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Sager DF, Manz N, Manser S, Laubscher L, Stark AW, Schütze J, Heiniger PS, Markendorf S, Kaufmann PA, Gräni C, Buechel RR. Reproducibility of Left Ventricular Function Derived From Cardiac Magnetic Resonance and Gated 13N-Ammonia Positron Emission Tomography Myocardial Perfusion Imaging: A Head-to-Head Comparison Using Hybrid Positron Emission Tomography/Magnetic Resonance. Acad Radiol 2024; 31:1248-1255. [PMID: 37940426 DOI: 10.1016/j.acra.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
RATIONALE AND OBJECTIVES Cardiac magnetic resonance (CMR) and gated 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI) offer accurate and highly comparable global left ventricular ejection fraction (LVEF) measurements. In addition to accuracy, however, reproducibility is crucial to avoid variations in LVEF assessment potentially negatively impacting treatment decisions. We performed a head-to-head comparison of the reproducibility of LVEF measurements derived from simultaneously acquired CMR and PET-MPI using different state-of-the-art commercially available software. MATERIALS AND METHODS 93 patients undergoing hybrid PET/MR were retrospectively included. LVEF was derived from CMR and PET-MPI at two separate core labs, using two state-of-the-art software packages for CMR (cvi42 and Medis Suite MR) and PET (QPET and CardIQ Physio). Intra- and inter-reader agreement was assessed using correlation and Bland-Altman (BA) analyses. RESULTS While intra- and inter-reader reproducibility of LVEF was high among both modalities and all software packages (r ≥ 0.87 and ICC≥0.91, all significant at p < 0.0001), LVEF derived from PET-MPI and analyzed with QPET outperformed all other analyses (intra-reader reproducibility: r = 0.99, ICC=0.99; inter-reader reproducibility: r = 0.98, ICC=1.00; Pearson correlations significantly higher than all others at p ≤ 0.0001). BA analyses showed smaller biases for LVEF derived from PET-MPI (-0.1% and +0.9% for intra-reader, -0.4% and -0.8% for inter-reader agreement) than those derived from CMR (+0.7% and +2.8% for intra-reader, -0.9% and -2.2% for inter-reader agreement) with similar results for BA limits of agreement. CONCLUSION Gated 13N-ammonia PET-MPI provides equivalent reproducibility of LVEF compared to CMR. It may offer a valid alternative to CMR for patients requiring LV functional assessment.
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Affiliation(s)
- Dominik F Sager
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Nico Manz
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Sarah Manser
- Faculty of Medicine, University of Bern, Murtenstrasse 11, CH-3008 Bern, Switzerland (N.M., S.M.)
| | - Lily Laubscher
- Department of Health Science and Technology, ETH Zurich, Ramistrasse 101, CH-8092 Zurich, Switzerland (L.L.)
| | - Anselm W Stark
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Jonathan Schütze
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Pascal S Heiniger
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Susanne Markendorf
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.)
| | - Christoph Gräni
- Department of Cardiology, University Hospital of Bern, Freiburgstrasse 15, CH-3010 Bern, Switzerland (A.W.S., J.S., C.G
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging , University Hospital of Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland (D.F.S., P.S.H., S.M., P.A.K., R.R.B.).
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Nordström J, Kvernby S, Kero T, Sörensen J, Harms HJ, Lubberink M. Left-ventricular volumes and ejection fraction from cardiac ECG-gated 15O-water positron emission tomography compared to cardiac magnetic resonance imaging using simultaneous hybrid PET/MR. J Nucl Cardiol 2023; 30:1352-1362. [PMID: 36482239 PMCID: PMC10372106 DOI: 10.1007/s12350-022-03154-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND 15O-water PET is the gold standard for noninvasive quantification of myocardial blood flow. In addition to evaluation of ischemia, the assessment of cardiac function and remodeling is important in all cardiac diseases. However, since 15O-water is freely diffusible and standard uptake images show little contrast between the myocardium and blood pool, the assessment of left-ventricular (LV) volumes and ejection fraction (EF) is challenging. Therefore, the aim of the present study was to investigate the feasibility of calculating LV volumes and EF from first-pass analysis of 15O-water PET, by comparison with cardiac magnetic resonance imaging (CMR) using a hybrid PET/MR scanner. METHODS Twenty-four patients with known or suspected CAD underwent a simultaneous ECG-gated cardiac PET/MR scan. The 15O-water first-pass images (0-50 seconds) were analyzed using the CarPET software and the CMR images were analyzed using the software Segment, for LV volumes and EF calculations. The LV volumes and EF were compared using correlation and Bland-Altman analysis. In addition, inter- and intra-observer variability of LV volumes and EF were assessed for both modalities. RESULTS The correlation between PET and CMR was strong for volumes (r > 0.84) and moderate for EF (r = 0.52), where the moderate correlation for EF was partly due to the small range of EF values. Agreement was high for all parameters, with a slight overestimation of PET values for end-diastolic volume but with no significant mean bias for other parameters. Inter- and intra-observer agreement of volumes was high and comparable between PET and CMR. For EF, inter-observer agreement was higher for PET and intra-observer agreement was higher for CMR. CONCLUSION LV volumes and EF can be calculated by first-pass analysis of a 15O-water PET scan with high accuracy and comparable precision as with CMR.
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Affiliation(s)
- Jonny Nordström
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden.
- Centre for Research and Development, Uppsala/Gävleborg County, Gävle, Sweden.
| | - Sofia Kvernby
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Hendrik J Harms
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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