Comparison of Left Ventricular Ejection Fraction Among ¹⁸ F-FDG Dual-Gated PET/CT, Single-Gated PET/MRI, and Cardiac MRI

Left ventricular ejection fraction (LVEF) is a critical parameter in the evaluation of cardiac function, and its measurement can guide treatment decisions in patients with breast cancer undergoing chemotherapy. We obtained LVEF measurements with gated PET-based methods to determine if they produced comparable results to those obtained with cardiac MRI. <b>Methods:</b> Patients with breast cancer who visited the National Cyclotron and PET Centre, Chulabhorn Hospital, in Bangkok, Thailand, between July 1, 2022, and February 28, 2023, for LVEF assessment were included in this prospective study. All patients underwent PET/CT using 3 different reconstruction techniques: dual-gated with electrocardiography and respiratory gating, dual-gated with artificial intelligence-assisted list-mode respiratory-compensated PET/CT (dual-gated list-mode PET/CT), and single-gated (electrocardiography-gated) PET/CT. Additionally, single-gated PET/MRI and cardiac MRI were performed to collect data on end-diastolic volume (EDV), end-systolic volume (ESV), and LVEF. <b>Results:</b> There were no statistically significant differences in LVEF measurements between any modality. Dual-gated PET/CT showed the lowest average percentage difference when compared with cardiac MRI (6.45%). Differences in EDV and ESV were not statistically significant among the PET-based methods but were significant between the cardiac MRI and all PET-based methods, with consistent percentage differences ranging from -37.64% to -39.38% for EDV and -43.68% to -45.32% for ESV. Intraclass correlation coefficients showed moderate to good reliability, and Pearson correlation coefficients indicated good to strong correlations between cardiac MRI and PET/MRI and among PET-based methods. <b>Conclusion:</b> PET-based methods produced comparable LVEF measurements to those obtained by cardiac MRI. The use of PET-based methods to evaluate LVEF may offer advantages in terms of convenience and accessibility in this population.