SPECT volume quantitation: influence of spatial resolution, source size and shape, and voxel size

Effects of non-linear flow and spatial orientation on technetium-99m hexamethylpropylene amine oxime single-photon emission tomography

The effects of two post-acquisition corrections on the visual and quantitative analysis of technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) were determined. The corrections were for: (1) the improper spatial orientation of the patient data sets, and (2) the non-linear uptake of HMPAO across the blood-brain barrier. Reorienting the SPET image data sets removed observers' uncertainty in assessment caused by suspected head tilt; however, it increased their uncertainty due to perceived subtle perfusion deficits. Applying the correction to compensate for the decrease in uptake of HMPAO in high-flow regions resulted in an increase in the number of positive assessments. In a study involving 30 patient studies, intra-observer reliability increased from 62% to 83% (average of two observers) after applying both of the corrections, while inter-observer reliability improved from 62% to 81%. Quantitative methods of analysing the images are also affected by the corrections. In an ROI-based classification scheme, the quantitative assessments of more than one-half of the images are affected by the two corrections. These results need to be considered when comparing both quantitative and visual results from different studies in which the corrections may or may not have been applied.

Automatic determination of LV orientation from SPECT data

Presents a new method to determine the orientation or pose of the left ventricle (LV) of the heart from cardiac SPECT (single photon emission computed tomography) data. This proposed approach offers an accurate, fast, and robust delineation of the LV long-axis. The location and shape of the generated long-axis can then be utilized to define automatically the tomographic slices for enhanced visualization and quantification of the clinical data. The methodology is broadly composed of two main steps: (1) volume segmentation of cardiac SPECT data; and (2) topological goniometry, a novel approach incorporating volume visualization and computer graphics ideas to determine the overall shape of 3-D objects. The outcome of the algorithm is a 3-D curve representing the overall pose of the LV long-axis. Experimental results on both phantom and clinical data (50 technetium-99m and 74 thallium-201) are presented. An interactive graphical interface to visualize the volume (3-D) data, the left ventricle, and its pose is an integral part of the overall methodology. This technique is completely data driven and expeditious, making it viable for routine clinical use.

Blood flow measurement in extremity soft tissue sarcoma with technetium-99m hexamethyl-propyleneamineoxime and single photon emission computed tomography

Blood flow measurements were made in 28 patients with soft tissue sarcoma of the extremities to investigate the prognostic significance of tumour vascularity. Four patients with benign tumours also underwent blood flow measurement. Mean and maximum tumour blood flow was calculated from technetium-99m hexamethyl-propyleneamineoxime uptake measured using single photon emission computed tomography (SPECT), tumour volume measured from SPECT transaxial image reconstructions and cardiac output assessed with Doppler ultrasonography. Twenty-seven malignant lesions and one benign tumour showed increased uptake of isotope relative to surrounding tissues. Mean sarcoma blood flow varied between 1 and 33 ml per 100 ml tumour per min, and maximum flow between 5 and 57 ml per 100 ml per min. Fourteen patients developed progressive disease during the first year of follow-up. Eight of 11 patients with a high isotope uptake ratio, eight of 12 with a high mean blood flow and eight of 14 with a high maximum blood flow relative to the respective medians for the series showed disease progression.

Quantitative single-photon emission computed tomography: basics and clinical considerations

Although quantitative single-photon emission computed tomography (SPECT) has been the goal of much research effort for a number of years, only recently has it received wide interest, especially for clinical applications. It has been increasingly recognized that the achievement of quantitative SPECT will increase the accuracy of measurements, such as dimensions of specific regions of interest, absolute amount of radioactivity, and dosimetry calculations, and substantially reduce reconstruction image artifacts and distortions, thus, greatly improving clinical diagnosis. This article provides a review of the definition of terms, major factors affecting SPECT quantitation and their degrading effects on SPECT image quality, and methods to compensate for these effects. Compensation methods include those that make certain approximations for ease of implementation and those that provide more accurate compensation by modeling the imaging process more exactly, usually at the cost of increased complexity and computational requirements. Different reconstruction and compensation methods may be compared through the use of phantom cardiac and brain SPECT studies. The clinical efficacy of the methods may be demonstrated by applying them to a clinical thallium-201 myocardial perfusion SPECT study. The results clearly demonstrate that, by modeling the imaging process and/or image degrading factors three-dimensionally, quantitative reconstruction and compensation methods provide the best image quality and quantitative accuracy. Important research efforts and developmental work being conducted currently to bring quantitative SPECT into routine clinical use are also discussed.

A three-dimensional second-derivative surface-detection algorithm for volume determination on SPECT images

Most existing techniques for determining volumes on single-photon-emission computed tomography (SPECT) data employ thresholding, two-dimensional edge detection, or manual delineation of edges. These methods, however, are limited in both accuracy and applicability. In seeking to overcome these limitations, a truly three-dimensional (3D) second-derivative-based algorithm which can be implemented with relative ease has been developed. The method incorporates 3D matrix operators; these are convoluted with the SPECT count data in order to produce a 3D voxel map whose data elements correspond to the second derivative of counts in the image. This map is then searched, a suitable derivative-based edge-defining criterion being applied to each voxel position, in order to locate the derivative surface boundary which defines the volume. Validation is obtained using phantom data from 99Tcm-filled bottles of volumes 200, 580 and 2500 cm3 placed within a body-sized tank containing background activities set to give a range of contrasts between 1.00 and 0.75 (i.e. background 0% to 25%). The performance of the algorithm is encouraging: the volumes of the two larger bottles are determined to within a 3% accuracy without the need for any prior calibration, and the results obtained over all bottle sizes are found to be contrast independent to within approximately 4%.

Quantitative single photon emission tomography: verification for sources in an elliptical water phantom

Accurate absorbed dose calculations are important for a proper dose planning in internal radionuclide therapy. The activity distribution must be measured and the target volume defined. This can be done with single photon emission tomography (SPET) if proper attenuation and scatter correction are employed. This study investigated the calculation of the activity and the volume of different spherical sources. These two parameters are essential for a proper dose calculation. The scatter and attenuation correction method is based on spatially variant scatter functions and density maps. The volume calculation method is based on obtaining a threshold from a grey-level histogram. Both point sources and spheres of different diameters containing technetium-99m were placed in different locations in an elliptical water phantom and imaged by SPET. The activity and the volume of the spheres were calculated from the SPET images and compared with known activities. Results show a quantification of activity within 10% for most of the sources. Important influences on the quantification are (a) the presence of artefacts due to improper reconstruction and (b) the finite spatial resolution which affects the total number of counts within the determined volume.