Phantom evaluation of simultaneous thallium-201/technetium-99m aquisition in single-photon emission tomography

Optimisation of simultaneous tl-201/tc-99m dual isotope reconstruction with monte-carlo-based scatter correction

Simultaneous Tl-201/Tc-99m dual isotope myocardial perfusion SPECT is seriously hampered by down-scatter from Tc-99m into the Tl-201 energy window. This paper presents and optimises the ordered-subsets-expectation-maximisation-(OS-EM-) based reconstruction algorithm, which corrects the down-scatter using an efficient Monte Carlo (MC) simulator. The algorithm starts by first reconstructing the Tc-99m image with attenuation, collimator response, and MC-based scatter correction. The reconstructed Tc-99m image is then used as an input for an efficient MC-based down-scatter simulation of Tc-99m photons into the Tl-201 window. This down-scatter estimate is finally used in the Tl-201 reconstruction to correct the crosstalk between the two isotopes. The mathematical 4D NCAT phantom and physical cardiac phantoms were used to optimise the number of OS-EM iterations where the scatter estimate is updated and the number of MC simulated photons. The results showed that two scatter update iterations and 10(5) simulated photons are enough for the Tc-99m and Tl-201 reconstructions, whereas 10(6) simulated photons are needed to generate good quality down-scatter estimates. With these parameters, the entire Tl-201/Tc-99m dual isotope reconstruction can be accomplished in less than 3 minutes.

A method for quantitative cell tracking using SPECT for the evaluation of myocardial stem cell therapy

PURPOSE

A promising SPECT-based method for evaluating stem cells therapy uses (111)In-labelled cells, transfected with a reporter gene. Cells are first transplanted to the infarct, and subsequently interrogated for transgenic expression using a systemic injection of an (131)I-labelled reporter probe. The method is impeded by the physical effects of scatter, (131)I/(111)In cross-talk, and attenuation. We hypothesize that correcting for physical effects improves detection of transgenic expression in transplanted cells when (111)In localization is available.

METHODS

Canine bone marrow mesenchymal cells (BMMCs), radiolabelled and transfected, were injected into infarcted myocardium. Next, a reporter probe was injected systemically, and 22 SPECT scans were acquired over 20 h. Finally, (99m)Tc-sestamibi was injected and imaged. The animal was killed, the heart sectioned, and counted for (131)I and (111)In in a well-counter ('gold standard'). Canine SPECTs were reconstructed in two ways: with corrections for physical effects and without corrections. The first (111)In reconstruction and the (99m)Tc reconstruction were used to define volumes-of-interest over the transplanted BMMC (VBMMC) and normal myocardium (VNM), respectively.

RESULTS

(131)I reconstructions without corrections for physical effects had negligible differential uptake. With corrections, VBMMC was consistently higher than VNM, demonstrating transgene expression. (131)I had the following VBMMC:VNM activity ratio: without correction for physical effects=0.869; with corrections=1.23; and well-counter=1.21. VNM showed the following (131)I:(111)In activity ratio: without corrections=3.07; with corrections=1.38; and well-counter=1.58.

CONCLUSIONS

In dual-isotope SPECT, corrections for physical effects were required to detect transgene expression in cells transplanted into an infarction when localization information was available.

Physical characteristics of low and medium energy collimators for 123I imaging and simultaneous dual-isotope imaging

Septal penetration of high energy photons may degrade 123I images obtained with a low energy collimator. We evaluated the physical characteristics of a low energy, high resolution (LEHR) collimator, special LEHR (SLEHR) collimator, and medium energy collimator for 123I studies. The cross-talk of 99mTc and 123I into the 201Tl window was also examined. Sensitivity and spatial resolution were measured with each collimator. Point sources of 99mTc and 123I were imaged at various source-collimator distances using multiple energy windows, and the effects of collimator choice on energy spectrum and spatial distribution of photopeak counts were assessed. For 99mTc, both sensitivity and resolution were similar with the low energy collimators, and higher sensitivity and lower resolution were observed with the medium energy collimator. For 123I, the full width at tenth maximum was larger for 123I than for 99mTc when using the LEHR collimator. Acquisitions with multiple energy windows revealed severe degradation due to septal penetration in imaging 123I with the LEHR collimator, especially at short distances. The degradation was reduced with the SLEHR collimator and further with the medium energy collimator. In both 99mTc and 123I imaging, cross-talk into the 201Tl window was larger at shorter distances and the largest with the LEHR collimator. In conclusion, variation in collimator geometry causes differences in the effect of septal penetration on 123I images and in cross-talk into the 201Tl window. The SLEHR collimator may be suitable for use in high resolution 123I imaging and simultaneous 99mTc/201Tl imaging. Use of the medium energy collimator appears to be preferable in quantitative 123I studies.

Efficient simulation of SPECT down-scatter including photon interactions with crystal and lead

A major image degrading factor in simultaneous Dual Isotope (DI) SPECT or simultaneous Emission-Transmission (ECT-TCT) imaging, is the detection of photons emitted by the higher energy isotope in the energy window used for imaging the lower energy isotope. In Tc-99m/Tl-201 DI-SPECT typically tens of percents of the total detected down-scatter is caused by lead x rays. In Tc-99m/Gd-153 ECT-TCT, a comparable fraction of the down-scatter originates from Tc-99m photons which only partly deposit their energy in the detector crystal (i.e., due to crystal interactions). Efficient simulation methods which model down-scatter can be used to optimize DI-SPECT or ECT-TCT imaging acquisition or reconstruction protocols. In this paper we adapt a previously proposed efficient down-scatter simulation method, to include the interactions of photons with the detector crystal and collimator lead. To this end, point spread function tables including crystal and lead interactions are precalculated. Subsequently, photons are traced through the patient body until their last scatter position, and the precalculated responses are used to project the photons onto the detector plane, while photon attenuation in the patient is taken into account. The approach is evaluated by comparing simulated Tc-99m down-scatter projections with measured projections. Incorporation of photon interaction with crystal and lead leads to significantly improved accuracy of the shape of down-scatter responses, while differences in total counts between simulated and measured projections typically decrease from tens of percents to a couple of percents. Calculating 60 down-scatter projections of an extended distribution on a 64 x 64 x 64 grid takes about three minutes on a PC with two 1.2 GHz processors. We conclude that accurate and efficient simulation of down-scatter is now possible including the major effects of the nonuniform mass density of the patient as well as photon interactions with the crystal and collimator lead.

Detection of myocardial viability using rest-redistribution thallium-201 imaging in a stress 99Tcm-tetrofosmin/rest thallium-201 dual-isotope protocol

This study investigated the utility of optional thallium-201 (201Tl) imaging for detecting myocardial viability in the stress 99Tcm-tetrofosmin/rest 201Tl dual-isotope protocol. Seventy-nine patients with old myocardial infarction and 25 patients with acute myocardial infarction underwent acquisition of three consecutive 201Tl images (early, intermediate and delayed) using the dual-isotope protocol. A polar map was created and defect scores (extent and severity) were determined by comparison with normal control data. Fluorodeoxyglucose positron emission tomography was also performed in 16 patients with old myocardial infarction. In patients with old infarction, the severity score decreased significantly from the early to the intermediate images, and decreased further on the delayed images. In patients with acute infarction, the score increased from the early to the intermediate images, but not on the delayed images. Regional uptake on the delayed images showed a better correlation with the fluorodeoxyglucose images than that on the early images. Redistribution on the delayed images was exclusively observed in the myocardial segments with less uptake than that estimated by fluorodeoxyglucose. In conclusion, addition of delayed 201Tl imaging to the dual-isotope protocol could improve the sensitivity for detecting myocardial viability.

Assessment of resistance to paclitaxel of murine tumors by (99m)Tc-MIBI/(201)Tl dual-radionuclide imaging

This study investigated P-glycoprotein (Pgp) expression by murine tumors with and without resistance to paclitaxel and the role of (99m)Tc-2-methoxyisobutylisonitrile (MIBI)/(201)Tl imaging in predicting the effect of paclitaxel. Antitumor effect of paclitaxel and biodistribution of the radiopharmaceuticals were evaluated in mice bearing four tumor types. Pgp expression did not correlate with the antitumor efficacy of paclitaxel. Although the absolute uptake of (99m)Tc-MIBI did not correlate with Pgp expression, (99m)Tc-MIBI could predict paclitaxel sensitivity by its higher uptake.

Simultaneous technetium-99m/thallium-201 SPECT imaging with model-based compensation for cross-contaminating effects

Simultaneous acquisition of dual-isotope SPECT data offers a number of advantages over separately acquired data; however, simultaneous acquisition can result in cross-contamination between isotopes. In this work we propose and evaluate two frameworks for iterative model-based compensation of cross-contamination in dual-isotope SPECT. The methods were applied to cardiac imaging with technetium-99m-sestamibi and thallium-201, and they were compared with a subtraction-based compensation method using a cross-talk estimate obtained from an auxiliary energy window. Monte Carlo simulations were performed to carefully study aspects of bias and noise for the methods, and a torso phantom with cardiac insert was used to evaluate the performance of the methods for experimentally acquired data. The cross-talk compensation methods substantially improved lesion contrast and significantly reduced quantitative errors for simultaneously acquired data. Thallium image normalized mean square error (NMSE) was reduced from 0.522 without cross-talk compensation to as low as 0.052 with model-based cross-talk compensation. This is compared with a NMSE of 0.091 for the subtraction-based compensation method. The application of a preliminary model for cross-talk arising from lead fluorescence x-rays and collimator scatter gave promising results, and the future development of a more accurate model for collimator interactions would probably benefit simultaneous Tc/Tl imaging. Model-based compensation methods provide feasible cross-talk compensation in clinically acceptable times, and they may ultimately make simultaneous dual-isotope protocols an effective alternative for many imaging procedures.