Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Analysis of Myocardial Function Using Gated Myocardial SPET : Comparison of QGS, 4D-MSPECT Software and Echocardiography

게이트 심근관류 SPECT를 이용한 심기능 분석: 정량분석 소프트웨어 QGS, 4D-MSPECT 및 심초음파법의 비교

  • Lee, Seok-Mo (Department of Nuclear Medicine, Inje University College of Medicine) ;
  • Bae, Sang-Kyun (Department of Nuclear Medicine, Inje University College of Medicine)
  • 이석모 (인제대학교 의과대학 핵의학교실) ;
  • 배상균 (인제대학교 의과대학 핵의학교실)
  • Published : 2008.12.31
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Abstract

Purpose: Gated myocardial perfusion SPECT provides not only myocardial perfusion status but also various functional parameters of left ventricle. We compared left ventricular ejection fraction, end-diastolic volume, LV mass by cardiac SPECT using Quantitative Gated SPECT (QGS), 4D-MSPECT software and standard 2D-echocardiography. Materials and Methods: One hundred fourteen patients (male 51, female 63; 29-85 years old, mean $61.3\;{\pm}\;13.3$ years old) with normal perfusion status on Tc-99m tetrofosmin gated myocardial perfusion SPECT were analyzed retrospectively. Ejection fraction (LVEF), End-diastolic volume (LVED), LV mass (LVM) were calculated using QGS, 4D-MSPECT, and LVEF, LVM using 2D-echocardiography. Statistical analysis including Bland-Altman plot was performed using $MedCalc^{(R)}$ (MedCalc software, Mariakerke, Belgium). Results: The correlation of LVEF between methods was good: 0.95/0.96 (stress/rest) between QGS and 4D-MSPECT, 0.79 between QGS and echocardiography, 0.79 between 4D-MSPECT and echocardiography (p<0.001). Using Bland-Altman plot, the 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -12.7% to 7.3% / from -12.2% to 6.5% (stress/rest). The agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -17.4% to 24.0%, and -14.8% to 27.0% respectively. The correlation of LVM between methods was also good: 0.95 between QGS and 4D-MSPECT, 0.76 between QGS and echocardiography, 0.73 between 4D-MSPECT and echocardiography (p<0.001). The 95% confidence interval of agreement between QGS and 4D-MSPECT ranged from -33.8g to 14.1g (stress/rest), The 95% confidence interval of agreement between QGS and echocardiography, 4D-MSPECT and echocardiography ranged from -148.7 g to 21.8. g, and -142.8 g to 35.5 g, respectively. Conclusion: There was a good correlation for LVEF, LVEO, LVM among methods (QGS, 4D-MSPECT, echocardiography), but the variance between methods was big. Therefore, the functional parameters by each method cannot be used interchangeably.

목적 : 게이트 심근 관류 SPECT는 심근 관류 소견 뿐 아니라, 좌심실의 벽운동, 벽의 두꺼워짐, 좌심실 용적, 좌심실 박출율 등의 부가적인 정보를 제공한다. 심근영상에서 이들 정보를 얻기 위한 여러 가지 프로그램들이 제공되고 있다. 이 연구에서는 게이트 심근 관류 SPECT 분석 프로그램인 Quantitative Gated SPECT (QGS), 4D-MSPECT 소프트웨어를 이용하여 좌심실 박출율, 확장기말 좌심실 용적, 좌심근 질량을 구하고 이면성 심초음파검사를 통해 좌심실 박출율과 좌심근 질량을 구해 비교하였다. 대상 및 방법 : 핵의학과에 심근관류 SPECT 검사를 위해 의뢰되었던 환자 중 심근관류 SPECT에서 관류소견이 정상이었던 114명(남자51명, 여자 63명, 평균 $61.3{\pm}13.3$세, 29-85세)의 자료를 후향적으로 분석하였다. 게이트 심근 관류 SPECT는 이데노신 (0.14 mg/kg/min)을 6분간 부하하면서 Tc-99m Tetrofosmin (Myoview)을 주사하여 부하기 영상을 얻고, 4시간 후 휴식기 영상을 얻었다. Quantitative Gated SPECT (QGS), 4D-MSPECT 소프트웨어를 이용하여 좌심실 박출율, 확장기말 좌심실 용적, 좌심근질량을 구하고 이면성 심초음파검사를 이용하여 좌심실 박출율, 좌심근질량을 구하였다. 각 방법 사이의 상관계수를 구하고 Bland-Altman분석을 이용하여 변이의 범위를 분석하였다. 결과: 좌심실 박출율의 분석에서 QGS와 4D-MSPECT사이의 상관계수는 부하기/휴식기 각각 0.95/0.96로 강한 상관관계를 보였고, QGS와 심초음파 검사 사이의 상관계수는 0.79, 4D-MSPECT SPECT와 심초음파 검사 사이의 상관계수는 0.79로 좋은 상관관계를 보였다 (p<0.001). 확장기말 좌심실 용적의 경우 QGS와 4D-MSPECT SPECT 사이의 상관계수는 부하기/휴식기 모두 0.99로 강한 상관관계를 보였다(p<0.001). 좌심근 질량의 경우 QGS와 4D-MSPECT사이의 상관계수는 부하기/휴식기 각각 0.94/0.95로 강한 상관관계를 보였고, QGS와 심초음파 검사 사이의 상관계 수는 0.76, 4D-MSPECT SPECT와 심초음파 검사 사이의 상관계수는 0.73로 좋은 상관관계를 보였다(p<0.001). Bland-Altman 방법으로 분석하였을 때, 좌심실 박출율의 경우 QGS와 4D-MSFECT 검사 사이의 변이의 95% 신뢰구간은 부하기/휴식기 각각 $-12.7%\;{\sim}\;7.3%/-12.2%\;{\sim}\;6.5%$였고, QGS와 심초음파 검사의 경우 $-17.4%\;{\sim}\;24%$, 4D-MSPECT SPECT와 심초음파 검사 경우 $-14.8%\;{\sim}\;27%$였다. 확장기말 좌심실 용적의 경우 QGS와 4D-MSPECT검사 사이의 변이의 95% 신뢰구간은 부하기/휴식기 각각 $-24.6\;mL\;{\sim}\;3.8\;mL/-28.6\;mL\;{\sim}\;6.1\;mL$였다. 좌심근 질량의 경우 QGS와 4D-MSFECT 검사 사이의 변이의 95%신뢰간은 부하기/휴식기 각각 $-40.4\;g\;{\sim}\;14.4\;g$과 $-33.8\;g\;{\sim}\; 14.1\;g$이었고, QGS와 심초음파 검사 사이는 $-148.7\;g\;{\sim}\;21.8\;g$이었으며, 4D-MSPECT와 심초음파 검사 사이는 $-142.8\;g\;{\sim}\;35.5\;g$이었다. 결론: 좌심실 박출율, 확장기말 좌심실 용적, 좌심근 질량 등을 구하는 자동정량화 소프트웨어 QGS, 4D-MSPECT, 심초음파 검사(좌심실 박출율, 좌심근 질량) 상호간에 좋은 상관관계가 있었다. 하지만 Bland-Altman분석에서 QGS, 4D-MSPECT, 심초음파 검사간의 변이의 범위가 큰 편이어서 서로 바꾸어 사용할 수는 없었다.

Keywords

References

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