Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Respiratory Motion Reduction with a Dual Gating Approach in Myocardial Perfusion SPECT: Effect on Left Ventricular Functional Parameters Matti J. Kortelainen, Tuomas M. Koivumäki, Marko J. Vauhkonen, Marja K. Hedman, Satu T. J. Kärkkäinen, Juanita Nino Quintero, Mikko A. Hakulinen University of Eastern Finland, Kuopio, Finland; Kuopio University Hospital, Kuopio, Finland; Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- Respiratory motion (RM) is inevitable in myocardial perfusion SPECT and may compromise the diagnostic accuracy of the examination1 2- RM can be reduced with respiratory gating; however, the reconstructed images may contain limited-angle errors if conventional gamma cameras are used2 3- It is unclear how RM reduction affects left ventricular (LV) functional parameters 4- In this paper, a novel dual gating algorithm is presented to reduce RM and its impact on LV function quantification is evaluated 1 Polycarpou I, Chrysanthou-Baustert I, Demetriadou O, Parpottas Y, Panagidis C, Marsden PK, et al. Impact of respiratory motion correction on SPECT myocardial perfusion imaging using a mechanically moving phantom assembly with variable cardiac defects. J Nucl Cardiol. 2015:1-10. doi:10.1007/s12350-015-0323-0. 2 Qi W, Yang Y, Wernick MN, Pretorius PH, King MA. Limited-angle effect compensation for respiratory binned cardiac SPECT. Med Phys. 2016;43:443-54. Copyright American Society of Nuclear Cardiology

METHODS Study type: Retrospective/Repeated measures Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: Retrospective/Repeated measures Study subjects: 18 patients with known or suspected CAD and referred to one-day stress/rest MP-SPECT examinations ECG and thoracic electrical impedance signals of the patients were recorded during rest MP-SPECT image acquisition Signals and list-mode emission data were processed to generate cardiac-gated and dual-gated images with cardiac cycle divided to 1, 8 and 16 frames Study variables: LV perfusion, shape index, volumes, wall motion, wall thickening and phase analysis parameters evaluated with QPS/QGS software (Cedars-Sinai Medical Center) Statistical significance evaluated with Wilcoxon signed rank test Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Results from the automatic analysis (QPS) of 1-frame cardiac-gated and dual-gated images, N = 16   Cardiac-gated Dual-gated P q V1 (ml) 77.1 ± 26.8 79.8 ± 27.6 .006* -.486 SI1 0.57 ± 0.05 0.56 ± 0.05 .036* -.371 MPANT (%) 64.4 ± 6.5 65.4 ± 5.2 .268 -.196 MPLAT (%) 69.4 ± 5.6 68.1 ± 5.3 .079 -.311 MPINF (%) 58.6 ± 9.1 59.1 ± 9.3 .800 -.045 MPSEP (%) 66.3 ± 6.2 65.7 ± 5.9 .528 -.112 MPAPX (%) 73.5 ± 7.2 73.3 ± 8.4 .468 -.128 V1 left ventricular volume, SI1 shape index, MP myocardial perfusion, ANT anterior, LAT lateral, INF inferior, SEP septal, APX apical, P p-value, q effect size. The results are expressed as mean ± standard deviation. Asterisk (*) denotes a statistically significant difference at level p < .05 between cardiac-gated and dual-gated images. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Results from the automatic analysis (QGS) of 8-frame and 16-frame cardiac-gated and dual-gated images, N = 16 8-frame images 16-frame images   Cardiac-gated Dual-gated P q EDV (ml) 81.0 ± 26.8 82.9 ± 28.8 .123 -.273 82.4 ± 26.9 84.6 ± 28.4 .156 -.251 ESV (ml) 33.3 ± 21.1 34.5 ± 21.4 .034* -.374 30.1 ± 20.5 31.2 ± 21.4 .154 -.252 SV (ml) 47.7 ± 9.87 48.4 ± 11.4 .752 -.056 52.3 ± 10.6 53.4 ± 12.7 .680 -.073 EF (%) 62.2 ± 12.8 61.2 ± 11.2 .219 -.217 66.7 ± 12.4 66.2 ± 12.3 .380 -.155 SIED 0.64 ± 0.05 0.62 ± 0.05 .006* -.487 0.65 ± 0.05 0.63 ± 0.05 -.482 SIES 0.47 ± 0.064 0.46 ± 0.06 .350 -.165 0.45 ± 0.07 0.45 ± 0.06 .900 -.022 WMANT (mm) 8.3 ± 1.7 8.4 ± 1.5 .534 -.110 9.4 ± 1.9 9.5 ± 2.0 .460 -.131 WMLAT (mm) 9.1 ± 1.9 8.9 ± 1.5 .660 -.078 10.3 ± 1.9 10.2 ± 1.7 .977 -.005 WMINF (mm) 6.4 ± 1.9 6.2 ± 1.7 .338 -.169 7.1 ± 2.0 7.0 ± 1.8 .477 -.126 WMSEP (mm) 4.8 ± 2.0 4.5 ± 1.7 .125 -.271 5.4 ± 2.2 5.2 ± 2.2 .178 -.238 WMAPX (mm) 7.3 ± 2.2 6.8 ± 1.9 .112 -.281 7.9 ± 2.3 8.0 ± 2.3 .918 -.018 WMGLB (mm) 7.2 ± 1.6 6.9 ± 1.3 .162 -.247 8.0 ± 1.7 .438 -.137 WTANT (%) 35.8 ± 10.5 34.5 ± 8.4 .301 -.183 39.4 ± 10 38.7 ± 11.5 .332 -.171 WTLAT (%) 36.6 ± 13.0 35.6 ± 9.5 .628 -.086 42.3 ± 12.9 41.7 ± 12.5 .816 -.041 WTINF (%) 30.4 ± 12.1 29.3 ± 10.1 .207 -.223 33.4 ± 14.0 34.1 ± 11.6 .586 -.096 WTSEP (%) 37.1 ± 12.3 33.6 ± 10.0 .008* -.469 40.8 ± 12.0 38.6 ± 11.9 .023* -.403 WTAPX (%) 55.1 ± 15.9 51.8 ± 13.9 .083 -.307 60.6 ± 19.2 60.1 ± 16.2 .887 -.025 WTGLB (%) 39.0 ± 11.8 36.9 ± 9.4 -.375 43.3 ± 12.0 42.6 ± 11.3 .320 -.176 BW (°) 44.8 ± 20 48.8 ± 27.2 .826 -.039 41.3 ± 18.7 38.8 ± 16.1 StDev (°) 13 ± 6.2 14.5 ± 8.7 .642 -.082 11.3 ± 5.7 11.5 ± 5.3 .959 -.009 ENT (%) 59.3 ± 5.85 60.3 ± 6.4 58.3 ± 6.4 58.3 ± 6.2 EDV end-diastolic volume, ESV end-systolic volume, SV stroke volume, EF ejection fraction, SIED shape index at end-diastole, SIES shape index at end-systole, WM wall motion, WT wall thickening, ANT anterior, LAT lateral, INF inferior, SEP septal, APX apical, GLB global, BW bandwidth of phase angle histogram, StDev standard deviation of phase angle histogram, ENT entropy of phase angle histogram, P p-value, q effect size. The results are expressed as mean ± standard deviation. Asterisk (*) denotes a statistically significant difference at level p < .05 between cardiac-gated and dual-gated images. Insert a key table or a key figure If figure, insert legend Delete slide if second results slide not necessary Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- A novel dual gating algorithm was introduced to reduce RM in MP-SPECT 2- RM reduction increases LV volumes and reduces LV shape index and wall thickening 3- RM does not significantly affect phase analysis parameters Copyright American Society of Nuclear Cardiology