An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images

We have developed a software suite that automatically selects, analyses, quantitates and displays all the key image data in a myocardial perfusion SPECT study. Methods: The files automatically selected (upon specification of the patient name) are rest and stress projections, rest and stress short axis and gated short axis files, and all 'snapshot' files. The projection data sets are presented in cine mode for evaluation of patient motion, while the lung/heart ratio at rest and stress is calculated from regions of interest (ROIs) that are automatically derived and overlayed on the LAO 45 images. Left ventricular (LV) cavity volumes at rest and stress are calculated from the short axis data sets, and the related transient ischemic dilation (TID) ratio derived and displayed. Quantitative measurements of global (ejection fraction) and regional function parameters are performed from the gated short axis dataset. All algorithms use the C++, X-Windows and OSF-Motif standards. The overall suite executes in less than 1 minute on a SunSPARC5 with 32 Mb of RAM and no proprietary hardware. Results: The software was validated on 144 patients(118 rest Tl-201/post-stress Tc-99m-sestamibi, 18 post-stress Tc-99m-sestamibi, 8 rest Tl-201) acquired on a 90 degrees dual detector (ADAC Vertex, 91 patients) and a triple detector camera (Picker Prism 3000, 53 patients). Overall, the individual algorithms for the analysis of projection, short axis and gated short axis images were successful in 622/660 (94.2%) of the images. In 80.5% of the patients (73/91+43/53) all algorithms executed successfully, without significant difference in success rates for Tl-201 versus Tc-99m-sestamibi images. Conclusion: Our automated approach to myocardial perfusion SPECT analysis and review is highly successful, intrinsically reproducible, and can produce time and cost savings while improving accuracy in a clinical or teleradiology-type environment.