Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Left ventricular ejection fraction by multigated acquisition scan using planar sodium iodide and cadmium-zinc-telluride cameras: a comparison with two-dimensional echocardiography

Document Type : Original Article

Authors
Gouri V G Kumar Das 1
Chen Siew Ng 1
Mahayuddin Abdul Manap 2
1 Department of Nuclear Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
2 Oncological and Radiological Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Penang, Malaysia
10.22038/aojnmb.2022.60392.1424
Abstract
Objective(s):  This study was undertaken to compare the correlation and agreement between Modified Simpson’s method two-dimensional-echocardio-graphy (2D-echo) and rest multigated acquisition scan (MUGA) using both planar sodium iodide (pNaI) and cadmium-zinc-telluride (CZT) cameras to measure left ventricular ejection fraction (LVEF).
Methods: One hundred and nine breast cancer patients monitored for cardiotoxicity underwent 2D-echo, followed by pNaI and CZT MUGA scans on the same day. LVEF for CZT camera was processed using both automatic and manual processing methods, thus yielding four methods for the LVEF analysis.
Results: Significant correlation (p<0.01) was seen among all four methods, with varied correlation strengths. Moderate correlation was seen between 2D-echo and both pNaI (r=0.56) and CZT cameras (automatic r=0.54, manual r=0.56). Strong correlation was registered between pNaI and CZT camera (automatic r=0.72, manual r=0.71). Bland-Altman limits of agreement among the three scans were wide and suboptimal. The widest limits were -21.1 to +16.2 (37%) between 2D-echo and CZT auto-processing.
Conclusion: Any one of the modalities can be used to measure LVEF, however, their results should not be used interchangeably. The same method of measurement is advised for serial scans.


Keywords
Breast cancer
LVEF
2D-echocardiography
MUGA scan
planar NaI camera
CZT camera
  1. Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Research. 2011; 13(3):1-9.
  2. Hasbullah HH, Bustamam A, Munn TL, Phua V. Assessment of Survival and Cardiotoxicity of Adjuvant Trastuzumab among HER2 Breast Cancer Patients in an Oncology Centre in Malaysia. Journal of Clinical and Health Sciences. 2017; 3: 33-42.
  3. Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology. 2017; 35(8):893-911.
  4. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal Cardio-vascular Imaging. 2014; 15(10):1063-93.
  5. Curigliano G, Cardinale D, Suter T, Plataniotis G, De Azambuja E, Sandri MT, et al. ESMO Guidelines Working Group. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Annals of Oncology. 2012; 23: vii155-66.
  6. National Institute for Health and Care Excellence (2006, amended 2017). Trastuzumab for the adjuvant treatment of early-stage HER2-positive breast cancer (NICE Technology Appraisal Guidance). Retrieved from https://www.nice.org.uk/ guidance/ta107.
  7. de Geus-Oei LF, Mavinkurve-Groothuis AM, Bellersen L, Gotthardt M, Oyen WJ, Kapusta L, et al. Scintigraphic techniques for early detection of cancer treatment–induced cardiotoxicity. Journal of nuclear medicine technology. 2013; 41(3):170-81.
  8. Altena R, Perik PJ, Van Veldhuisen DJ, De Vries EG, Gietema JA. Cardiovascular toxicity caused by cancer treatment: strategies for early detection. The lancet oncology. 2009; 10(4):391-9.
  9. Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance. Are they interchangeable? European heart journal. 2000; 21(16):1387-96.
  10. Ganz WI, Sridhar KS, Ganz SS, Gonzalez R, Chakko S, Serafini A. Review of tests for monitoring doxorubicin-lnduced cardio- myopathy. Oncology. 1996; 53(6): 461-70.
  11. Schwartz RG, McKenzie WB, Alexander J, Sager P, D'Souza A, Manatunga A, et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy: seven-year experience using serial radionuclide angiocardiography. The American journal of medicine. 1987; 82(6):1109-18.
  12. Huang H, Nijjar PS, Misialek JR, Blaes A, Derrico NP, Kazmirczak F, et al. Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance. 2017; 19(1):1-9.
  13. Oreto L, Todaro MC, Umland MM, Kramer C, Qamar R, Carerj S, et al. Use of echocardiography to evaluate the cardiac effects of therapies used in cancer treatment: what do we know? Journal of the American Society of Echocardiography. 2012; 25(11):1141-52.
  14. Hendel RC, Patel MR, Kramer CM, Poon M, Hendel RC, Carr JC, et al. ACCF/ACR/ SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: A report of the American College of Cardiology foundation quality strategic directions committee appropriateness criteria working group, American College of Radiology, society of cardiovascular computed tomography, society for cardiovascular magnetic resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society For .... Journal of the American College of Cardiology. 2006; 48(7):1475-97.
  15. Cranney GB, Lotan CS, Dean L, Baxley W, Bouchard A, Pohost GM. Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imaging. Validation by calibrated ventricular angiography. Circulation. 1990; 82(1): 154-63.
  16. Naik MM, Diamond GA, Pai T, Soffer A, Siegel RJ. Correspondence of left ventricular ejection fraction determinations from two-dimensional echocardio-graphy, radionuclide angiography and contrast cineangiography. Journal of the American College of Cardiology. 1995; 25(4):937-42.
  17. Bland JM, Altman D. Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet. 1986; 327(8476):307-10.
  18. Garcia EV, Faber TL, Esteves FP. Cardiac dedicated ultrafast SPECT cameras: new designs and clinical implications. Journal of Nuclear Medicine. 2011; 52(2):210-7.
  19. Slomka PJ, Patton JA, Berman DS, Germano G. Advances in technical aspects of myocardial perfusion SPECT imaging. Journal of nuclear cardiology. 2009; 16(2):255-76.
  20. Jensen MM, Schmidt U, Huang C, Zerahn B. Gated tomographic radionuclide angiography using cadmium-zinc-telluride detector gamma camera; comparison to traditional gamma cameras. Journal of Nuclear Cardiology. 2014; 21(2):384-96.
  21. Jac Scheiner, Albert Sinusas, Mark D. Wittry, Henry D. Royal, Josef Machac, Helena R. Balon, et al. Society of Nuclear Medicine Procedure Guideline for Gated Equilibrium Radionuclide Ventriculography Version 3.0, approved June 15, 2002.
  22. British Nuclear Medicine Society Procedure Guideline for Planar Radionuclide Cardiac Ventriculogram for the Assessment of Left Ventricular Systolic Function, Version 2, 2016.
  23. Callahan RJ, Radiolabeled red blood cells: method and mechanisms. The University of New Mexico Health Sciences Center College of Pharmacy Accreditation Council for Pharmacy Education ACPE; 2006.
  24. US Pharmacopeia Expert Committee: (RMI05) Radiopharmaceuticals and Medical Imaging Agents 05; USP29–NF24 Page 2074 Technetium Tc 99m Red Blood Cells Injection.
  25. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and inter-pretation. Anesthesia & Analgesia. 2018; 126(5):1763-8.
  26. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic 2016; 15(2):155-63.
  27. Himelman RB, Cassidy MM, Landzberg JS, Schiller NB. Reproducibility of quantitative two-dimensional echocardiography. American heart journal. 1988; 115(2):425-31.
  28. Fatima N, uz Zaman M, Hashmi A, Kamal S, Hameed A. Assessing adriamycin-induced early cardiotoxicity by estimating left ventricular ejection fraction using technetium-99m multiple-gated acquisition scan and echocardiography. Nuclear medicine communications. 2011; 32(5): 381-5.
  29. Mitra D, Basu S. Equilibrium radionuclide angiocardiography: Its usefulness in current practice and potential future applications. World journal of radiology. 2012; 4(10):421.
  30. Duvall WL, Guma-Demers KA, George T, Henzlova MJ. Radiation reduction and faster acquisition times with SPECT gated blood pool scans using a high-efficiency cardiac SPECT camera. Journal of Nuclear Cardiology. 2016; 23(5):1128-38.
  31. Chen YC, Ko CL, Yen RF, Lo MF, Huang YH, Hsu PY, Wu YW, Cheng MF. Comparison of biventricular ejection fractions using cadmium-zinc-telluride SPECT and planar equilibrium radionuclide angiography. Journal of Nuclear Cardiology. 2016; 23(3): 348-61.
  32. Russell RR, Alexander J, Jain D, Poornima IG, Srivastava AV, Storozynsky E, et al. The role and clinical effectiveness of multimodality imaging in the management of cardiac complications of cancer and cancer therapy. Journal of Nuclear Cardiology. 2016; 23(4): 856-84.
  33. Jensen MM, Haase C, Zerahn B. Interstudy repeatability of left and right ventricular volume estimations by serial‐gated tomographic radionuclide angiographies using a cadmium‐zinc‐telluride detector gamma camera. Clinical physiology and functional imaging. 2015; 35(6):418-24.
  34. Bailliez A, Blaire T, Bellevre D, Agostini D, Manrique A. Gated blood pool SPECT using cadmium zinc telluride (CZT) and Anger camera for the assessment of global LV and RV function and quantitative Fourier analysis of ventricular asynchrony compared to planar angiography. Journal of Nuclear Medicine. 2015; 56 (3): 129.
  35. Foley TA, Mankad SV, Anavekar NS, Bonnichsen CR, Morris MF, Miller TD, et al. Measuring left ventricular ejection fraction-techniques and potential pitfalls. European Cardiology. 2012; 8(2):108-14.
  36. Nakajima K, Okuda K, Nyström K, Richter J, Minarik D, Wakabayashi H, et al. Improved quantification of small hearts for gated myocardial perfusion imaging. European journal of nuclear medicine and molecular imaging. 2013; 40(8):1163-70.
  37. Yoneyama H, Shibutani T, Konishi T, Mizutani A, Hashimoto R, Onoguchi M, et al. Validation of Left Ventricular Ejection Fraction with the IQ SPECT System in Small-Heart Patients. Journal of Nuclear Medicine Technology. 2017; 45(3):201-7.
  38. Chono T, Onoguchi M, Hashimoto A. Assessment of Left Ventricular Diastolic Function Using ECG-gated Myocardial Perfusion SPECT in Small Heart: Comparison with Ultrasound Echocardio-graphy. Nihon Hoshasen Gijutsu Gakkai zasshi. 2018; 74(6):572-9.
  39. Akincioglu C, Berman DS, Nishina H, Kavanagh PB, Slomka PJ, Abidov A, et al. Assessment of diastolic function using 16-frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. Journal of Nuclear Medicine. 2005; 46(7):1102-8.
  40. Ioannidis JP, Trikalinos TA, Danias PG. Electrocardiogram-gated single-photon emission computed tomography versus cardiac magnetic resonance imaging for the assessment of left ventricular volumes and ejection fraction: A meta-analysis. Journal of the American College of Cardiology. 2002; 39(12):2059-68.
  41. Dabagh KV, Zakavi SR, Sadeghi R, Emadzadeh M, Vojdani A. Normal values of left ventricular functional indices in gated 99mTc-MIBI myocardial perfusion SPECT. Iranian Journal of Nuclear Medicine. 2008;16(1):14-19.
  42. Khalil MM, Elgazzar A, Khalil W, Omar A, Ziada G. Assessment of left ventricular ejection fraction by four different methods using 99mTc tetrofosmin gated SPECT in patients with small hearts: correlation with gated blood pool. Nuclear medicine communications. 2005; 26(10):885-93.
  43. Trägårdh E, Ljungberg M, Edenbrandt L, Örndahl E, Johansson L, Gustafsson A, et al. Evaluation of inter-departmental variability of ejection fraction and cardiac volumes in myocardial perfusion scintigraphy using simulated data. EJNMMI physics. 2015; 2(1):1-8.
  44. Véra P, Manrique A, Pontvianne V, Hitzel A. Thallium-gated SPECT in patients with major myocardial infarction: effect of filtering and zooming in comparison with equilibrium radionuclide imaging and left ventriculography. The Journal of Nuclear Medicine. 1999; 40(4):513.
  45. Bailliez A, Lairez O, Merlin C, Piriou N, Legallois D, Blaire T, Agostini D, Valette F, Manrique A. Left ventricular function assessment using 2 different cadmium-zinc-telluride cameras compared with a γ-camera with cardiofocal collimators: dynamic cardiac phantom study and clinical validation. Journal of Nuclear Medicine. 2016; 57(9):1370-5.
  46. Wright GA, McDade M, Martin W, Hutton I. Quantitative gated SPECT: the effect of reconstruction filter on calculated left ventricular ejection fractions and volumes. Physics in Medicine & Biology. 2002; 47(8):N99.
  47. Makis W. MUGA image artefacts caused by metallic injection ports in breast reconstruction tissue expanders: a report of two breast cancer patients. BJR| case reports. 2016:20150421.
  48. Mar MV, Kim EE. False-positive pericardial effusion due to breast attenuation on equilibrium radionuclide angiocardio-graphy. Journal of nuclear medicine technology. 2011; 39(2):105-10.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 11, Issue 1
January 2023
Pages 55-70