Automated detection of left ventricular dyskinesis by gated blood pool SPECT

Abstract

The ability to detect left ventricular (LV) apical dyskinesis, the hallmark of an aneurysm, is an important requirement of diagnostic cardiac imaging modalities that perform wall motion analysis. Our investigation assessed the ability of gated blood pool single-photon emission-computed tomography (GBPS) to automatically detect LV dyskinesis, using cardiac magnetic resonance (CMR) as the reference standard. GBPS data were analyzed for 41 patients with congestive heart failure or cardiomyopathy and compared with ECG-gated TrueFISP CMR evaluations. An experienced nuclear cardiologist without the knowledge of quantitative GBPS or CMR results graded visual impressions of regional wall motion while examining cinematic playbacks of GBPS images. GBPS algorithms automatically isolated LV counts and computed regional phase (phi) values in each of 17 conventional American Heart Association LV segments. LV asynchrony was quantified by the two local measures: maximum apical phi difference (Deltaalpha), and standard deviation among apical phases (sigmaalpha), and by the five global measures: varphi histogram bandwidth (BWHistogram), phi histogram standard deviation (sigmaHistogram), Z-scores, Entropy, and Synchrony. For CMR data, an expert manually drew endocardial LV outlines to measure regional wall motion in 17 LV segments. Apical dyskinesis was present in nine patients. Among GBPS measurements, the method with the greatest accuracy for detecting dyskinesis was Deltaalpha (receiver operating characteristic area=95%). The only method with a sufficiently high kappa statistic to represent 'very good agreement' with CMR was Deltaalpha, with kappa=0.81. Deltaalpha was more sensitive in detecting dyskinesis than visual analysis (100 vs. 33%, P=0.01). Automatic GBPS computations accurately identified patients with LV dyskinesis, and detected dyskinesis more successfully than did visual analysis.