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Verrecchia-Ramos E, Morel O, Retif P, Ben Mahmoud S. Innovative procedure for measuring left ventricular ejection fraction from 18F-FDG first-pass ultra-sensitive digital PET/CT images: evaluation with an anthropomorphic heart phantom. EJNMMI Phys 2021; 8:42. [PMID: 34018067 PMCID: PMC8137784 DOI: 10.1186/s40658-021-00387-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is usually measured by cine-cardiac magnetic resonance imaging (MRI), planar and single-photon emission-computerized tomography (SPECT) equilibrium radionuclide angiocardiography (ERNA), and echocardiography. It would be clinically useful to measure LVEF from first-pass positron-emission tomography/computed tomography (PET/CT) radionuclide angiography, but this approach has been limited by fast radiotracer diffusion. Ultra-sensitive digital PET systems can produce high-quality images within 3-s acquisition times. This study determined whether digital PET/CT accurately measured LVEF in an anthropomorphic heart phantom under conditions mimicking radiotracer first-pass into the cardiac cavities. Methods Heart phantoms in end-diastole and end-systole were 3D-printed from a patient’s MRI dataset. Reference left ventricle end-diastole volume (EDV), end-systole volume (ESV), and LVEF were determined by phantom weights before/after water filling. PET/CT (3-s acquisitions), MRI, and planar and SPECT ERNA were performed. EDV, ESV, and/or LVEF were measured by manual and automated cardiac cavity delineation, using clinical segmentation softwares. LVEF was also measured from PET images converted to 2D “pseudo-planar” images along the short axis and horizontal long axis. LVEF was also calculated for planar ERNA images. All LVEF, ESV and EDV values were compared to the reference values assessed by weighing. Results Manually calculated 3D-PET-CT-based EDV, ESV, and LVEF were close to MRI and reference values. Automated calculations on the 3D-PET-CT dataset were unreliable, suggesting that the SPECT-based tool used for this calculation is not well adapted for PET acquisitions. Manual and automated LVEF estimations from “pseudo-planar” PET images were very close/identical to MRI and reference values. Conclusions First-pass “pseudo-planar” PET may be a promising method for estimating LVEF, easy to use in clinical practice. Processing 3D PET images is also a valid method but to date suffers from a lack of well-suited software for automated LV segmentation.
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Affiliation(s)
- Emilie Verrecchia-Ramos
- Medical Physics Unit, CHR Metz-Thionville, Mercy Hospital, 1 allée du château, 57530 Ars-Laquenexy, Metz, France.
| | - Olivier Morel
- Nuclear Medicine Department, CHR Metz-Thionville, Mercy Hospital, 1 allée du château, 57530 Ars-Laquenexy, Metz, France
| | - Paul Retif
- Medical Physics Unit, CHR Metz-Thionville, Mercy Hospital, 1 allée du château, 57530 Ars-Laquenexy, Metz, France.,CNRS, CRAN, University of Lorraine, F-54000, Nancy, France
| | - Sinan Ben Mahmoud
- Nuclear Medicine Department, CHR Metz-Thionville, Mercy Hospital, 1 allée du château, 57530 Ars-Laquenexy, Metz, France
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Ben Bouallègue F, Maïmoun L, Kucharczak F, Le Fur P, Vauchot F, Hay B, Rondet E, Mariano-Goulart D. Left ventricle function assessment using gated first-pass 18F-FDG PET: Validation against equilibrium radionuclide angiography. J Nucl Cardiol 2021; 28:594-603. [PMID: 31044403 DOI: 10.1007/s12350-019-01731-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
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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Affiliation(s)
- Fayçal Ben Bouallègue
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France.
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France.
| | - Laurent Maïmoun
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France
| | | | - Pierre Le Fur
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France
| | - Fabien Vauchot
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France
| | - Boramy Hay
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France
| | - Eric Rondet
- UMR QualiSud, Montpellier University, Montpellier, France
| | - Denis Mariano-Goulart
- Nuclear Medicine Department, Lapeyronie University Hospital, Avenue du Doyen Giraud 371, 34295, Montpellier Cedex 5, France
- PhyMedExp, INSERM, CNRS, Montpellier University, Montpellier, France
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3
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Foulkes S, Claessen G, Howden EJ, Daly RM, Fraser SF, La Gerche A. The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview. Front Cardiovasc Med 2020; 7:32. [PMID: 32211421 PMCID: PMC7076049 DOI: 10.3389/fcvm.2020.00032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022] Open
Abstract
With progressive advancements in cancer detection and treatment, cancer-specific survival has improved dramatically over the past decades. Consequently, long-term health outcomes are increasingly defined by comorbidities such as cardiovascular disease. Importantly, a number of well-established and emerging cancer treatments have been associated with varying degrees of cardiovascular injury that may not emerge until years following the completion of cancer treatment. Of particular concern is the development of cancer treatment related cardiac dysfunction (CTRCD) which is associated with an increased risk of heart failure and high risk of morbidity and mortality. Early detection of CTRCD appears critical for preventing long-term cardiovascular morbidity in cancer survivors. However, current clinical standards for the identification of CTRCD rely on assessments of cardiac function in the resting state. This provides incomplete information about the heart's reserve capacity and may reduce the sensitivity for detecting sub-clinical myocardial injury. Advances in non-invasive imaging techniques have enabled cardiac function to be quantified during exercise thereby providing a novel means of identifying early cardiac dysfunction that has proved useful in several cardiovascular pathologies. The purpose of this narrative review is (1) to discuss the different non-invasive imaging techniques that can be used for quantifying different aspects of cardiac reserve; (2) discuss the findings from studies of cancer patients that have measured cardiac reserve as a marker of CTRCD; and (3) highlight the future directions important knowledge gaps that need to be addressed for cardiac reserve to be effectively integrated into routine monitoring for cancer patients exposed to cardiotoxic therapies.
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Affiliation(s)
- Stephen Foulkes
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.,Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Guido Claessen
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Erin J Howden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robin M Daly
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Steve F Fraser
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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4
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Sciagrà R. Right ventricular perfusion: Do we need additional evidence or just a simple methodology? J Nucl Cardiol 2019; 26:272-274. [PMID: 28702923 DOI: 10.1007/s12350-017-0987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
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Ben Bouallègue F, Mariano-Goulart D, Agostini D, Manrique A. Feasibility of biventricular volume and function assessment using first-pass gated 15O-water PET. EJNMMI Res 2018; 8:92. [PMID: 30225682 PMCID: PMC6141411 DOI: 10.1186/s13550-018-0445-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/07/2018] [Indexed: 01/17/2023] Open
Abstract
Background We investigated the feasibility of left ventricular (LV) and right ventricular (RV) volume and function estimation using a first-pass gated 15O-water PET. This prospective study included 19 patients addressed for myocardial perfusion reserve assessment using 15O-water PET. PET data were acquired at rest and after regadenoson stress, and gated first-pass images were reconstructed over the time range corresponding to tracer first-pass through the cardiac cavities and post-processed using TomPool software; LV and RV were segmented using a semi-automated 4D immersion algorithm. LV volumes were computed using a count-based model and a fixed threshold at 30% of the maximal activity. RV volumes were computed using a geometrical model and an adjustable threshold that was set so as to fit LV and RV stroke volumes. Ejection curves were fitted using a deformable reference curve model. LV results were compared to those obtained using 99mTc-sestamibi gated myocardial SPECT in terms of end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and ejection fraction (EF). Results There was an excellent concordance between rest and stress PET in terms of EDV and ESV (Lin’s coefficient ~ 0.85–0.90), SV (~ 0.80), and EF (~ 0.75) for both ventricles. Correlation with myocardial SPECT was high for LV EDV (Pearson’s R = 0.89, p < 0.001) and ESV (R = 0.87, p < 0.001) and satisfying for LV SV (R = 0.67, p < 0.001) and EF (R = 0.67, p < 0.001). Minimal LV ESV overestimation (+ 4 mL, p = 0.03) and EF underestimation (− 4%, p = 0.01) were observed using PET. Conclusions Biventricular volume and function assessment are achievable using the first-pass PET, and LV parameters correlate well with those derived from gated myocardial SPECT.
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Affiliation(s)
- Fayçal Ben Bouallègue
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France. .,PhyMedExp, INSERM - CNRS, Montpellier University, Montpellier, France. .,Nuclear Medicine Department, CHU de Caen, Caen, France.
| | - Denis Mariano-Goulart
- Nuclear Medicine Department, Montpellier University Hospital, Montpellier, France.,PhyMedExp, INSERM - CNRS, Montpellier University, Montpellier, France
| | | | - Alain Manrique
- Nuclear Medicine Department, CHU de Caen, Caen, France.,UNICAEN, EA 4650 SEILIRM, GIP Cyceron, Normandie University, Caen, France
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Ohira H, Beanlands RS, Davies RA, Mielniczuk L. The role of nuclear imaging in pulmonary hypertension. J Nucl Cardiol 2015; 22:141-57. [PMID: 25161042 DOI: 10.1007/s12350-014-9960-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Pulmonary hypertension (PH) is a disease characterized by a chronic elevation of pulmonary artery pressure from various causes. Pulmonary artery hypertension (PAH) is one of subtype which results in premature death often as a result of right ventricular (RV) dysfunction. In spite of the recent progress in novel cardiac imaging techniques and new drugs for PAH, there remain significant unresolved issues including a need for earlier diagnosis, refinement of risk stratification, and monitoring the effects of treatment. Cardiac and pulmonary imaging with transthoracic echocardiography (TTE) with Doppler, magnetic resonance imaging (MRI), and computed tomography (CT) are done routinely in many clinical centers. However, routine and emerging nuclear techniques may have a pivotal role of assessment of the patient with PH, and is currently the subject of significant research. Potential Roles for Nuclear Imaging in the Evaluation of the PH Patient: (1) Evaluation of cardiac structure and function (RNA) (non-nuclear techniques would include TTE, CT, and MRI). (2) Functional imaging. This includes the use of ventilation-perfusion scintigraphy (V/Q scan) to diagnose chronic thromboembolic pulmonary hypertension (CTEPH), 123l-metaiodobenzylguanidine (MIBG) imaging to evaluate the cardiac sympathetic nervous system (non-nuclear techniques include invasive right heart catheterization and TTE). (3) Measurement of RV perfusion (with gated SPECT studies). (4) Evaluation of cardiac and pulmonary metabolism (PET scans). This review article will summarize the pathophysiology, classification, natural history, and diagnostic approach of PH. Current and emerging nuclear techniques will be discussed under the four themes of evaluation of structure, functional imaging, flow, and metabolism. These will be compared to current and emerging nuclear and non-nuclear diagnostic tests in the evaluation and management of patients with PH. We will also discuss research applications exploring new insights into flow and metabolism in the right heart and lung and the application of new radioligands.
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Affiliation(s)
- H Ohira
- Advanced Heart Disease and Pulmonary Hypertension Programs, National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Room 3409, Ottawa, ON, K1Y 4W7, Canada
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7
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Vijayvergiya R, Singh J, Rana SS, Shetty R, Mittal BR. Early and six-month assessment of bi-ventricular functions following surgical closure of atrial septal defect. Indian Heart J 2014; 66:617-21. [PMID: 25634395 DOI: 10.1016/j.ihj.2014.10.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/28/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The effect of surgical closure of atrial septal defect (ASD) on biventricular functions is not well studied. We studied effect of surgical closure of ASD on bi-ventricular functions. METHODS Patients undergoing surgical closure of ASD from December 2007 to June 2009 had 3 sequential echocardiograms examination: pre-procedure, post surgery at 1-month and at 6-month of follow up. Pulse Doppler velocities across mitral and tricuspid valves were measured as peak early diastolic (E wave) and peak late diastolic (A wave). Tissue Doppler velocities across lateral wall of both right ventricle (RV) and left ventricle (LV) were measured as peak early diastolic (E'), peak late diastolic (A'), and peak systolic (S') wave. Radionuclide angiography was performed to assess RV and LV ejection fraction at baseline and at 1-month follow up. RESULTS The mean age of 20 enrolled patients was 21.85 ± 10.9 years; 8 females & 12 males. Trans-tricuspid flow velocities significantly decreased following surgery at one and 6-month (p < 0.005). There was no significant change in trans-mitral flow velocities at one and 6-months. Tricuspid and mitral E/A ratio and E/E' ratio also had an insignificant change following surgery. There was no significant change in LV ejection fraction as assessed by echocardiography (p = 0.132) and radionuclide scan (p = 0.143). Right ventricular ejection fraction had a significant improvement at 1-month of follow up (p = 0.005). CONCLUSIONS There was a significant improvement in RV systolic function and an insignificant change in RV and LV diastolic functions following surgical closure of ASD.
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Affiliation(s)
- Rajesh Vijayvergiya
- Associate Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India.
| | - Jiten Singh
- Cardio-thoracic Surgery, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sandeep S Rana
- Cardio-thoracic Surgery, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ranjan Shetty
- Associate Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India
| | - Bhagwant R Mittal
- Nuclear Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Gargiulo P, Cuocolo A, Dellegrottaglie S, Prastaro M, Savarese G, Assante R, Zampella E, Paolillo S, Scala O, Ruggiero D, Marsico F, Perrone Filardi P. Nuclear Assessment of Right Ventricle. Echocardiography 2014; 32 Suppl 1:S69-74. [DOI: 10.1111/echo.12180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
- Department of Biomorphological and Functional Sciences; Federico II University; Naples Italy
| | - Santo Dellegrottaglie
- Division of Cardiology; Ospedale Medico-Chirurgico Accreditato Villa dei Fiori; Acerra Naples Italy
- Z. and M.A. Wiener Cardiovascular Institute; M.J. and H.R. Kravis Center for Cardiovascular Health; Mount Sinai Medical Center; New York New York
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Gianluigi Savarese
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Roberta Assante
- SDN Foundation; Institute of Diagnostic and Nuclear Development; Naples Italy
| | - Emilia Zampella
- SDN Foundation; Institute of Diagnostic and Nuclear Development; Naples Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Oriana Scala
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Donatella Ruggiero
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
| | - Fabio Marsico
- Department of Advanced Biomedical Sciences; Federico II University; Naples Italy
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Abstract
The evaluation of left ventricular systolic function is one of the most common reasons for referral for a non-invasive cardiac imaging study. In addition to its diagnostic and prognostic value, an assessment of ejection fraction can also be used to guide medical and device therapy. Thus, obtaining an accurate and reproducible assessment of LVEF is essential for patient management. This review will focus on novel multi-modality techniques used for the quantification of left ventricular systolic function. Emerging echocardiography techniques such as three-dimensional echocardiography and strain imaging and their incremental role over traditional 2D imaging will be discussed. In addition, new developments expanding nuclear imaging techniques' evaluation of left ventricular systolic function will be reviewed. Finally, an overview of advances in imaging techniques such as cardiac magnetic resonance and cardiac computed tomography, which now allow for an accurate and highly reproducible assessment of LVEF, will be presented.
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Affiliation(s)
- Sonal Chandra
- Non-invasive Cardiac Imaging Center, Section of Cardiology, University of Chicago Medical Center, 5841 S. Maryland Ave, MC 5084, Chicago, IL 60637, USA
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11
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The role of first-pass radionuclide angiography in the era of gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2008; 15:838-40. [PMID: 18984460 DOI: 10.1007/bf03007366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aguadé Bruix S, Castell Conesa J, Candell Riera J. [Evaluation of ventricular function in Nuclear Medicine]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2008; 27:374-400. [PMID: 18817671 DOI: 10.1157/13126198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- S Aguadé Bruix
- Servicio de Medicina Nuclear. Hospital Universitari Vall d'Hebron. Barcelona. España.
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Abstract
Radionuclide imaging of cardiac function represents a number of well-validated techniques for accurate determination of right (RV) and left ventricular (LV) ejection fraction (EF) and LV volumes. These first European guidelines give recommendations for how and when to use first-pass and equilibrium radionuclide ventriculography, gated myocardial perfusion scintigraphy, gated PET, and studies with non-imaging devices for the evaluation of cardiac function. The items covered are presented in 11 sections: clinical indications, radiopharmaceuticals and dosimetry, study acquisition, RV EF, LV EF, LV volumes, LV regional function, LV diastolic function, reports and image display and reference values from the literature of RVEF, LVEF and LV volumes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "prevailing or general consensus". The guidelines are designed to assist in the practice of referral to, performance, interpretation and reporting of nuclear cardiology studies for the evaluation of cardiac performance.
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