Radiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bavelaar-Croon, C. D. L.
Right arrow Articles by Atsma, D. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bavelaar-Croon, C. D. L.
Right arrow Articles by Atsma, D. E.
(Radiology. 2000;217:572-575.)
© RSNA, 2000

Technical Developments

Left Ventricular Function: Correlation of Quantitative Gated SPECT and MR Imaging over a Wide Range of Values1

Carine D. L. Bavelaar-Croon, MD, Hein W. M. Kayser, MD, Ernst E. van der Wall, MD, PhD, Albert de Roos, MD, PhD, Petra Dibbets-Schneider, CNMTM, Ernest K. J. Pauwels, PhD, Guido Germano, PhD and Douwe E. Atsma, MD, PhD

1 From the Department of Radiology (H.W.M.K., A.d.R.), Divisions of Nuclear Medicine (C.D.L.B.C., P.D.S., E.K.J.P.) and Cardiology (E.E.v.d.W., D.E.A.), Leiden University Medical Centre, Albinusdreef 2, C4Q-80, 2333 ZA Leiden, the Netherlands; and the Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (G.G.). Received November 10, 1999; revision requested December 15; revision received February 7, 2000; accepted March 30. Address correspondence to C.D.L.B.C. (e-mail: C.Bavelaar-Croon@inter.nl.net).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 Materials and Methods
Results
 Discussion
 REFERENCES
 
In 21 patients, the authors compared results with quantitative gated single photon emission computed tomography (SPECT) to results with magnetic resonance imaging in the assessment of left ventricular (LV) end-diastolic volume (LVEDV), end-systolic volume (LVESV), and ejection fraction (LVEF). Between the two methods, correlations were good for LVEF (r = 0.85), LVEDV (r = 0.94), and LVESV (r = 0.95). Quantitative gated SPECT can help determine LVEF, LVEDV, and LVESV.

Index terms: Heart, function, 524.91 • Heart, MR, 524.121412 • Heart, SPECT, 524.12162 • Heart, ventricles, 524.121412, 524.12162, 524.91 • Heart, volume, 524.121412, 524.12162 • Magnetic resonance (MR), comparative studies, 524.121412, 524.1262


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
Materials and Methods
Results
 Discussion
 REFERENCES
 
Left ventricular (LV) ejection fraction (LVEF), end-diastolic volume (LVEDV), and end-systolic volume (LVESV) are major diagnostic and prognostic parameters in patients with coronary artery disease (1–4). Traditionally, these parameters are derived from various imaging modalities including echocardiography, blood pool scintigraphy, ventriculography, and magnetic resonance (MR) imaging. Electrocardiography (ECG) gated myocardial perfusion single photon emission computed tomography (SPECT) offers the potential to simultaneously assess LV function and myocardial perfusion with just one acquisition procedure (5–9). Accurate delineation of the endocardial and epicardial contours on the reconstructed tomographic images is a prerequisite for reliable calculation of LV volumes and LVEF. Germano et al (7,10,11) developed a software program that is capable of automatically delineating the myocardial contours and calculating LV volumes and LVEF. The algorithm is operator independent and highly reproducible. Various reports indicate that MR imaging can provide accurate estimates of LVEF and LV volumes (12–16). Although the gated SPECT technique has been extensively validated against various two-dimensional imaging techniques, such as echocardiography (17) and ventriculography (18), there are only a limited number of studies comparing gated SPECT with other three-dimensional techniques such as MR imaging, which is considered the reference standard for assessing LV volumes (19,20).

The aim of this study was to validate LVEF, LVEDV, and LVESV measurements with gated SPECT over a wide range of values, with MR imaging as the reference standard.


   Materials and Methods
TOP
 ABSTRACT
 INTRODUCTION
 Materials and Methods
Results
 Discussion
 REFERENCES
 
Patients
Twenty-one patients (14 men and seven women; mean age, 58 years ± 12 [SD]; age range, 36–73 years) with known or suspected coronary artery disease were included in our study. They had been referred for gated SPECT for accepted clinical indications. They were already scheduled to undergo MR imaging as part of research protocols approved by the Leiden University Hospital review board and had given informed consent. The time between the two studies was less than 6 weeks.

Thirteen (62%) of the 21 patients had experienced a myocardial infarction. The infarction was located in the anterior wall in eight patients and in the inferior wall in five. No cardiac events occurred between the two studies. At LV angiography in 12 patients, hypokinesia or akinesia was found in 10 patients and aneurysm in four.

Gated SPECT Acquisition
In our department, 1- and 2-day protocols are used interchangeably (21). Six (29%) of our patients underwent a 1-day protocol; and 15 patients, a 2-day protocol. In the 1-day protocol, 250 MBq of technetium 99m tetrofosmin (Nycomed-Amersham; Oslo, Norway) was administered 45–60 minutes prior to acquisition of the rest gated SPECT study. Four hours later, 750 MBq of 99mTc tetrofosmin was injected during peak bicycle exercise or after infusion of adenosine or dobutamine. Thirty minutes later, the gated acquisitions of the stress SPECT study was started.

In the 2-day protocol, 500 MBq of 99mTc-tetrofosmin was administered 45–60 minutes prior to rest gated SPECT and 30 minutes prior to stress SPECT. In this protocol, gating was applied during the rest SPECT acquisition because of logistical reasons.

Imaging was performed with a triple-headed gamma camera (model GCA 9300; Toshiba Medical, Tokyo, Japan) with "step-and-shoot" rotation, 90 projections over a 360° arc, 35 seconds per projection, and 64 x 64 matrices. Sixteen frames per cardiac cycle were acquired. Transverse sections were reconstructed with a 9.0 Butterworth filter and a cutoff frequency of 0.32 cycles per pixel for the at-rest MR imaging study or 0.26 cycles per pixel for the after-stress SPECT study (pixel size, 6 mm). Numeric values of LV volumes and LVEF were calculated by using commercially available software (GATED SPECT, version 1.0, revision B; Toshiba Medical) developed by Germano et al (7). This algorithm uses gated SPECT short-axis image volumes. It estimates the location of the LV endocardial surface and the valve plane in the three-dimensional space and then adds the volumes of the voxels bound by these two structures. The technique used to identify the endocardial surface was based on artificial intelligence combined with the Gaussian fitting of count profiles normal to the myocardium. LVEF is derived from the LV volume images without operator interaction (Fig 1).



View larger version (194K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 1. Infarction in the distribution of the left anterior descending coronary artery. Left: LVEDV MR (top) and gated SPECT (bottom) short-axis images. Right: LVESV MR (top) and gated SPECT (bottom) short-axis images.

 
MR Imaging Examinations
MR imaging studies were performed with a 1.5-T system (Gyroscan; Philips, Best, the Netherlands). Prospective electrocardiographically triggered, multisection, multiphase gradient-echo (repetition time of 30 msec, echo time of 10–12 msec, flip angle of 40°–50°, field of view of 350–400 mm, section thickness of 8–10 mm, section gap of 0.8–1.0 mm, matrix of 128 x 128 reconstructed to a display matrix of 256 x 256) MR imaging of the heart was performed to encompass both ventricles with 10–12 imaging planes in the short axis, with a heart phase interval of less than 40 msec (temporal resolution of 20–25 heart phases per cardiac cycle). In addition, phase-encoded artifact reduction was used to minimize motion artifacts from respiration.

A workstation (Sparc; Sun Microsystems, Mountain View, Calif) was used for further analysis, performed with fixed window width and window level settings. LV volumes were calculated from the gradient-echo MR imaging data by using an analytical software package (MASS, version 4.0; Leiden University Medical Center, Leiden, the Netherlands) (22). The cross-sectional areas of endocardial tracings at end systole and at end diastole were added, and the sum was multiplied by the section thickness. The end-diastolic phase was identified as the first frame of the cine loop and represented the maximum LV volume. The end-systolic phase was identified as the frame that showed the minimal cavity volume. LVEF was calculated on the basis of the LVEDV and LVESV values (Fig 1).

Statistical Analysis
Regression analysis was performed to determine the correlation between LVEF, LVEDV, and LVESV measured with gated SPECT and MR imaging. A Bland-Altman plot was used to assess systematic trends in the differences between the two methods. With this plot, the mean LVEF value with the two methods was shown on the ordinate, and the difference in LVEF values was shown on the abscissa.


   Results
TOP
 ABSTRACT
 INTRODUCTION
 Materials and Methods
Results
Discussion
 REFERENCES
 
Correlation was good between LVEF values measured with gated SPECT and MR imaging (r = 0.85, P < .001) (Fig 2). Correlation was good between LVEDV and LVESV values measured with gated SPECT and MR imaging (LVEDV, r = 0.94, P < .001; LVESV, r = 0.95, P < .001) (Fig 3).



View larger version (27K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 2. Scatterplot depicts LVEF measured with MR imaging versus gated SPECT (n = 21). The correlation is good (r = 0.85).

 


View larger version (34K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 3. Scatterplot depicts LVEDV (ED) and LVESV (ES) measured with MR imaging versus gated SPECT (n = 21). The correlations are good (LVEDV, r = 0.94; LVESV, r = 0.95).

 
The Bland-Altman plot (Fig 4) did not reveal a significant over- or underestimation of LVEF with gated SPECT as compared with MR imaging: The slope was not significantly different from 0 (P = .48). Higher mean LVEDV and LVESV values were measured with MR imaging as compared with gated SPECT, but the differences were not significant. LVEF did not differ significantly between MR imaging and gated SPECT (Table).



View larger version (26K):
[in this window]
[in a new window]
[Download PPT slide]
  		Figure 4. Bland-Altman plot shows mean LVEF values measured with gated SPECT and MR imaging on the ordinate and the difference in these values on the abscissa. Dotted lines indicate the 95% CIs. The slope of the regression line is not significantly different from 0 (P = .48).

 

View this table:
[in this window]
[in a new window]

  		Comparison of Findings With Gated SPECT and MR Imaging
 
When the data for the six patients who underwent the 1-day protocol were separated from those for the 15 patients who underwent the 2-day protocol, correlation between LVEF measured with gated SPECT and MR imaging did not change significantly (with the six patients, r2 = 0.7249; without, r2 = 0.7164; P = 0.56).


   Discussion
TOP
 ABSTRACT
 INTRODUCTION
 Materials and Methods
Results
 Discussion
REFERENCES
 
In this study, we found good correlation for LV volumes and LVEF measured with gated SPECT and MR imaging over a wide range of values. This finding suggests that simultaneous assessment of LV perfusion and function by means of the algorithm used in this study is reliable in both normal and distorted ventricles.

Because LVEF and LVESV are major diagnostic and prognostic parameters (1,3,23), the ability to obtain quantitative measurements of LVEF and LVESV represents an important feature of gated SPECT. Before gated SPECT is used routinely, however, it is important to establish the reliability of the functional information, preferably by validating it against an accurate standard of reference. MR imaging has been shown to be an accurate method for measuring LV volumes and LVEF (13). Previous studies found good correlations between wall motion and wall thickening values with obtained gated SPECT and MR imaging. In some patients with severely reduced tracer uptake, however, functional information may be suboptimal (24–26). In the patients in our study, a good correlation was found between quantitative parameters with MR imaging and gated SPECT, with both correlation coefficients and scatter around the regression lines comparable to those previously reported for this and other software packages (9,11,18–20).

In this study, the endocardial borders on the MR images were drawn manually. The resultant inter- and intraobserver variability was within acceptable limits (27) but would be expected to cause somewhat higher scatter of the LVEF correlations than that of the volume correlations, owing to propagation of error in the former. With quantitative gated SPECT, LVEF may be slightly overestimated in patients with small LVESVs (28). Although it may be difficult to detect the endocardial border in patients with severely reduced tracer uptake (24–26), we did not find this to be the case in our study. In none of our patients was LVEF diagnosed as definitely abnormal (<40%) with one method and as definitely normal (>50%) with the other method.

Good correlation between LV function measurements with gated SPECT and MR imaging was found recently by Tadamura et al (20), who also used the software program used in this study. In another study, Vaduganathan et al (19) also found a good correlation in patients with a previous myocardial infarction. Tadamura et al (20) used 99mTc sestamibi and thallium 201, and the gating was performed with eight frames per cycle. In our study, gating was performed with 16 frames per cycle. Although the use of eight frames per cycle may result in an underestimation of LVEF, the use of 16 frames per cycle may reduce count statistics in the individual frames to the point that errors may be introduced in the measurement of LV volumes (11). Vaduganathan et al (19) included only patients with a previous myocardial infarction, but we included patients with and those without myocardial infarction; therefore, the patient population was different.

On the basis of the Bland-Altman plot in our study, no systematic under- or overestimation of LVEF was found with gated SPECT as compared with the MR imaging standard of reference. Although our data demonstrated a slight underestimation of LVEDV and LVESV with gated SPECT as compared with MR imaging, this finding did not reach statistical significance. This finding is most likely due to the inclusion of more outflow tract tissue on MR images than is routinely visible on gated SPECT images. The outflow tract is never part of the LV volume acquired at gated SPECT because the edge of the left ventricle is defined by the mitral valve. The membranous part of the septum is not shown on gated SPECT images, but the calculation of LV volumes on MR images includes this part of the septum. These findings do not appreciably influence the calculation of LVEF, because both the LV volumes are overestimated and, therefore, the ratio of LVEDV to LVESV remains unaffected.

A clear advantage of gated SPECT as compared with MR imaging is the automatic delineation of the myocardial border with gated SPECT in conjunction with the algorithm used in this study and the consequent high reproducibility and lack of operator dependence on the gated SPECT results (11). Although echocardiographically determined LV function may be available for patients seen at a nuclear medicine laboratory, quantitative gated SPECT is also valuable for the following reasons: (a) gated SPECT offers the potential to assess LV function (LV volumes, LVEF, wall motion, wall thickening) and myocardial perfusion simultaneously and on the basis of just one acquisition procedure, (b) the acquisition of functional information adds essentially no extra costs to the standard perfusion study, and (c) functional measurements with gated SPECT are completely automated with the approach used in this study. Moreover, gated SPECT can also be useful in patients with an uninterpretable or unreliable echocardiogram owing to obesity or pulmonary emphysema.

In six (29%) of our 21 patients, the gated SPECT study was performed 30 minutes after stress, whereas the MR imaging study was always performed at rest. In patients with coronary artery disease, LV function 30 minutes after stress may be depressed compared with that at rest, owing to myocardial stunning (29–31). However, when data for the six patients were separated from those for the 15 patients, the correlation for LVEF measured with gated SPECT and MR imaging did not change significantly. Therefore, we conclude that myocardial stunning probably did not influence our results.

On the basis of findings in this study, we believe gated SPECT is a reliable, accurate method for measuring LV function in patients over a wide range of LV volume and LVEF values.


   FOOTNOTES
 
Abbreviations: ECG = electrocardiography, LV = left ventricular, LVEDV = LV end-diastolic volume, LVEF = LV ejection fraction, LVESV = LV end-systolic volume

Author contributions: Guarantors of integrity of entire study, C.D.L.B.C., D.E.A.; study concepts, D.E.A., C.D.L.B.C., G.G.; study design, D.E.A., C.D.L.B.C., G.G.; definition of intellectual content, D.E.A.; literature research, C.D.L.B.C., D.E.A.; clinical studies, D.E.A., E.E.v.d.W.; data acquisition, P.D.S.; data analysis, H.W.M.K., D.E.A.; statistical analysis, D.E.A.; manuscript preparation, C.D.L.B.C.; manuscript editing, C.D.L.B.C., E.E.v.d.W., D.E.A.; manuscript review, E.E.v.d.W., A.d.R., E.K.J.P.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 Materials and Methods
Results
 Discussion
 REFERENCES
 

  1. Morris KG, Palmeri ST, Califf RM, et al. Value of radionuclide angiography for predicting specific cardiac events after acute myocardial infarction. Am J Cardiol 1985; 55:318-324.[Medline]
  2. Shaw LJ, Heinle SK, Borges-Neto S, Kesler K, Coleman RE, Jones RH. Prognosis by measurements of left ventricular function during exercise. J Nucl Med 1998; 39:140-146.[Abstract/Free Full Text]
  3. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 1987; 76:44-51.[Abstract/Free Full Text]
  4. Johnson SH, Bigelow C, Lee KL, Pryor DB, Jones RH. Prediction of death and myocardial infarction by radionuclide angiocardiography in patients with suspected coronary artery disease. Am J Cardiol 1991; 67:919-926.[Medline]
  5. Najm YC, Timmis AD, Maisey MN, et al. The evaluation of ventricular function using gated myocardial imaging with Tc-99m MIBI. Eur Heart J 1989; 10:142-148.[Abstract/Free Full Text]
  6. Marcassa C, Marzullo P, Parodi O, Sambuceti G, L’Abbate A. A new method for noninvasive quantitation of segmental myocardial wall thickening using technetium-99m 2-methoxy-isobutyl-isonitrile scintigraphy: results in normal subjects. J Nucl Med 1990; 31:173-177.[Abstract/Free Full Text]
  7. Germano G, Kavanagh PB, Berman DS. An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images. Int J Card Imaging 1997; 13:337-346.[Medline]
  8. Faber TL, Akers MS, Peshock RM, Corbett JR. Three-dimensional motion and perfusion quantification in gated single-photon emission computed tomograms. J Nucl Med 1991; 32:2311-2317.[Abstract/Free Full Text]
  9. DePuey EG, Nichols K, Dobrinsky C. Left ventricular ejection fraction assessed from gated technetium-99m-sestamibi SPECT. J Nucl Med 1993; 34:1871-1876.[Abstract/Free Full Text]
  10. Germano G, Erel J, Lewin H, Kavanagh PB, Berman DS. Automatic quantitation of regional myocardial wall motion and thickening from gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1997; 30:1360-1367.[Abstract]
  11. Germano G, Kiat H, Kavanagh PB, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995; 36:2138-2147.[Abstract/Free Full Text]
  12. Lamb HJ, Doornbos J, van der Velde EA, Kruit MC, Reiber JH, de Roos A. Echo planar MRI of the heart on a standard system: validation of measurements of left ventricular function and mass. J Comput Assist Tomogr 1996; 20:942-949.[Medline]
  13. Longmore DB, Klipstein RH, Underwood SR, et al. Dimensional accuracy of magnetic resonance in studies of the heart. Lancet 1985; 1:1360-1362.[Medline]
  14. Forbat SM, Sakrana MA, Darasz KH, El Demerdash F, Underwood SR. Rapid assessment of left ventricular volume by short axis cine MRI. Br J Radiol 1996; 69:221-225.[Abstract/Free Full Text]
  15. van Rugge FP, Holman ER, van der Wall EE, de Roos A, van der Laarse A, Bruschke AV. Quantitation of global and regional left ventricular function by cine magnetic resonance imaging during dobutamine stress in normal human subjects. Eur Heart J 1993; 14:456-463.[Abstract/Free Full Text]
  16. Soldo SJ, Haywood LJ, Norris SL, Gober JR, Colletti PM, Terk MR. Method for assessing cardiac function using magnetic resonance imaging. Biomed Instrum Technol 1996; 30:359-363.[Medline]
  17. Chua T, Kiat H, Germano G, et al. Gated technetium-99m sestamibi for simultaneous assessment of stress myocardial perfusion, postexercise regional ventricular function and myocardial viability: correlation with echocardiography and rest thallium-201 scintigraphy. J Am Coll Cardiol 1994; 23:1107-1114.[Abstract]
  18. Paul A, Hasegawa S, Yoshioka J, et al. Left ventricular volume and ejection fraction from quantitative gated SPECT: comparison with gated pool SPECT and contrast ventriculography (abstr). J Nucl Med 1999; 40(P):178.
  19. Vaduganathan P, He ZX, Vick GW, Mahmarian JJ, Verani MS. Evaluation of left ventricular wall motion, volumes, and ejection fraction by gated myocardial tomography with technetium 99m-labeled tetrofosmin: a comparison with cine magnetic resonance imaging. J Nucl Cardiol 1999; 6:3-10.[Medline]
  20. Tadamura E, Kudoh T, Motooka M, et al. Assessment of regional and global left ventricular function by reinjection T1-201 and rest Tc-99m sestamibi ECG-gated SPECT: comparison with three-dimensional magnetic resonance imaging. J Am Coll Cardiol 1999; 33:991-997.[Abstract/Free Full Text]
  21. van Eck-Smit BL, Poots S, Zwinderman AH, Bruschke AV, Pauwels EK, van der Wall EE. Myocardial SPECT imaging with 99mTc-tetrofosmin in clinical practice: comparison of a 1 day and 2 day imaging protocol. Nucl Med Commun 1997; 18:24-30.[Medline]
  22. van der Geest RJ, Buller VG, Jansen E, et al. Comparison between manual and semiautomated analysis of left ventricular volume parameters from short-axis MR images. J Comput Assist Tomogr 1997; 21:756-765.[Medline]
  23. Sharir T, Germano G, Kavanagh PB, et al. Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 1999; 100:1035-1042.[Abstract/Free Full Text]
  24. Stollfuss JC, Haas F, Matsunari I, et al. Regional myocardial wall thickening and global ejection fraction in patients with low angiographic left ventricular ejection fraction assessed by visual and quantitative resting ECG-gated 99mTc-tetrofosmin single-photon emission tomography and magnetic resonance imaging. Eur J Nucl Med 1998; 25:522-530.[Medline]
  25. Gunning MG, Anagnostopoulos C, Davies G, Forbat SM, Ell PJ, Underwood SR. Gated technetium-99m-tetrofosmin SPECT and cine MRI to assess left ventricular contraction. J Nucl Med 1997; 38:438-442.[Abstract/Free Full Text]
  26. Anagnostopoulos C, Gunning MG, Pennell DJ, Laney R, Proukakis H, Underwood SR. Regional myocardial motion and thickening assessed at rest by ECG-gated 99mTc-MIBI emission tomography and by magnetic resonance imaging. Eur J Nucl Med 1996; 23:909-916.[Medline]
  27. Pattynama PMT, Lamb HJ, van der Velde EA, van der Wall EE, de Roos A. Left ventricular measurements with cine and spin-echo MR imaging: a study of reproducibility with variance component analysis. Radiology 1993; 187:261-268.[Abstract/Free Full Text]
  28. Case JA, Cullum SJ, Bateman TM, Banhart C, Saunders MJ. Overestimation of LVEF by gated MIBI myocardial perfusion SPECT in patients with small hearts (abstr). J Am Coll Cardiol 1998; 31(suppl A):43A.
  29. Kloner RA, Allen J, Cox TA, Zheng Y, Ruiz CE. Stunned left ventricular myocardium after exercise treadmill testing in coronary artery disease. Am J Cardiol 1991; 68:329-334.[Medline]
  30. Johnson LL, Verdesca SA, Aude WY, et al. Postischemic stunning can affect left ventricular ejection fraction and regional wall motion on post-stress gated sestamibi tomograms. J Am Coll Cardiol 1997; 30:1641-1648.[Abstract]
  31. Ambrosio G, Betocchi S, Pace L, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina: evidence of myocardial stunning in patients with coronary artery disease. Circulation 1996; 94:2455-2464.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 JNMHome page
D. Knollmann, O. H. Winz, P. T. Meyer, M. Raptis, T. Krohn, K.-C. Koch, and W. M. Schaefer
Gated Myocardial Perfusion SPECT: Algorithm-Specific Influence of Reorientation on Calculation of Left Ventricular Volumes and Ejection Fraction
J. Nucl. Med., October 1, 2008; 49(10): 1636 - 1642.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
M S KRISHNAM, A TOMASIAN, M. Iv, S G RUEHM, R SALEH, C PANKNIN, and J G GOLDIN
Left ventricular ejection fraction using 64-slice CT coronary angiography and new evaluation software: initial experience
Br. J. Radiol., June 1, 2008; 81(966): 450 - 455.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
T. Schepis, O. Gaemperli, P. Koepfli, I. Valenta, K. Strobel, A. Brunner, S. Leschka, L. Desbiolles, L. Husmann, H. Alkadhi, et al.
Comparison of 64-Slice CT with Gated SPECT for Evaluation of Left Ventricular Function
J. Nucl. Med., August 1, 2006; 47(8): 1288 - 1294.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
W. M. Schaefer, C. S.A. Lipke, D. Standke, H. P. Kuhl, B. Nowak, H.-J. Kaiser, K.-C. Koch, and U. Buell
Quantification of Left Ventricular Volumes and Ejection Fraction from Gated 99mTc-MIBI SPECT: MRI Validation and Comparison of the Emory Cardiac Tool Box with QGS and 4D-MSPECT
J. Nucl. Med., August 1, 2005; 46(8): 1256 - 1263.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
M. Yamamuro, E. Tadamura, S. Kubo, H. Toyoda, T. Nishina, M. Ohba, R. Hosokawa, T. Kimura, N. Tamaki, M. Komeda, et al.
Cardiac Functional Analysis with Multi-Detector Row CT and Segmental Reconstruction Algorithm: Comparison with Echocardiography, SPECT, and MR Imaging
Radiology, February 1, 2005; 234(2): 381 - 390.
[Abstract] [Full Text] [PDF]

Home page
 J. Nucl. Med. Technol.Home page
A. K. Paul and H. A. Nabi
Gated Myocardial Perfusion SPECT: Basic Principles, Technical Aspects, and Clinical Applications
J. Nucl. Med. Technol., December 1, 2004; 32(4): 179 - 187.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
W. M. Schaefer, C. S.A. Lipke, H. P. Kuhl, K.-C. Koch, H.-J. Kaiser, P. Reinartz, B. Nowak, and U. Buell
Prone Versus Supine Patient Positioning During Gated 99mTc-Sestamibi SPECT: Effect on Left Ventricular Volumes, Ejection Fraction, and Heart Rate
J. Nucl. Med., December 1, 2004; 45(12): 2016 - 2020.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns
Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology
Eur. Heart J., May 2, 2004; 25(10): 815 - 836.
[Abstract] [Full Text] [PDF]

Home page
 JNMHome page
V. Go, M. R. Bhatt, and R. C. Hendel
The Diagnostic and Prognostic Value of ECG-Gated SPECT Myocardial Perfusion Imaging
J. Nucl. Med., May 1, 2004; 45(5): 912 - 921.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. P. A. Ioannidis, T. A. Trikalinos, and P. G. Danias
Electrocardiogram-gated single-photonemission computed tomography versus cardiacmagnetic resonance imaging for the assessmentof left ventricular volumes and ejection fraction: A meta-analysis
J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2059 - 2068.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bavelaar-Croon, C. D. L.
Right arrow Articles by Atsma, D. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bavelaar-Croon, C. D. L.
Right arrow Articles by Atsma, D. E.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOLOGY RADIOGRAPHICS RSNA JOURNALS ONLINE