Development of Evaluation Method of Regional Contractility of Left Ventricle Using Gated Myocardial SPECT and Assessment of Reproducibility

게이트 심근 SPECT를 이용한 좌심실의 국소탄성률 평가방법 개발 및 재현성 평가

  • Lee, Byeong-Il (Department of Information & Computer Engineering, Inje University) ;
  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Jae-Sung (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kang, Won-Jun (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Chung, June-Key (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Myung-Chul (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Choi, Heung-Kook (Department of Information & Computer Engineering, Inje University)
  • 이병일 (인제대학교 정보컴퓨터공학부) ;
  • 이동수 (서울대학교의과대학 핵의학교실) ;
  • 이재성 (서울대학교의과대학 핵의학교실) ;
  • 강원준 (서울대학교의과대학 핵의학교실) ;
  • 정준기 (서울대학교의과대학 핵의학교실) ;
  • 이명철 (서울대학교의과대학 핵의학교실) ;
  • 최흥국 (인제대학교 정보컴퓨터공학부)
  • Published : 2003.12.30

Abstract

Purpose: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. Materials and Methods: Seven patients(male:female=5:2, $58{\pm}11.9$ years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. Results: Measured regional contractility was $3.36{\pm}3.38{mm}Hg/mL$ using 15-segment model, $3.16{\pm}2.25{mm}Hg/mL$ using 7-segment model, and $3.11{\pm}2.57{mm}Hg/mL$ using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. Conclusion: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.

목적: 게이트 심근 SPECT 영상에서 국소부피변화를 얻으면, 요골동맥 긴장도를 측정하여 얻은 중심 동맥의 압력 곡선으로부터 최대탄성률을 얻을 수 있다. 이 연구에서는 좌심실의 국소탄성률을 평가하기 위한 방법을 개발하고 국소탄성률 측정의 재현성을 평가하였다. 대상 및 방법: 게이트 Tc-99m MIBI 심근 관류 SPECT를 두 번 연속으로 시행한 환자 7명(남:여=5:2, $58{\pm}11.9$세)을 대상으로 하였다. 국소적 부피변화를 측정하기 위하여 개발한 CSA(Cardiac SPECT Analyzer) 소프트웨어를 이용하여 좌심실의 부피변화를 측정하였으며, 시간-압력곡선과 국소 시간-부피 곡선을 이용하여 반복연산을 통하여 구한 국소 시간-탄성률 곡선에서 국소탄성률을 얻었다. 같은 SPECT 영상에 대해서 두 번 측정한 국소탄성률의 재현성과, 같은 환자에서 연속하여 두 번 얻은 SPECT 영상에 대해서 측정한 국소탄성률의 재현성을 평가하였다. 결과: 평균 국소탄성률은 15분할모델에서 $3.36{\pm}3.38mmHg/mL$이었으며, 7분할모델과 5분할모델에서 각각 $3.16{\pm}2.25mmHg/mL,\;3.11{\pm}2.52mmHg/mL$이었다. 국소탄성률의 조화평균은 전체탄성률과 일치하였다. 동일한 데이터에서 두 번 측정한 국소탄성률 값의 상관계수는 모든 모델에서 0.97이상이었고, Bland Altman 도표에서 차이의 2-표준편차는 각각 1.5%, 1.0%, 0.9%였다. 동일 환자에서 두 번 연속 촬영한 SPECT 데이터로부터 측정한 국소탄성률의 상관계수는 모든 모델에서 0.95이상이었으며, Bland Altman 도표에서 차이의 2-표준편차는 각각 2.2%, 1.0%, 1.2%였다. 결론: 게이트 심근 SPECT를 이용한 좌심실의 국소탄성률을 측정하였으며 재현성 있는 결과를 얻었다. 심근 SPECT를 이용하여 얻은 국소탄성률의 평가방법은 향후 임상적인 데이터를 바탕으로 새로운 심기능 분석지표로 활용될 수 있을 것이다.

Keywords

References

  1. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su H-T, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138-47
  2. Germano G, Kavanagh PB, Waechter P, Areeda J, Kriekinge SV, Sharir T, et al. A new algorithm for the quantitation of myocardial perfusion SPECT.I: Technical principles and reproducibility. J Nucl Med 2000;41:712-19
  3. Faber TL, Cooke CD, Folks RR, Vansant JP, Nichols KJ, DePuey EG, et al. Left ventricular function and perfusion from gated SPECT perfusion images: An integrated method. J Nucl Med 1999;40:650-59
  4. Lee BI, Lee JS, Lee DS. Regional contractility measurement of the left ventricle using gated myocardial SPECT. Proceedings of IEEE MIC 2002; M10-229
  5. Senzaki H, Chen C-H, Kass DA. Single-beat estimation of end-systolic pressure-volume relation in humans: a new method with the potential for noninvasive application. Circulation 1996;94: 2497-2506 https://doi.org/10.1161/01.CIR.94.10.2497
  6. Lee DS, Kim KM, Kim SK, Cheon GJ, Kim YK, Chung J-K, et al. Development of a method for measuring myocardial contractility with gated myocardial SPECT and arterial tonometry. J Nucl Cardiol. 1999;6:657-63 https://doi.org/10.1016/S1071-3581(99)90104-6
  7. Kim KM, Lee DS, Kim YK, Cheon GJ, Kim SK, Chung JK, et al. Reproducibility of non-invasive measurement for left ventricular contractility using gated myocardial SPECT. Korean J Nucl Med, 2001;35:152-60
  8. Suga H. Paul Dudley. White International Lecture: Cardiac performance as viewed through the pressure-volume window. Jpn Heart J, 1994;35: 263-80
  9. Sharir T, Marmor A, Ting CT, Chen JW, Liu CP, Chang MS, et al. Validation of a method for noninvasive measurement of central arterial pressure. Hypertension 1993;21:74-82 https://doi.org/10.1161/01.HYP.21.1.74
  10. yoshizawa M, Abe KI, Tokeda H, Tambe T, Nitta SI. Classical but effective techniques for estimating cardiovascular dynamics: achieving accurate results using linear models. IEEE Eng in Med Biol Mag,1997; 16:106-12
  11. Lee BI, Lee DS, Lee JS, Choi HK. Development of gated myocardial SPECT analysis software and evaluation of left ventricular contraction function. Korean J Nucl Med, 2003;(2)37:1-10
  12. Paeng JC, Lee DS, Cheon GJ, Kim YK, Chung J-K, Lee MC. Reproducibility of an automatic quantitation of regional myocardial wall motion and systolic thickening on gated Tc-99m MIBI myocardial SPECT. J Nucl Med, 2001;42:779-84