Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Measurement of Shunt Amount Using Radionuclide Angiocardiography: Accuracy According to Level of Shunt and Associated Lesion

방사성 동위원소 심혈관 조영술을 이용한 단락량 측정법: 정확성에 영향을 미치는 인자

  • Kim, Yang-Min (Department of Radiology, Sejong General Hospital & Sejong Heart Institute)
  • Published : 2006.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Determination of pulmonary to systemic blood flow ratio (QP/QS) is important for the management of patients with left-to-right shunt. This study was performed to assess the agreement of Qp/Qs ratio using the radionuclide method and oxymetry, to investigate the factors influencing the agreement, and to know how interchangeable the results of each technique. Materials and Methods: We compared the Qp/Qs measured by single-pass radionuclide angiocardiography and oxymetry during catheterization in 207 patients who underwent both studies. In radionuclide method, Qp/Qs was calculated from the pulmonary time-activity curves using a gamma variate fit. The correlation and Bland-Altman analysis were performed according to the levels of shunt and associated lesions. Results: The mean Qp/Qs was $1.83{\pm}0.50$ by radionuclide, and $1.74{\pm}0.51$ by oxymetry. The overall correlation coefficient was 0.86(p<0.001), and Bland-Altman range of agreement encompassing 4SD was 1.05. For atrial septal defect, ventricular septal defect, patent ductus arteriosus, tricuspid and mitral insufficiency, the correlation coefficient was 0.78, 0.90, 0.84, 0.63 and 0.44, and Bland-Altman range was 1.51, 0.74, 0.96, 1.57, and 1.50, respectively. Conclusion: There is good agreement but wide variance between the Qp/Qs ratios by radionuclide method and oxymetry. Associated atrioventricular valvar insufficiency decreases the correlation coefficient and widens the variance. Wide overall variance suggests that Qp/Qs measurements by two techniques should not be used interchangeably.

목적: 산소포화도법과 비교하여 동위원소법을 이용한 Qp/Qs측정의 정확도를 알아보고, 이와 연관된 요인이 무엇인지, 추적 검사시 두 검사법의 결과를 서로 비교해서 사용할 수 있는지에 대하여 알아보고자 하였다. 대상 및 방법: 두 검사법으로 Qp/Qs를 측정한 207명의 환자를 대상으로 하였다. 동위원소를 이용한 방법은 폐에 관심영역을 설정하여 시간-방사능 곡선을 얻어서 gamma variate model에 적용하여 면적으로부터 Qp/Qs를 구하였다. 환자의 연령, 좌우 단락의 종류와 동반된 질환 등에 따라서 방사성 동위원소 조영술과 심도자술로 얻어진 Qp/Qs의 상관계수와 일치도를 분석하였다. 결과: 동위원소 검사법과 심도자술로 얻어진 Qp/Qs의 평균치는 각각 $1.85{\pm}0.50,\;1.74{\pm}0.51$이며, 두 검사법으로 얻은 Qp/Qs의 상관계수는 0.86 (p<0.001)으로 강한 상관관계를 보였다. Bland-Altman 분석에서 두 검사법에 의한 Qp/Qs의 일치의 한계값은 $-0.42{\sim}0.63$, 범위는 1.05였다. 심실중격 결손증 환자에서는 상관계수가 0.90으로 강한 상관관계를 보였으며, 일치의 한계값은 $-0.29{\sim}0.45$ 였다. 심방중격 결손증, 심실중격 결손증, 동맥관 개존증 환자와 삼첨판 부전증과 승모판 부전증이 동반된 환자에서의 상관계수는 각각 0.78, 0.90, 0.84, 0.63, 0.44 였으며, 일치의 범위는 1.52, 0.74, 0.96, 1.57. 1.50이였다. 결론: 동위원소 검사법과 심도자술로 얻어진 Qp/Qs는 전체적으로 좋은 상관관계를 보이나 일치의 한계값이 크므로 추적 검사시 서로 호환하여 사용하기 어렵다. 방실판막 부전증이 동반된 경우에는 낮은 상관관계와 낮은 일치도를 보였다.

Keywords

References

  1. Dittmann H, Jacksch R, Voelker W, Karsch KR, Seipel L. Accuracy of Doppler echocardiography in quantification of left to right shunts in adult patients with atrial septal defect. J Am Coll Cardiol 1988;11:338-42 https://doi.org/10.1016/0735-1097(88)90099-X
  2. Johnson MC, Sekarski TJ, Balzer DT. Echocardiographic prediction of left-to-right shunt with atrial septal defects. J Am Soc Echocardiogr 2000;13:1038-42 https://doi.org/10.1067/mje.2000.106679
  3. Shiota T, Jones M, Aida S, Chikada M, Tsujino H, El-Kadi T, et al. Validation of the accuracy of both right and left ventricular outflow volume determinations and semiautomated calculation of shunt volumes through atrial septal defects by digital color Doppler flow mapping in a chronic animal model. J Am Coll Cardiol 1999;34:587-93 https://doi.org/10.1016/S0735-1097(99)00210-7
  4. Moises VA, Maciel BC, Hornberger LK, Murillo-Olivas A, Valdes-Cruz LM, Sahn DJ, et al. A new method for noninvasive estimation of ventricular septal defect shunt flow by Doppler color flow mapping: imaging of the laminar flow convergence region on the left septal surface. J Am Coll Cardiol 1991;18:824-32 https://doi.org/10.1016/0735-1097(91)90808-M
  5. Boehrer JD, Lange RA, Willard JE, Grayburn PA, Hillis LD. Advantages and limitations of methods to detect, localize, and quantitate intracardiac left-to-right shunting. Am Heart J 1992;124:448-55 https://doi.org/10.1016/0002-8703(92)90612-Y
  6. Arheden H, Holmqvist C, Thilen U, Hanseus K, Bjorkhem G, Pahlm O, et al. Left-to-right cardiac shunts: comparison of measurements obtained with MR velocity mapping and with radionuclide angiography. Radiology 1999;211:453-8 https://doi.org/10.1148/radiology.211.2.r99ma43453
  7. Antman EM, Marsh JD, Green LH, Grossman W. Blood oxygen measurements in the assessment of intracardiac left-to-right shunts: A critical appraisal of methodology. Am J Cardiol 1980;46:265-71 https://doi.org/10.1016/0002-9149(80)90068-5
  8. Malz DL, Treves S. Quantitative radionuclide angiocardiography: Determination of Qp;Qs in children. Circulation 1973;47:1049-56 https://doi.org/10.1161/01.CIR.47.5.1049
  9. Treves S, Folge R, Lang P. Radionuclide angiography in congenital heart disease. Am J Cardiol 1980;46:1247-55 https://doi.org/10.1016/0002-9149(80)90295-7
  10. Alderson PO, Jost RG, Strauss AW, Boonvisut S, Markham J. Radionuclide angiocardiography: Improved diagnosis and quantitation of left-to-right cardiac shunts using area ratio techniques in children. Circulation 1975;51:1136-43 https://doi.org/10.1161/01.CIR.51.6.1136
  11. Anderson PA, Bowyer KW, Jones RH. Effects of age on radionuclide angiographic detection and quantitation of left-to-right shunts. Am J Cardiol 1984;53:879-83 https://doi.org/10.1016/0002-9149(84)90517-4
  12. Askenazi, J, Ahnberg DS, Lafarge CG, Malz DL, Treves S. Quantitative radionuclide angiocardiography; Detection and quantification of left to right shunt. Am J Cardiol 1976;37:382-7 https://doi.org/10.1016/0002-9149(76)90287-3
  13. Hurwitz RA, Treves S, Keane JF, Girod DA, Caldwell RL. Current value of radionuclide angiocardiography for shunt quantification and management in patients with secundum atrial septal defect. Am Heart J 1982;103:421-5 https://doi.org/10.1016/0002-8703(82)90283-6
  14. Smallhorn JF, Adams AP, Goldblatt E, Savage JP. Quantitative radionuclide angiocardiography for left-to-right cardiac shunts in children. Pediatr Cardiol 1982;3:1-5 https://doi.org/10.1007/BF02082322
  15. Mcliveen BM, Murray IPC, Giles RW, Molk GH, Scarg CM. Cardie RM. Clinical application of radionuclide quantitation of left to right cardiac shunts in children. Am J Cardiol 1982;47:1273-8 https://doi.org/10.1016/0002-9149(81)90258-7
  16. Alderson PO, Douglass KH, Mendenhall KG, Guadiani VA, Watson DC, Links JM, et al. Deconvolution analysis in radionuclide quantitation of left-to-right cardiac shunts. J Nucl Med 1979;20: 502-6
  17. Bourguignon MH, Links JM, Douglass HN, Alderson PO, Roland JM, Wagner NH. Quantification of left to right cardiac shunts by multiple deconvolution analysis. Am J Cardiol 1981;48:1086-90 https://doi.org/10.1016/0002-9149(81)90324-6
  18. Kuruc A, Treves S, Parker JA, Cheng C, Sawan A. Radionuclide angiocardiography: An improved deconvolution technique for improvement after suboptimal bolus injection. Radiology 1981;148: 233-8
  19. Oh YS, Lee MC, Cho BY, Koh CS. Radionuclide quantitation of left-to-right cardiac shunts using deconvolution analysis. Korean J Nucl Med 1984;18:9-17
  20. Kim OH, Bahk WY, Kim CK. Angiocardiographic evaluation of left-to-right cardiac shunts : analysis of time - active curves. Korean J Nucl Med 1987;21:155-65
  21. Kim BC, Noh BS, Sohn MH, Song HY, Kim CS, Kim JK, et al. Radionuclide angiocardiography in cogenital heart disease. Korean J Nucl Med 1984;20:85-91
  22. Hong CY, Choi JY, Park SW, Yun YS. Koh CS. Comparative study on quantitation of left to right shunt in ventricular septal defect using oxymetry and radionuclide method. Korean J Pediatr 1984;28:36-41