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Nuklearmedizin 1999; 38(06): 172-177
DOI: 10.1055/s-0038-1632214
Originaler Artikel
Schattauer GmbH

ROC Analysis of Three Perfusion Display Options for ECG-gated Perfusion SPECT in Severe CAD

ROC-Analyse von drei Darstellungsoptionen für die EKG-gegatete Perfusion-SPECT bei schwerer KHK
T. Leitha
1   University Clinic Nuclear Medicine, Vienna und Österreich
,
H. Bailer
2   KH Krems/Donau, Österreich
,
Marianne Gwechenberger
1   University Clinic Nuclear Medicine, Vienna und Österreich
,
Martha Pruckmayer
1   University Clinic Nuclear Medicine, Vienna und Österreich
,
A. Staudenherz
1   University Clinic Nuclear Medicine, Vienna und Österreich
,
G. Kronik
2   KH Krems/Donau, Österreich
› Author Affiliations
Further Information

Publication History

Received: 27 October 1997

in revised form: 14 April 1998

Publication Date:
02 February 2018 (online)

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Summary

Aim: The simultaneous computation and display of wall motion and perfusion patterns in a single 3D ventricular model would considerably ease the assessment of ECG-gated Tc-99m-sestamibi SPECT, yet the effect on the accuracy of allocating regional perfusion has so far not been validated. Methods: 3D perfusion mapping (3D Perfusion/Motion Map Software) was compared to the visual assessment of ungated tomographic slices and polar perfusion mapping (Cedars-Sinai PTQ) by correlation analysis and receiver operating characteristics (ROC) analysis at different cut-off levels for coronary stenoses in 50 patients (11 single-, 22 two-, 16 three-vessel disease). Ungated SPECT data were obtained by adding the intervals prior to reconstruction and displaying conventional tomographic slices. All display options were visually assessed in 8 ventricular segments according to a 4-point scoring system and compared to the graded results of coronary angiography. Results: All three display options showed a comparable diagnostic performance for the detection of severe stenoses. The diagnostic gain for the detection of stenoses above 59% was highest for ungated tomographic slices, followed by ungated polar mapping and 3D mapping. Regional assessment revealed a limited performance of 3D mapping in the proximal anterior and distal lateral wall. Polar mapping showed a balanced regional performance. Conclusion: 3D Perfusion mapping provides comparable information to conventional display options with the highest diagnostic strength in severe stenoses. Further improvement of the algorithm is needed in the definition of the valve plane.

Zusammenfassung

Ziel: Eine gleichzeitige Darstellung von Wandbewegung und Perfusionsmuster auf einem gemeinsamen 3D-Modell des linken Ventrikels erleichtert die Beurteilung von EKG-getriggerter Tc-99-Sestamibi SPECT, wobei bisher jedoch keine Validierung der regionalen Zuordnung der Perfusion zu bestimmten Wandabschnitten in einem 3D-Modell vorliegt. Methoden: Die Ergebnisse der 3D-Perfusionsdarstellung (3D-Perfusion/Motion Map Software) wurden mit der visuellen Beurteilung der ungetriggerten tomographischen Schnitte und der polaren Darstellung (Cedars-Sinai PTQ) korreliert und mittels Receiver Operating Characteristics (ROC)-Analyse für verschiedene Grade an Koronarstenosen in 50 Patienten (11 Ein-, 22 Zwei-, 16 Drei-Gefäß-Erkrankung) verglichen. Nichtgetriggerte SPECT wurde durch Addition der Intervalle vor dem Rekonstruktionsprozeß erhalten und mittels konventioneller Schnittechnik dargestellt. Alle Darstellungsoptionen wurden visuell in acht ventrikulären Segmenten gemäß eines 4-Punkt-Scoring-Systems beurteilt und mit den quantitativen Resultaten der Koronarangiographie verglichen. Ergebnisse: Alle drei Darstellungsoptionen zeigten einen vergleichbaren diagnostischen Gewinn für die Erkennung von schweren Stenosen. Der diagnostische Gewinn für das Erkennen von Stenosen über 59% war am höchsten für die Darstellung ungegateter Schnitte, gefolgt von der polaren und der 3D-Darstellung. In der regionalen Beurteilung zeigte die 3D-Darstellung eine eingeschränkte Performance im proximalen anterioren und distalen lateralen Segment, während die polare Darstellung eine ausgewogene regionale Beurteilbarkeit aufwies. Zusammenfassung: Die 3D-Darstellung der Perfusion ermöglicht eine, den konventionellen Darstellungsformen vergleichbare, diagnostische Information und zeigt ihren höchsten diagnostischen Gewinn bei schweren Koronarstenosen. Weitere Verbesserungen der Methode erscheinen wünschenswert für die Definition der Klappenebene.

Key words

Gated SPECT - technetium-99m-sestamibi - 3D Motion/Perfusion - polar map - ROC analysis

Schlüsselwörter:

Gegatete SPECT - Technetium-99m-Sestamibi - 3D Bewegung/Perfusion - polare Darstellung - ROC-Analyse
 

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