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Aim: Purpose of this study was to assess the impact of mediastinal region of interest (ROI) definition on intra- and inter-observer variability in relation to collimator type., Methods: Thirty-five subjects with CHF (80% men, mean age 66 ± 9 years, NYHA 2.4 ± 0.5, LVEF 29 ± 8.4%) were enrolled. 15 minutes and 4 hours post-injection (p.i.) of (123)I-MIBG, planar images were sequentially acquired with low energy high energy (LEHR) and medium energy (ME) collimators. In the first analysis, observer-defined mediastinal ROI was used. In the second analysis, a predefined mediastinal ROI was used. Intra- and inter-observer variability of late H/M was assessed using Lin's concordance coefficient (LCC)., Results: There was substantial agreement between all three observers using predefined mediastinum ROI. LCCs for LEHR were 0.98, 0.96, and 0.95, for ME 0.98, 0.97, and 0.97. However, observer-defined mediastinal ROI resulted in poor-moderate agreement. LCCs for LEHR were 0.82, 0.94, and 0.70, for ME 0.77, 0.91, and 0.80. Intra-observer analysis using predefined mediastinal ROI showed substantial agreement. LCC was 0.97 for LEHR and 0.96 for ME., Conclusion: Predefined mediastinal ROI results in low intra- and inter-observer variability of late H/M and is, therefore, to be preferred over observer-defined mediastinal ROI. Intra- and inter-observer variability of late H/M is not influenced by collimator choice.

Purpose: For the quantification of cardiac (123)I-metaiodobenzylguanidine (MIBG) uptake, the mediastinum is commonly used as a reference region reflecting nonspecific background activity. However, variations in the quantity of vascular structures in the mediastinum and the rate of renal clearance of (123)I-MIBG from the blood pool may contribute to increased interindividual variation in uptake. This study examined the relationship between changes in heart (H) and mediastinal (M) counts and the change in vascular (123)I-MIBG activity, including the effect of renal function., Methods: Fifty-one subjects with ischemic heart disease underwent early (15 min) and late (4 h) anterior planar images of the chest following injection of (123)I-MIBG. Vascular (123)I-MIBG activity was determined from venous blood samples obtained at 2 min, 15 min, 35 min, and 4 h post-injection. From the vascular clearance curve of each subject, the mean blood counts/min per ml at the time of each acquisition and the slope of the clearance curve were determined. Renal function was expressed as the estimated creatinine clearance (e-CC) and the estimated glomerular filtration rate (e-GFR). Relations between H and M region of interest (ROI) counts/pixel, vascular activity, and renal function were then examined using linear regression., Results: Changes in ROI activity ratios between early and late planar images could not be explained by blood activity, the slope of the vascular clearance curves, or estimates of renal function. At most 3% of the variation in image counts could be explained by changes in vascular activity (p = 0.104). The e-CC and e-GFR could at best explain approximately 1.5% of the variation in the slopes of the vascular clearance curve (p = 0.194)., Conclusion: The change in measured H and M counts between early and late planar (123)I-MIBG images is unrelated to intravascular levels of the radiopharmaceutical. This suggests that changes in M counts are primarily due to decrease in soft tissue activity and scatter from the adjacent lungs.