Gated myocardial perfusion SPECT underestimates left ventricular volumes and shows high variability compared to cardiac magnetic resonance imaging -- a comparison of four different commercial automated software packages

BACKGROUND: We sought to compare quantification of left ventricular volumes and ejection fraction by different gated myocardial perfusion SPECT (MPS) programs with each other and to magnetic resonance (MR) imaging. METHODS: N = 100 patients with known or suspected coronary artery disease were examined at rest with (99 m)Tc-tetrofosmin gated MPS and cardiac MR imaging. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were obtained by analysing gated MPS data with four different programs: Quantitative Gated SPECT (QGS), GE MyoMetrix, Emory Cardiac Toolbox (ECTb) and Exini heart. RESULTS: All programs showed a mean bias compared to MR imaging of approximately -30% for EDV (-22 to -34%, p < 0.001 for all), ESV (-12 to -37%, p < 0.001 for ECTb, p < 0.05 for Exini, p = ns for QGS and MyoMetrix) and SV (-21 to -41%, p < 0.001 for all). Mean bias ± 2 SD for EF (% of EF) was -9 ± 27% (p < 0.01), 6 ± 29% (p = ns), 15 ± 27% (p < 0.001) and 0 ± 28% (p = ns) for QGS, ECTb, MyoMetrix, and Exini, respectively. CONCLUSIONS: Gated MPS, systematically underestimates left ventricular volumes by approximately 30% and shows a high variability, especially for ESV. For EF, accuracy was better, with a mean bias between -15 and 6% of EF. It may be of value to take this into consideration when determining absolute values of LV volumes and EF in a clinical setting.