Effect of respiratory motion on cardiac defect contrast in myocardial perfusion SPECT: a physical phantom study

OBJECTIVE: Correction for respiratory motion in myocardial perfusion imaging requires sorting of emission data into respiratory windows where the intra-window motion is assumed to be negligible. However, it is unclear how much intra-window motion is acceptable. The aim of this study was to determine an optimal value of intra-window residual motion. METHODS: A custom-designed cardiac phantom was created and imaged with a standard dual-detector SPECT/CT system using Tc-99m as the radionuclide. Projection images were generated from the list-mode data simulating respiratory motion blur of several magnitudes from 0 (stationary phantom) to 20 mm. Cardiac defect contrasts in six anatomically different locations, as well as myocardial perfusion of apex, anterior, inferior, septal and lateral walls, were measured at each motion magnitude. Stationary phantom data were compared to motion-blurred data. Two physicians viewed the images and evaluated differences in cardiac defect visibility and myocardial perfusion. RESULTS: Significant associations were observed between myocardial perfusion in the anterior and inferior walls and respiratory motion. Defect contrasts were found to decline as a function of motion, but the magnitude of the decline depended on the location and shape of the defect. Defects located near the cardiac apex lost contrast more rapidly than those located on the anterior, inferior, septal and lateral wall. The contrast decreased by less than 5% at every location when the motion magnitude was 2 mm or less. According to a visual evaluation, there were differences in myocardial perfusion if the magnitude of the motion was greater than 1 mm, and there were differences in the visibility of the cardiac defect if the magnitude of the motion was greater than 9 mm. CONCLUSIONS: Intra-window respiratory motion should be limited to 2 mm to effectively correct for respiratory motion blur in myocardial perfusion SPECT.