector design (StarGuide™, GE HealthCare). METHODS Our recently developed cardiac phantom with injected technetium-99m radiotracer was used to create physiological time activity curves (TACs) for the left ventricular (LV) cavity and the myocardium. The TACs allow the calculation of uptake rate (K1) and MBF. The StarGuide system was used to acquire and process the TACs, and these were compared to the TACs produced by the phantom and its mathematical model. Fifteen (15) experiments with different doses representing various MBF values were conducted, and a standard statistic tool was applied for significance. RESULTS The TACs produced by the StarGuide system had a significant correlation (p < 0.001) with the reference TACs generated by the phantom both for the LV (r = 0.94) and for the myocardium (r = 0.89). The calculated MBF difference between the system and the phantom was 0.14 ± 0.16 ml/min/g and the average relative absolute difference was 13.2 ± 8.1%. A coefficient of variance of ≤ 11% was observed for all MBF subranges. The regional uptake rate values were similar to the global one with a maximum difference of 5%. CONCLUSIONS Our newly developed dynamic cardiac phantom was used for validation of the dynamic hybrid SPECT/CT CZT-based system (StarGuide™, GE). The accuracy and precision of the system for assessing MBF values were high. The new StarGuide system can reliably perform dynamic SPECT acquisitions over a wide range of myocardial perfusion flow rates.
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Affiliation(s)
- Elad Gelbart
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Alexander Krakovich
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Yigal Sherm
- GE HealthCare Molecular Imaging, Haifa, Israel
| | - Gilad Rabin
- GE HealthCare Molecular Imaging, Haifa, Israel
| | | | - Mickey Scheinowitz
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - Ronen Goldkorn
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
- Nuclear Cardiology Center, Lev Leviev Heart Institute, Sheba Medical Center, 52621, Ramat-Gan, Tel Hashomer, Israel.
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Manini C, Nemchyna O, Akansel S, Walczak L, Tautz L, Kolbitsch C, Falk V, Sündermann S, Kühne T, Schulz-Menger J, Hennemuth A. A simulation-based phantom model for generating synthetic mitral valve image data-application to MRI acquisition planning. Int J Comput Assist Radiol Surg 2024; 19:553-569. [PMID: 37679657 PMCID: PMC10881710 DOI: 10.1007/s11548-023-03012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Numerical phantom methods are widely used in the development of medical imaging methods. They enable quantitative evaluation and direct comparison with controlled and known ground truth information. Cardiac magnetic resonance has the potential for a comprehensive evaluation of the mitral valve (MV). The goal of this work is the development of a numerical simulation framework that supports the investigation of MRI imaging strategies for the mitral valve. METHODS We present a pipeline for synthetic image generation based on the combination of individual anatomical 3D models with a position-based dynamics simulation of the mitral valve closure. The corresponding images are generated using modality-specific intensity models and spatiotemporal sampling concepts. We test the applicability in the context of MRI imaging strategies for the assessment of the mitral valve. Synthetic images are generated with different strategies regarding image orientation (SAX and rLAX) and spatial sampling density. RESULTS The suitability of the imaging strategy is evaluated by comparing MV segmentations against ground truth annotations. The generated synthetic images were compared to ones acquired with similar parameters, and the result is promising. The quantitative analysis of annotation results suggests that the rLAX sampling strategy is preferable for MV assessment, reaching accuracy values that are comparable to or even outperform literature values. CONCLUSION The proposed approach provides a valuable tool for the evaluation and optimization of cardiac valve image acquisition. Its application to the use case identifies the radial image sampling strategy as the most suitable for MV assessment through MRI.
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Affiliation(s)
- Chiara Manini
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany.
| | - Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Lars Walczak
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
| | | | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Sündermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Titus Kühne
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Krakovich A, Zaretsky U, Gelbart E, Moalem I, Naimushin A, Rozen E, Scheinowitz M, Goldkorn R. Anthropomorphic cardiac phantom for dynamic SPECT. J Nucl Cardiol 2023; 30:516-527. [PMID: 35760983 DOI: 10.1007/s12350-022-03024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND As myocardial blood flow measurement (MBF) in SPECT systems became recently available, significant effort has been devoted to its validation. For that purpose, we have developed a cardiac phantom that is able to mimic physiological radiotracer variation in the left ventricle cavity and in the myocardium, while performing beating-like motion. The new phantom is integrated inside a standard anthropomorphic torso allowing a realistic tissue attenuation and gamma-ray scattering METHODS AND RESULTS: A mechanical cardiac phantom was integrated in a commercially available anthropomorphic torso. Using a GE Discovery 530c SPECT, measurements were performed. It was found that gamma-ray attenuation effects are significant and limit the MBF measurements to global/three-vessel resolution. Dynamic SPECT experiments were performed to validate MBF accuracy and showed mean relative error of 14%. Finally, the effect of varying radiotracer dose on the accuracy of dynamic SPECT was studied CONCLUSIONS: A dynamic cardiac phantom has been developed and successfully integrated in a standard SPECT torso. A good agreement was found between SPECT-reported MBF values and the expected results. Despite increased noise-to-signal ratio when radiotracer doses were reduced, MBF uncertainty did not increase significantly down to very low doses, thanks to the temporal integration of the activity during the measurement.
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Affiliation(s)
- A Krakovich
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
| | - U Zaretsky
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - E Gelbart
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - I Moalem
- Nuclear Cardiology Unit, Sheba Medical Center, Lev Leviev Heart Institute, Ramat Gan, Israel
| | - A Naimushin
- Nuclear Cardiology Unit, Sheba Medical Center, Lev Leviev Heart Institute, Ramat Gan, Israel
| | - E Rozen
- Nuclear Cardiology Unit, Sheba Medical Center, Lev Leviev Heart Institute, Ramat Gan, Israel
| | - M Scheinowitz
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv, Israel
| | - R Goldkorn
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Nuclear Cardiology Unit, Sheba Medical Center, Lev Leviev Heart Institute, Ramat Gan, Israel
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DePuey EG. How can we take creative research a step further? J Nucl Cardiol 2022; 29:188-189. [PMID: 32448999 DOI: 10.1007/s12350-020-02174-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
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Shibutani T. [[Nuclear Medicine] 3. Cardiac Phantom]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:513-519. [PMID: 35598960 DOI: 10.6009/jjrt.2022-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Takayuki Shibutani
- Department of Quantum Medical Technology, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
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Krakovich A, Zaretsky U, Moalem I, Naimushin A, Rozen E, Scheinowitz M, Goldkorn R. A new cardiac phantom for dynamic SPECT. J Nucl Cardiol 2021; 28:2299-2309. [PMID: 31997101 DOI: 10.1007/s12350-020-02028-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND In recent years, with the advance of myocardial blood flow (MBF) measurement capability in dynamic single photon emission computerized tomography (SPECT) systems, significant effort has been devoted to validation of the new capability. Unfortunately, the mechanical phantoms available for the validation process lack essential features-they either have a constant radiotracer concentration or they have rigid (static) walls unable to simulate cardiac beating. METHODS AND RESULTS We have developed a mechanical cardiac phantom that is able to mimic physiological radiotracer variation in the left ventricle (LV) cavity and in the myocardium (M), while performing beating-like motion. We have also developed a mathematical model of the phantom, allowing a description of the radiotracer concentrations in both regions (LV, M) as a function of time, which served as a tool for experiment planning and to accurately mimic physiological-like time-activity curves (TACs). A net retention model for the phantom was also developed, which served to compute the theoretical (i.e., expected) MBF of the phantom from measured quantities only, and thus validate the MBF reported by the SPECT system. In this paper, phantom experiments were performed on a GE Discovery NM 530c SPECT system. CONCLUSIONS A novel dynamic cardiac phantom for emission tomography has been developed. The new phantom is capable of producing a wide range of TACs that can mimic physiological (and potentially in the future, pathological) curves, similar to those observed in dynamic SPECT systems. SPECT-reported MBF values were validated against known (measured) activity of the injected radiotracer from phantom experiments, which allowed to determine the accuracy of the GE Discovery 530c SPECT system.
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Affiliation(s)
- A Krakovich
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel.
| | - U Zaretsky
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - I Moalem
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Naimushin
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - E Rozen
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
| | - M Scheinowitz
- Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - R Goldkorn
- Nuclear Cardiology Unit, Lev Leviev Heart Institute, Sheba Medical Center, Ramat Gan, Israel
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O'Dell WG. Accuracy of Left Ventricular Cavity Volume and Ejection Fraction for Conventional Estimation Methods and 3D Surface Fitting. J Am Heart Assoc 2019; 8:e009124. [PMID: 30866698 PMCID: PMC6475047 DOI: 10.1161/jaha.118.009124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background While left ventricular cavity volume (LVV) and ejection fraction (LVEF) are used routinely for clinical decision‐making, the errors in LVV and LVEF estimates in the clinic have yet to be rigorously quantified and are perhaps underappreciated. Methods and Results The goal of this study was to quantify the accuracy and precision of several common geometric‐model‐based methods for estimating LVV and LVEF using a highly sampled, high‐resolution magnetic resonance imaging data set and an independent ground truth. The effect on LVV and LVEF accuracy of slice number and orientation was also studied. When using the common geometric assumptions and limited short‐ and/or long‐axis views, the expected LVEF measurement uncertainty can be as high as 49%. The composite midpoint rule applied to a stack of short‐axis slices can achieve LVEF error <3% and LVV error of ≈10%, but in the clinic an additional ≈8% uncertainty is expected. An analogous approach applied to a series of radially prescribed long‐axis slices can achieve higher LVEF accuracy, up to 3.9% with 12 slices, and more reliable LVV measurements than methods based solely on short‐axis images. Using a mathematical 3‐dimensional surface model that incorporates anatomic information from multiple views achieves superior accuracy, with LVEF error <4% and LVV error <2.5% when using 6 slices in each short‐ and long‐axis view. Conclusions Combining anatomical information from multiple views into a conformal 3‐dimensional surface model greatly reduces errors in LVV and LVEF estimates, with potential clinical benefit via improved early detection of cardiac disease.
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Affiliation(s)
- Walter G O'Dell
- 1 Department of Radiation Oncology University of Florida College of Medicine Gainesville FL
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Velasco O, Beckett MQ, James AW, Loehr MN, Lewis TG, Hassan T, Janardhanan R. Real-Time Three-Dimensional Echocardiography: Characterization of Cardiac Anatomy and Function-Current Clinical Applications and Literature Review Update. Biores Open Access 2017; 6:15-18. [PMID: 28303211 PMCID: PMC5349224 DOI: 10.1089/biores.2016.0033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional echocardiography (2DE) in clinical cardiology. A Pubmed literature search on RT3DE was performed using the following key words: transthoracic, two-dimensional, three-dimensional, real-time, and left ventricular (LV) function. Articles included perspective clinical studies and meta-analyses in the English language, and focused on the role of RT3DE in human subjects. Application of RT3DE includes analysis of the pericardium, right ventricular (RV) and LV cavities, wall motion, valvular disease, great vessels, congenital anomalies, and traumatic injury, such as myocardial contusion. RT3DE, through a transthoracic echocardiography (TTE), allows for increasingly accurate volume and valve motion assessment, estimated LV ejection fraction, and volume measurements. Chamber motion and LV mass approximation have been more accurately evaluated by RT3DE by improved inclusion of the third dimension and quantification of volumetric movement. Moreover, RT3DE was shown to have no statistical significance when comparing the ejection fractions of RT3DE to cardiac magnetic resonance (CMR). Analysis of RT3DE data sets of the LV endocardial exterior allows for the volume to be directly quantified for specific phases of the cardiac cycle, ranging from end systole to end diastole, eliminating error from wall motion abnormalities and asymmetrical left ventricles. RT3DE through TTE measures cardiac function with superior diagnostic accuracy in predicting LV mass, systolic function, along with LV and RV volume when compared with 2DE with comparable results to CMR.
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Affiliation(s)
- Omar Velasco
- Department of Internal Medicine, University of Arizona , Tucson, Arizona
| | - Morgan Q Beckett
- Department of Chemistry and Biochemistry, University of Arizona , Tucson, Arizona
| | - Aaron W James
- Department of Pathology, Johns Hopkins University , Baltimore, Maryland
| | - Megan N Loehr
- Department of Chemistry and Biochemistry, University of Arizona , Tucson, Arizona
| | - Taylor G Lewis
- Department of Chemistry and Biochemistry, University of Arizona , Tucson, Arizona
| | - Tahmin Hassan
- Department of Chemistry and Biochemistry, University of Arizona , Tucson, Arizona
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Dullius M, Fonseca M, Botelho M, Cunha C, Souza D. Three new renal simulators for use in nuclear medicine. EPJ WEB OF CONFERENCES 2014. [DOI: 10.1051/epjconf/20146611010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ferreira FCL, Souza DDN. Aceitabilidade de um futuro banco de objetos simuladores para controle de qualidade em medicina nuclear. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000200010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: O objetivo deste trabalho foi verificar a aceitabilidade para a implantação no Brasil de um banco de objetos simuladores nacional, ou bancos regionais, para uso compartilhado desses objetos em atividades de controle de qualidade nos serviços de medicina nuclear. MATERIAIS E MÉTODOS: Foram analisadas as respostas dadas em um questionário que foi enviado a supervisores de radioproteção e físicos médicos de serviços de medicina nuclear do Brasil. Inicialmente, o questionário foi validado por profissionais da cidade de Aracaju, SE, que está localizada no Nordeste. De acordo com as regiões geográficas brasileiras, fizeram parte da amostra investigada: o Nordeste, com respostas de profissionais de 13 serviços de medicina nuclear; o Norte, com 2 profissionais; o Sul, com 7 profissionais; o Sudeste, com 43 profissionais; e o Centro-Oeste, com 2 profissionais. RESULTADOS: Segundo os dados analisados, 82% dos entrevistados consideram que a implantação de um banco de simuladores seria uma alternativa apropriada para o aprimoramento do controle de qualidade em medicina nuclear. O interesse em compartilhar com o banco foi de 87%. CONCLUSÃO: Os resultados mostraram que há motivação para o compartilhamento de objetos simuladores, ou seja, para o uso desses objetos de forma socializada.
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Yalçin H, Maza S, Yalçin F. Single photon emission computed tomography: an alternative imaging modality in left ventricular evaluation. Vasc Health Risk Manag 2009; 4:1069-72. [PMID: 19183754 PMCID: PMC2605329 DOI: 10.2147/vhrm.s3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Various diagnostic imaging modalities have been used for quantitative left ventricular (LV) parameters. Because of the suboptimal value of the most widely used technology, two-dimensional (2D) echocardiography, 3D ultrasonographic imaging has improved accuracy for LV volume and function. Single photon emission computed tomography (SPECT) is another diagnostic method where LV volumetric and functional parameters can be accurately provided by gated myocardial perfusion tomographic slices. First pass radionuclide venticulography is another imaging modality which has some practical limitations. Despite lower ejection fraction (EF) values compared with invasive approach, noninvasive techniques are accurate in determination of normal and depressed EF. Noninvasive techniques with 3D approach including gated SPECT are beneficial for not only global but also regional LV evaluation. It has been mentioned that the slight difference between echocardiography and SPECT could be caused by the diverse population studied. The results of diagnostic stress tests support that SPECT is feasible to use in evaluation of LV volume and functional analysis. Magnetic resonance imaging is an expensive modality to use routinely, but it preserves its importance in selected patients for providing precise LV geometric data.
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Affiliation(s)
- Hulya Yalçin
- Department of Nuclear Medicine, Charite University, Berlin, Germany.
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3D registration using a new implementation of the ICP algorithm based on a comprehensive lookup matrix: Application to medical imaging. Pattern Recognit Lett 2007. [DOI: 10.1016/j.patrec.2007.03.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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