Left Ventricular Ejection Fraction Evaluation Using SPECT Images

Mahmoud A. A. Musa; Sulieman M. S. Zobly; Mawahib G. A. Ahmed

Mahmoud A. A. Musa 3University of Gezira, Faculty of Engineering and Technology, Sudan
Sulieman M. S. Zobly University of Gezira; National Cancer Institute , Sudan
Mawahib G. A. Ahmed

Abstract

Cardiovascular diseases represent a major global health burden. In Sudan, the incidence has increased in recent years, partly due to diagnostic inaccuracies in cardiac imaging and the high cost of commercial image processing software. Accurate quantification of left ventricular ejection fraction (LVEF) is essential for cardiac function assessment. This study aimed to develop and validate a low-cost MATLAB-based algorithm for automated LVEF calculation from Gated Single Photon Emission Computed Tomography (Gated SPECT) images. Twelve cardiac patients underwent Gated SPECT imaging. A custom MATLAB toolbox was developed to perform left ventricular segmentation, detect end-diastolic (EDC) and end-systolic counts (ESC), and calculate LVEF. Algorithm performance was evaluated by comparing calculated LVEF with reference values and assessing diagnostic accuracy. Among the 12 patients, 5 exhibited normal cardiac function with LVEF values of 60.4%, 55.8%, 53.4%, 56.3%, and 59.1%, with 97% accuracy relative to reference software. Seven patients showed impaired function with LVEF values of 38.5%, 34.5%, 25.3%, 36.1%, 18.8%, 20.0%, and 40.7%. Correlation analysis yielded r = 0.80. The proposed MATLAB algorithm provides accurate, accessible, and reproducible LVEF quantification from Gated SPECT images, offering a viable alternative to expensive commercial software. The researcher recommends integrating this method into routine SPECT analysis in resource-limited settings and validating it on larger cohorts.

References

[1] Altman, D.G. (1991). Practical statistics for medical research. Chapman and Hall, London. ISBN:978-0412276309.
[2] Bavelaar-Croon, C.D.L., Kayser, H.W.M., van der Wall, E.E. (2000). Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values. Radiology, 217: 572–575.
[3] Bax,J.J, Delgado, V. (2010). Role of multimodality imaging , European heart Journal,31(22), 2721 -2732 .
[4] Bonhorst, D., Guerreiro, S., Fonseca, C., et al. (2019). Real-life data on heart failure before and after CRT/ICD implantation. Rev Port Cardiol , 38(1): 33–41.
[5] Cerqueira, M.D., Weissman, N.J., Dilsizian, V., et al. (2002). Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart Circulation, 105: 539–542.
[6] Chan, J., Jenkins, C., Khafagi, F., et al.(2006). Optimal clinical technique for measurement of left ventricular volume after myocardial infarction. _J. Am. Soc. Echocardiogr._, 19: 192–201.
[7] DePuey, E.G., Nichols, K., Dobrinsky, C. (1993). Left ventricular ejection fraction assessment from gated technetium-99m sestamibi SPECT. _J. Nucl. Med._, 34: 1871–1876.
[8] Germano, G., Kavanagh, P.B., Berman, D.S.(1994). An automatic approach to the analysis, quantitation and review of perfusion and function from myocardial perfusion SPECT images. Int. J. Card. Imag., 13: 337–346.
[9] Germano, G., Kiat, H., Kavanagh, P.B., et al.(1995). Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. _J Nucl Med._, 36: 2138–2147.
[10] Ioannidis, J.P., Trikalinos, T.A., Danias, P.G.(2002). ECG-gated SPECT versus cardiac MRI for the assessment of left ventricular volumes and ejection fraction. J. Am. Coll. Cardiol , 39: 2059–2068.
[11] Iskandrian, A.E., Germano, G., VanDecker, W., et al. (1998). Validation of left ventricular volume measurements by gated SPECT 99mTc-labeled sestamibi imaging. J Nucl Cardiol., 5: 574–581.
[12] Kim, Y., Lee, S.A., Kim, J., et al. (2025). Feasibility, accuracy and prognostic value of fully automated LVEF. Scientific Reports, Nature. PMID: 40312345.
[13] Kosaraju, A., Goyal, A., Grigorova, Y., Makaryus, A.N. (2022). Left ventricular ejection fraction.In StatPearls.StatPearls Publishing.ISBN:978-1-61533-065-8
[14] Lang, R.M., Badano, L.P., Mor-Avi, V., et al. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults. J American Soc. Echocardiography., 28(1): 1–39.
[15] Lim, T.K., Burden, L., Janardhanan, R., et al. (2006). Contrast echocardiography versus gated SPECT for assessment of left ventricular remodeling after acute myocardial infarction. J. Am. Soc. Echocardiogr., 19: 280–284.
[16] Marques, O., Borba, G.B. (2024). Image Processing Recipes in MATLAB.(1st ed).CRC Press.ISBN: 978-1032289476.
[17] Moon, Y.J., Kim, J.W., Bang, Y.S., et al. (2019). Prediction of all-cause mortality after liver transplantation using left ventricular function assessment. PLoS One, 14(1): e0209100.
[18] Patel, A.R. and Kadakia, J. (2024). Clinical interpretation of LVEF in heart failure guidelines. J Card Fail., 30(2): 145–152.
[19] Ross, J.C. and O’Connell, R.P. (2023). MATLAB-based image segmentation for cardiac nuclear medicine. Comput Methods Programs Biomed., 231: 107396.
[20] Slomka, P.J., Berman, D.S. and Germano, G. (2012). Quantification of myocardial perfusion SPECT. J Nucl Cardiol, 19(4): 817–836.
[21] Song, L., Brezden-Masley, C., Ramanan, V., et al. (2019). Serial measurements of left ventricular systolic and diastolic function by cardiac magnetic resonance imaging. Am J Cardiol., 123(7): 1173–1179.
[22] Vallejo, E., Dione, D.P., Sinusas, A.J., Wackers, F.J.T.(2000) Assessment of left ventricular ejection fraction with quantitative gated SPECT: accuracy and correlation with first-pass radionuclide angiography. _J. Nucl. Cardiol._, 7: 461–470.
[23] Wagner, A., Mahrholdt, H., Holly, T. (2003). Contrast-enhanced MRI and routine SPECT perfusion imaging for detection of subendocardial myocardial infarction. Lancet, 361: 374–379.
[24] Zhuang, X., Li, L., Payer, C., et al. (2019). Evaluation of algorithms for multi-modality whole heart segmentation. Med Image Anal., 58: 101537.