Effect of the number of projections collected on quantitative perfusion and left ventricular ejection fraction measurements from gated myocardial perfusion single-photon emission computed tomographic images

Background. Gated myocardial perfusion single-photon emission computed tomographic (SPECT) imaging is currently performed by step-and-shoot detector rotation, resulting in acquisition dead time and lengthened study duration compared with nongated SPECT imaging with continuous or pseudocontinuous rotation, Dead time is particularly undesirable in new fast-gated SPECT imaging protocols with inotropic pharmacologic stress. Methods and Results. This article evaluated the influence of projections' angular spacing on quantitative measurements of left ventricular ejection fraction (LVEF) and perfusion from postexercise Tc-99m-labeled sestamibi images. Gated 60-projection data sets from 30 patients were compacted into 30- and 15-projection sets, The three sets (corresponding to 3-, 6-, and 12-degree spacing over 180 degrees) were reconstructed into gated and ungated short-axis image sets, LVEFs were measured from the gated images according to a previously described automatic algorithm, whereas perfusion was assessed from the ungated images by a 20-segment division of their maximal pixel polar maps, LVEF values were essentially unchanged between 60- and 30-projection images (y = 0.37 + 0.996x; r = 0.999; standard error of the estimate = 0.56) and 60- and 15-projection images (y = 1.35 + 0.987x; r = 0.999; standard error of the estimate = 0.77) in the 30 patients, Overall, 30- and 15-projection polar maps differed by 1.87% +/- 1.24% and 4.38% +/- 2.25% from the 60-projection polar maps, respectively. Segmental perfusion score agreement between 60- and 30-projection images and between 60- and 15-projection images was 93% (kappa = 0.92; p < 0.001) and 83% (kappa = 0.81; p < 0.001), respectively. Sixty- and 30-projection images were visually undistinguishable, whereas loss of image resolution was noticed in many 15-projection gated and ungated images. Conclusions, Thirty-projection gated SPECT imaging is a practical, accurate, and timesaving approach in standard gated protocols and, potentially, fast-gated protocols. Fifteen-projection gated SPECT imaging is not generally recommended and should be considered only for LVEF assessment in conjunction with fast-gated protocols.