Assessment of MATLAB Algorithm used for LVEF Quantification for SPECT and MRI Images
الملخص
Accurate quantification of left ventricular ejection fraction (LVEF) from gated single photon emission computed tomography (SPECT) is essential for cardiac function assessment and treatment planning. However, commercial software such as QGS and 4D-MSPECT are expensive and inaccessible in many low-resource centers. This study aimed to develop and validate a semi-automated MATLAB algorithm for LVEF quantification from SPECT images, using cardiac magnetic resonance imaging (CMRI) as the gold standard reference. The study was conducted on 12 patients with suspected coronary artery disease [mean age 58.3 ± 9.7 years; 7 males and 5 females]. All patients underwent same-day gated SPECT and CMRI after ethical approval from the University of Gezira Institutional Review Board. SPECT images were reconstructed using a Hanning filter, then denoised using a 3D Gaussian filter. The left ventricle was segmented semi-automatically using the `activecontour` function, and end-diastolic counts (EDC) and end-systolic counts (ESC) were extracted using `regionprops` to calculate LVEF with the equation: [(EDC-ESC)/EDC] × 100. Performance was evaluated using Pearson correlation, ICC, and Bland-Altman analysis compared to CMRI by Simpson’s method. Mean LVEF by MATLAB was 44.8 ± 16.2% vs 52.3 ± 16.8% by CMRI, with strong correlation r=0.94 and ICC=0.93. Sensitivity for detecting LVEF<50% was 85.7% and specificity was 100%. The algorithm provides an accurate and low-cost alternative to measure LVEF, with the need for larger multi-center studies.
تمثل أمراض القلب والأوعية الدموية عبئاً صحياً عالمياً كبيراً، وفي السودان تزايدت الإصابة بها في السنوات الأخيرة جزئياً بسبب عدم دقة التشخيص في تصوير القلب وارتفاع تكلفة البرامج التجارية لمعالجة الصور. يعتبر القياس الدقيق لكسر قذف البطين الأيسر (LVEF) ضرورياً لتقييم وظيفة القلب. هدفت هذه الدراسة إلى تطوير والتحقق من خوارزمية تعتمد على MATLAB ومنخفضة التكلفة للحساب الآلي لـ LVEF من صور التصوير المقطعي المحوسب بانبعاث الفوتون المفرد المبوّب (Gated SPECT). خضع 12 مريض قلب لتصوير Gated SPECT، وتم تطوير صندوق أدوات MATLAB مخصص لإجراء تجزئة البطين الأيسر وكشف عدّات نهاية الانبساط (EDC) وعدّات نهاية الانقباض (ESC) وحساب LVEF. تم تقييم أداء الخوارزمية بمقارنة قيم LVEF المحسوبة مع القيم المرجعية وتقييم الدقة التشخيصية. من بين 12 مريض، أظهر 5 مرضى وظيفة قلب طبيعية بقيم LVEF: 60.4%، 55.8%، 53.4%، 56.3%، و 59.1% بدقة 97% مقارنة بالبرنامج المرجعي، بينما أظهر 7 مرضى ضعفاً في الوظيفة بقيم LVEF: 38.5%، 34.5%، 25.3%، 36.1%، 18.8%، 20.0%، و 40.7%. أعطى تحليل الارتباط معامل ارتباط 0.80= r . تخلص الدراسة إلى أن خوارزمية MATLAB المقترحة توفر قياساً دقيقاً ومتاحاً وقابلاً للتكرار لـ LVEF من صور Gated SPECT، مما يقدم بديلاً عملياً للبرامج التجارية باهظة الثمن. اوصي بدمج هذه الطريقة في التحليل الروتيني لـ SPECT في المراكز ذات الموارد المحدودة والتحقق منها على عينة أكبر.
المراجع
[1] Bavelaar-Croon, C.D.L., Kayser, H.W.M., van der Wall, E.E., de Roos, A., Dibbets-Schneider, P. and Pauwels, E.K.(2000). Left ventricular function: correlation of quantitative gated SPECT and MR imaging over a wide range of values. Radiology, 217(2), pp.572–575.
[2] Bax, J.J., Lamb, H., Dibbets, P., Pelikan, H., Boersma, E., Viergever, E.P., van der Wall, E.E. and de Roos, A., (2000). Comparison of gated single-photon emission computed tomography with magnetic resonance imaging for evaluation of left ventricular function in ischemic cardiomyopathy. _American Journal of Cardiology_, 86(12), pp.1299–1305.
[3] Beitner, N., Jenner, J. and Sorensson, P. (2019). Comparison of left ventricular volumes measured by SPECT and CMR. Journal of Cardiovascular Magnetic Resonance, 21(S1), p.O3.
[4] Captur, G., Manisty, C. and Moon, J.C. (2016). Cardiac MRI evaluation of myocardial disease. Heart, 102(18), pp.1429–1435.
[5] Carr, J.C. and Carroll, T.J. (2016). Magnetic Resonance Angiography: Principles and Applications(3rd ed). Springer, New York.ISBN:978-1-4939-3192-3.
[6] Cornbleet, P.J. and Gochman, N. (1979). Incorrect least-squares regression coefficients in method-comparison analysis. Clinical Chemistry, 25(3), pp.432–438.
[7] Dulce, M.C., Mostbeck, G.H., Friese, K.K., Caputo, G.R. and Higgins, C.B. (1993). Quantification of the left ventricular volumes and function with cine MRI: comparison of geometric models with three-dimensional data. Radiology, 188(2), pp.371–376.
[8] Faber, T.L., Cooke, C.D., Folks, R.D., Vansant, J.P., Nichols, K.J., DePuey, E.G., Pettigrew, R.I. and Garcia, E.V. (1999). Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method. Journal of Nuclear Medicine, 40(4), pp.650–659.
[9] Faber, T.L., Vansant, J.P., Pettigrew, R.I., Galt, J.R., Blais, M., Chatzimavroudis, G., Zhou, X. and Garcia, E.V. (2001). Evaluation of left ventricular endocardial volumes and ejection fractions computed from gated perfusion SPECT with magnetic resonance imaging: comparison of two methods. Journal of Nuclear Cardiology, 8(6), pp.645–651.
[10] Ficaro, E.P., Quaife, R.A., Kritzman, J.N. and Corbett, J.R. (1999). Accuracy and reproducibility of 3D-MSPECT for estimating left ventricular ejection fraction in patients with severe perfusion abnormalities. Circulation, 100(Suppl I), p.I-26.
[11] Germano, G., Kavanagh, P.B., Su, H.T., Mazzanti, M., Kiat, H., Hachamovitch, R., Merz, C.R. and Berman, D.S. (1995). Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. Journal of Nuclear Medicine, 36(6), pp.1107–1114.
[12] Greenwood, J.P., Motwani, M., Maredia, N., Brown, J.M., Everett, C.C., Nixon, J., Bijsterveld, P., Dickinson, C.J., Ball, S.G. and Plein, S. (2017). A comparison of cardiovascular magnetic resonance and single photon emission computed tomography (SPECT) perfusion imaging in left main stem or equivalent coronary artery disease. European Heart Journal, 38(1), pp.26–33.
[13] Hammermeister, K.E., DeRouen, T.A. and Dodge, H.T. (1979). Variables predictive of survival in patients with coronary disease: selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, quantitative angiographic evaluations. Circulation, 59(3), pp.421–430.
[14] Kosaraju, A., Goyal, A. and Grigorova, Y. (2022). Left ventricular ejection fraction. In: StatPearls. StatPearls Publishing, Treasure Island (FL).ISBN:978-1-61533-065-8
[15] Lang, R.M., Badano, L.P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F.A., Foster, E., Goldstein, S.A., Kuznetsova, T. and Lancellotti, P. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), pp.1–39.e14.
[16] Lima, R.S., Watson, D.D., Goode, A.R., Siadaty, M.S., Ragosta, M., Beller, G.A. and Samady, H. (2003). Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. Journal of the American College of Cardiology, 42(1), pp.64–70.
[17] Lipke, C.S., Kühl, H.P., Nowak, B., Kaiser, H.J., Reinartz, P., Koch, K.C., Buell, U. and Schaefer, W.M. (2004). Validation of 4D-MSPECT and QGS for quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPET: comparison with cardiac magnetic resonance imaging. European Journal of Nuclear Medicine and Molecular Imaging, 31(4), pp.482–490.
[18] Lum, D.P. and Coel, M.N. (2003). Comparison of automatic quantification software for the measurement of ventricular volume and ejection fraction in gated myocardial perfusion SPECT. Nuclear Medicine Communications, 24(3), pp.259–266.
[19] Marques, O. and Borba, G.B. (2024). Image Processing Recipes in MATLAB (1st ed). CRC Press, Boca Raton.ISBN-13:978-1032289476
[20] Nakajima, K., Higuchi, T., Taki, J., Kawano, M. and Tonami, N. (2001). Accuracy of ventricular volume and ejection fraction measured by gated myocardial SPECT: comparison of 4 software programs. Journal of Nuclear Medicine, 42(10), pp.1571–1578.
[21] Oge Marques, (2024). Image processing recipes in MATLAB. CRC Press, ISBN: 9780367767136.
[22] Schaefer, W.M., Lipke, C.S., Kühl, H.P., Koch, K.C., Kaiser, H.J., Reinartz, P. and Buell, U. (2004). Prone versus supine patient positioning during gated 99mTc-sestamibi SPECT: effect on left ventricular volumes, ejection fraction, and heart rate. Journal of Nuclear Medicine, 45(12), pp.2016–2020.
[23] Schaefer, W.M., Lipke, C.S., Kühl, H.P., Koch, K.C., Kaiser, H.J., Reinartz, P. and Buell, U. (2005). Quantification of LV volumes and EF from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory cardiac Tool Box with QGS and 4D-MSPECT. Journal of Nuclear Medicine, 46(1), pp.55–62.
[24] Sharir, T., Germano, G., Kavanagh, P.B., Lai, S., Cohen, I., Lewin, H.C., Friedman, J.D., Zellweger, M.J. and Berman, D.S. (1999). Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation, 100(10), pp.1035–1042.
[25] Sharir, T., Germano, G., Kang, X., Lewin, H.C., Miranda, R., Cohen, I., Aguilera, C., Merz, C.R. and Berman, D.S. (2001). Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. Journal of Nuclear Medicine, 42(6), pp.831–837.
[26] Stegger, L., Hoffmeier, A.N., Schäfers, K.P., Hermann, S., Schober, O. and Schäfers, M.A. (2006). Accurate non-invasive measurement of infarct size in mice with high resolution positron emission tomography. Journal of Nuclear Medicine, 47(11), pp.1837–1844.
[27] Thiruvikraman, P.K. (2019). A Course of Digital Image Processing with MATLAB. CRC Press, ISBN: 9780750326056.
[30] Thorley, P.J., Plein, S., Bloomer, T.N., Ridgway, J.P. and Sivananthan, U.M. (2003). Comparison of 99mTc-tetrofosmin gated SPECT measurements of left ventricular volumes and ejection fraction with MRI over a wide range of values. Nuclear Medicine Communications, 24(7), pp.763–769.
[31]Vaduganathan, P., He, Z., Vick, G.W. III, Mahmarian, J.J. and Verani, M.S. (1998). Evaluation of left ventricular wall motion, volumes, and ejection fraction by gated myocardial tomography with technetium 99m-labeled tetrofosmin: a comparison with cine magnetic resonance imaging. Journal of Nuclear Cardiology, 5(3), pp.249–255.
[32] Zhang, S., Li, Y., Wang, X., Liu, H. and Chen, Y. (2024). Prognostic value of LVEF acquired by gated SPECT and cardiac MRI. Frontiers in Cardiovascular Medicine, 11, p.1480501.
[2] Bax, J.J., Lamb, H., Dibbets, P., Pelikan, H., Boersma, E., Viergever, E.P., van der Wall, E.E. and de Roos, A., (2000). Comparison of gated single-photon emission computed tomography with magnetic resonance imaging for evaluation of left ventricular function in ischemic cardiomyopathy. _American Journal of Cardiology_, 86(12), pp.1299–1305.
[3] Beitner, N., Jenner, J. and Sorensson, P. (2019). Comparison of left ventricular volumes measured by SPECT and CMR. Journal of Cardiovascular Magnetic Resonance, 21(S1), p.O3.
[4] Captur, G., Manisty, C. and Moon, J.C. (2016). Cardiac MRI evaluation of myocardial disease. Heart, 102(18), pp.1429–1435.
[5] Carr, J.C. and Carroll, T.J. (2016). Magnetic Resonance Angiography: Principles and Applications(3rd ed). Springer, New York.ISBN:978-1-4939-3192-3.
[6] Cornbleet, P.J. and Gochman, N. (1979). Incorrect least-squares regression coefficients in method-comparison analysis. Clinical Chemistry, 25(3), pp.432–438.
[7] Dulce, M.C., Mostbeck, G.H., Friese, K.K., Caputo, G.R. and Higgins, C.B. (1993). Quantification of the left ventricular volumes and function with cine MRI: comparison of geometric models with three-dimensional data. Radiology, 188(2), pp.371–376.
[8] Faber, T.L., Cooke, C.D., Folks, R.D., Vansant, J.P., Nichols, K.J., DePuey, E.G., Pettigrew, R.I. and Garcia, E.V. (1999). Left ventricular function and perfusion from gated SPECT perfusion images: an integrated method. Journal of Nuclear Medicine, 40(4), pp.650–659.
[9] Faber, T.L., Vansant, J.P., Pettigrew, R.I., Galt, J.R., Blais, M., Chatzimavroudis, G., Zhou, X. and Garcia, E.V. (2001). Evaluation of left ventricular endocardial volumes and ejection fractions computed from gated perfusion SPECT with magnetic resonance imaging: comparison of two methods. Journal of Nuclear Cardiology, 8(6), pp.645–651.
[10] Ficaro, E.P., Quaife, R.A., Kritzman, J.N. and Corbett, J.R. (1999). Accuracy and reproducibility of 3D-MSPECT for estimating left ventricular ejection fraction in patients with severe perfusion abnormalities. Circulation, 100(Suppl I), p.I-26.
[11] Germano, G., Kavanagh, P.B., Su, H.T., Mazzanti, M., Kiat, H., Hachamovitch, R., Merz, C.R. and Berman, D.S. (1995). Automatic reorientation of three-dimensional, transaxial myocardial perfusion SPECT images. Journal of Nuclear Medicine, 36(6), pp.1107–1114.
[12] Greenwood, J.P., Motwani, M., Maredia, N., Brown, J.M., Everett, C.C., Nixon, J., Bijsterveld, P., Dickinson, C.J., Ball, S.G. and Plein, S. (2017). A comparison of cardiovascular magnetic resonance and single photon emission computed tomography (SPECT) perfusion imaging in left main stem or equivalent coronary artery disease. European Heart Journal, 38(1), pp.26–33.
[13] Hammermeister, K.E., DeRouen, T.A. and Dodge, H.T. (1979). Variables predictive of survival in patients with coronary disease: selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, quantitative angiographic evaluations. Circulation, 59(3), pp.421–430.
[14] Kosaraju, A., Goyal, A. and Grigorova, Y. (2022). Left ventricular ejection fraction. In: StatPearls. StatPearls Publishing, Treasure Island (FL).ISBN:978-1-61533-065-8
[15] Lang, R.M., Badano, L.P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F.A., Foster, E., Goldstein, S.A., Kuznetsova, T. and Lancellotti, P. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), pp.1–39.e14.
[16] Lima, R.S., Watson, D.D., Goode, A.R., Siadaty, M.S., Ragosta, M., Beller, G.A. and Samady, H. (2003). Incremental value of combined perfusion and function over perfusion alone by gated SPECT myocardial perfusion imaging for detection of severe three-vessel coronary artery disease. Journal of the American College of Cardiology, 42(1), pp.64–70.
[17] Lipke, C.S., Kühl, H.P., Nowak, B., Kaiser, H.J., Reinartz, P., Koch, K.C., Buell, U. and Schaefer, W.M. (2004). Validation of 4D-MSPECT and QGS for quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPET: comparison with cardiac magnetic resonance imaging. European Journal of Nuclear Medicine and Molecular Imaging, 31(4), pp.482–490.
[18] Lum, D.P. and Coel, M.N. (2003). Comparison of automatic quantification software for the measurement of ventricular volume and ejection fraction in gated myocardial perfusion SPECT. Nuclear Medicine Communications, 24(3), pp.259–266.
[19] Marques, O. and Borba, G.B. (2024). Image Processing Recipes in MATLAB (1st ed). CRC Press, Boca Raton.ISBN-13:978-1032289476
[20] Nakajima, K., Higuchi, T., Taki, J., Kawano, M. and Tonami, N. (2001). Accuracy of ventricular volume and ejection fraction measured by gated myocardial SPECT: comparison of 4 software programs. Journal of Nuclear Medicine, 42(10), pp.1571–1578.
[21] Oge Marques, (2024). Image processing recipes in MATLAB. CRC Press, ISBN: 9780367767136.
[22] Schaefer, W.M., Lipke, C.S., Kühl, H.P., Koch, K.C., Kaiser, H.J., Reinartz, P. and Buell, U. (2004). Prone versus supine patient positioning during gated 99mTc-sestamibi SPECT: effect on left ventricular volumes, ejection fraction, and heart rate. Journal of Nuclear Medicine, 45(12), pp.2016–2020.
[23] Schaefer, W.M., Lipke, C.S., Kühl, H.P., Koch, K.C., Kaiser, H.J., Reinartz, P. and Buell, U. (2005). Quantification of LV volumes and EF from gated 99mTc-MIBI SPECT: MRI validation and comparison of the Emory cardiac Tool Box with QGS and 4D-MSPECT. Journal of Nuclear Medicine, 46(1), pp.55–62.
[24] Sharir, T., Germano, G., Kavanagh, P.B., Lai, S., Cohen, I., Lewin, H.C., Friedman, J.D., Zellweger, M.J. and Berman, D.S. (1999). Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation, 100(10), pp.1035–1042.
[25] Sharir, T., Germano, G., Kang, X., Lewin, H.C., Miranda, R., Cohen, I., Aguilera, C., Merz, C.R. and Berman, D.S. (2001). Prediction of myocardial infarction versus cardiac death by gated myocardial perfusion SPECT: risk stratification by the amount of stress-induced ischemia and the poststress ejection fraction. Journal of Nuclear Medicine, 42(6), pp.831–837.
[26] Stegger, L., Hoffmeier, A.N., Schäfers, K.P., Hermann, S., Schober, O. and Schäfers, M.A. (2006). Accurate non-invasive measurement of infarct size in mice with high resolution positron emission tomography. Journal of Nuclear Medicine, 47(11), pp.1837–1844.
[27] Thiruvikraman, P.K. (2019). A Course of Digital Image Processing with MATLAB. CRC Press, ISBN: 9780750326056.
[30] Thorley, P.J., Plein, S., Bloomer, T.N., Ridgway, J.P. and Sivananthan, U.M. (2003). Comparison of 99mTc-tetrofosmin gated SPECT measurements of left ventricular volumes and ejection fraction with MRI over a wide range of values. Nuclear Medicine Communications, 24(7), pp.763–769.
[31]Vaduganathan, P., He, Z., Vick, G.W. III, Mahmarian, J.J. and Verani, M.S. (1998). Evaluation of left ventricular wall motion, volumes, and ejection fraction by gated myocardial tomography with technetium 99m-labeled tetrofosmin: a comparison with cine magnetic resonance imaging. Journal of Nuclear Cardiology, 5(3), pp.249–255.
[32] Zhang, S., Li, Y., Wang, X., Liu, H. and Chen, Y. (2024). Prognostic value of LVEF acquired by gated SPECT and cardiac MRI. Frontiers in Cardiovascular Medicine, 11, p.1480501.
منشور
2026-08-15
كيفية الاقتباس
MUSA, Mahmoud A. A.; ZOBLY, Sulieman M. S.; AHMED, Mawahib G. A..
Assessment of MATLAB Algorithm used for LVEF Quantification for SPECT and MRI Images.
Gezira Journal of Engineering and Applied Sciences, [S.l.], v. 20, n. 2, p. 1-9, aug. 2026.
ISSN 1858-5698. متوفر في: <http://journals.uofg.edu.sd/index.php/gjeas/article/view/2611>. تأريخ الوصول: 03 sep. 2026.
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