Application of transmission scan-based attenuation compensation to scatter-corrected thallium-201 myocardial single-photon emission tomographic images

Novel attenuation correction of SPECT images using scatter photopeak window data for the detection of coronary artery disease

BACKGROUND

Attenuation correction using segmentation with scatter and photopeak window data (SSPAC) may enable evaluation of the attenuation map in a patient-specific manner without the need for additional radiation exposure and more acquisition time. We examined the feasibility of SSPAC and compared the sensitivity, specificity, and accuracy of this new correction method with that of conventional non-corrected myocardial perfusion single-photon emission computed tomography (SPECT) among patients with suspected or diagnosed coronary artery disease.

METHODS AND RESULTS

One hundred sixty-one patients who underwent both (99m)Tc-tetrofosmin stress/rest SPECT examination and invasive coronary angiography were enrolled in the study. Data from the SSPAC-corrected and non-corrected methods were analyzed quantitatively using summed stress scores. Attenuation maps were obtained successfully for 150 (93%) of the patients. The SSPAC-corrected and non-corrected methods accurately predicted coronary artery disease defined as >50% luminal stenosis verified by coronary artery angiography and/or prior myocardial infarction, for 91% and 77% patients, respectively (P < .05). For diagnosis of coronary artery disease, SSPAC improved sensitivity in the left anterior descending artery territory and specificity in the right coronary artery territory.

CONCLUSIONS

Attenuation correction with SSPAC may be a feasible method of correction for myocardial perfusion SPECT and in some cases may provide better accuracy for diagnosing coronary artery disease.

Simultaneous dual-isotope imaging based on an artificial neural network for evaluating myocardial perfusion and fatty acid metabolism

BACKGROUND

We contrived a scatter correction method based on an artificial neural network (ANN) and applied it to the simultaneous evaluation of myocardial perfusion and fatty acid metabolism in single-photon emission computed tomography (SPECT).

METHODS

The count data of three energy windows were used as inputs of the ANN. The count ratios of the estimated primary-to-total photons for (99m)Tc and (123)I, which were used to reconstruct (99m)Tc and (123)I images, were calculated using the ANN. In a phantom study, single- and dual-isotope imaging with (99m)Tc/(123)I and (201)Tl/(123)I was performed by means of a cardiac phantom simulating patients with and without obesity. In a human study, five normal volunteers and ten patients with myocardial infarction underwent myocardial perfusion and fatty acid metabolism imaging with single and dual SPECT with combinations of (99m)Tc-methoxyisobutylisonitrile/(123)I-beta-methyl(p-iodophenyl)pentadecanoic acid (BMIPP) and (201)Tl/(123)I-BMIPP as tracers.

RESULTS

Technetium-99m yielded more homogeneous images than (201)Tl because of the lower degree of photon attenuation, especially in the condition of obese patients, resulting in clearer visualization of the perfusion-metabolism mismatch. Dual (99m)Tc/(123)I SPECT offered comparable images with single SPECT in assessing myocardial damage.

CONCLUSIONS

The method effectively separated (99m)Tc and (123)I primary photons and proved applicable to (99m)Tc/(123)I dual-isotope myocardial SPECT.

Comparison of 3D phase-sensitive inversion-recovery and 2D inversion-recovery MRI at 3.0 T for the assessment of late gadolinium enhancement in patients with hypertrophic cardiomyopathy

RATIONALE AND OBJECTIVES

To compare free-breathing three-dimensional (3D) phase-sensitive inversion recovery (PSIR) with breath-holding two-dimensional (2D) IR sequences to determine which is better for detecting and characterizing myocardial late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) patients.

MATERIALS AND METHODS

Thirty HCM patients clinically underwent 3.0 T cardiac magnetic resonance imaging that included 3D-PSIR and 2D-IR. The amount of LGE lesions was calculated and expressed as %LGE of the myocardial mass, and the average of the %LGE value reported by two observers was recorded as the final %LGE. We also counted the number of LGE lesions and recorded their location. The myocardium-LGE contrast, margin sharpness, artifacts, and overall image quality were graded on a 4-point grading scale (1 = poor, 2 = fair, 3 = good, 4 = excellent).

RESULTS

The mean %LGE on 2D-IR was 24.7 ± 0.6, 17.5 ± 0.6, and 8.5 ± 0.3, respectively, for the basal, mid-, and apical myocardium; the corresponding values were 24.2 ± 0.4, 20.0 ± 0.4, and 7.7 ± 0.3 on 3D-PSIR (2D-IR versus 3D-PSIR, P = .87). On 2D IR and 3D-PSIR images, 13, 52, and 53, and 9, 74, and 33 LGE lesions were detected in the subendocardial, midwall, subepicardial area, respectively. The myocardium-LGE contrast and overall image quality were significantly higher on 3D-PSIR than 2D-IR images (P < .001); the sequences did not differ significantly with respect to margin sharpness and artifact.

CONCLUSION

Three-dimensional PSIR sequence yields higher image contrast, better image quality, and greater detection ability for LGE lesions than 2D-IR sequence.

Object-specific Attenuation Correction at SPECT/CT in Thorax: Optimization of Respiratory Protocol for Image Registration

Institutional review board approval was obtained for multiple imaging examinations in healthy volunteers and patients and for the analysis of images. The purpose of the study, and the risks associated with radiation exposure with regard to stochastic effects that might result in cancer and/or genetic mutations, were explained to all subjects, and all questions from subjects were answered. Each subject provided written informed consent. The purpose of the study was to prospectively determine the respiratory protocol at computed tomography (CT) that results in the best registration of CT images with images acquired at single photon emission computed tomography (SPECT) in the thorax. Errors of registration between myocardial SPECT images and CT images obtained with different respiratory protocols (postinhalation breath hold, postexhalation breath hold, and free breathing) in 13 healthy subjects were compared. CT scans obtained with free breathing and postexhalation breath hold better matched SPECT images than did those obtained with postinhalation breath hold (one-way analysis of variance, P < .01). Fewer SPECT/CT images showed artifacts with registration performed by using internal landmarks (four, two, and one of 13 images with postinhalation breath-hold, postexhalation breath-hold, and free-breathing protocols, respectively) than with registration performed by using external markers (nine, four, and two of 13 images). CT data acquisition with a free-breathing or postexhalation breath-hold protocol and image registration by using internal landmarks are recommended for attenuation correction.

Effect of Beta-Blocker Therapy on Myocardial Perfusion Defects in Thallium-201 Scintigraphy in Patients with Dilated Cardiomyopathy

BACKGROUND

The beneficial effects of beta-blocker therapy in patients with heart failure have been confirmed. However, the effects of beta-blockers on myocardial perfusion defects are unclear. The aim of this study was to evaluate the effect of beta-blockers on myocardial perfusion defects estimated by thallium-201 myocardial scintigraphy in patients with dilated cardiomyopathy (DCM) and to investigate the relationships between beta-blocker treatment and myocardial damage and cardiac function.

METHODS

201Tl and echocardiography were performed in 37 patients before and after 6 months of beta-blocker therapy. Extent score (ES) by 201Tl was used to quantitate myocardial perfusion defects before and after treatment.

RESULTS

ES was significantly decreased by beta-blocker therapy. According to the change in ES, DCM patients were classified into three groups, patients who improved, patients showing no change and patients who deteriorated. In the improvement and no-change groups, beta-blocker therapy induced a reduction in left ventricular dimensions and an associated increase in ejection fraction. However, in the deterioration group, left ventricular dimensions and ejection fraction were unchanged. There was a significant relationship between the change in left ventricular dimension at end-diastole and the change in ES.

CONCLUSIONS

beta-Blocker therapy could attenuate myocardial perfusion defects in some patients with DCM. The improvement in left ventricular function associated with beta-blocker therapy may be related to the attenuation in myocardial perfusion defects.

Truncation correction of fan beam transmission data for attenuation correction using parallel beam emission data on a 3-detector SPECT system

BACKGROUND

When the simultaneous transmission computed tomography (TCT)/single photon emission CT (SPECT) acquisition protocol is applied to myocardial studies using a 3-detector SPECT, the narrow effective field of view of a fan beam collimator used for TCT acquisition may cause truncation artifacts on TCT images. In this paper, we propose a new method of correcting for the truncation of TCT.

METHODS

The truncated parts of the TCT projection data are corrected using quadratic functions, based on the properties that the integral of non-truncated TCT projection data is constant at any projection angle and the position of the centre of gravity is focused on a fixed point. The usefulness of our method was investigated in phantom and human studies using a 3-detector SPECT equipped with one cardiac fan beam collimator for TCT and two parallel beam collimators for SPECT. We used Tl as a tracer for SPECT and Tc as an external source for TCT.

RESULTS

The phantom and human studies showed that our method can adequately correct for the truncation of TCT data acquired using a fan beam collimator in a 3-detector SPECT, as long as there is no truncation in SPECT data.

CONCLUSION

Our method appears to be useful for improving the SPECT images obtained using simultaneous TCT/SPECT acquisition in a 3-detector SPECT. However, further studies will be necessary to establish the clinical usefulness of this method.

Segmented attenuation correction for myocardial SPECT

PURPOSE

One of the main factors contributing to the accuracy of attenuation correction for SPECT imaging using transmission computed tomography (TCT) with an external gamma-ray source is the radionuclide count. To reduce deterioration of TCT images due to inadequate radionuclide counts, a correction method, segmented attenuation correction (SAC), in which TCT data are transformed into several components (segments) such as water, lungs and spine, providing a satisfactory attenuation correction map with less counts, has been developed. The purpose of this study was to examine the usefulness of SAC for myocardial SPECT with attenuation correction.

METHODS

A myocardial phantom filled with Tc-99m was scanned with a triple headed SPECT system, equipped with one cardiac fan beam collimator for TCT and two parallel hole collimators for ECT. As an external gamma-ray source for TCT, 740 MBq of Tc-99m was also used. Since Tc-99m was also used for ECT, the TCT and ECT data were acquired separately. To make radionuclide counts, the TCT data were acquired in the sequential repetition mode, in which a 3-min-rotation was repeated 7 times followed by a 10-min-rotation 4 times (a total of 61 minutes). The TCT data were reconstructed by adding some of these rotations to make TCT maps with various radionuclide counts. Three types of SAC were used: (a) 1-segment SAC in which the body structure was regarded as water, (b) 2-segment SAC, in which the body structure was regarded as water and lungs, and (c) 3-segment SAC, in which the body structure was regarded as water, lungs and spine. We compared corrected images obtained with non-segmentation methods, and with 1- to 3-segment SACs. We also investigated the influence of radionuclide counts of TCT (3, 6, 9, 12, 15, 18, 21, 31, 41, 51, 61 min acquisition) on the accuracy of the attenuation correction.

RESULTS

Either 1-segment or 2-segment SAC was sufficient to correct the attenuation. When non-segmentation TCT attenuation methods were used, rotations of at least 31 minutes were required to obtain sufficiently large counts for TCT. When the 3-segment SAC was used, the minimal acquisition time for a satisfactory TCT map was 7 min.

CONCLUSION

The 3-segment SAC was effective for attenuation correction, requiring fewer counts (about 1/5 of the value for non-segmentation TCT), or less radiation for TCT.

Comparison of 99mTc-MIBI uptakes on planar images with those in excised rats organs

The precision with which images reflect tracer uptake in the myocardium has been studied. Additionally, the degree to which Tc methoxyisobutylisonitrile (99mTc-MIBI) in the liver gave the effect to a myocardial image has been examined. After administering Tc-MIBI to normal male rats, we compared the myocardial uptakes obtained using a gamma camera with the actual uptakes in the excised organs. Twenty-nine rats were used. Following imaging, the anterior view at 5, 10, 15, 30, 45, 60, 90 and 120 min after administration of the tracer, uptakes in the heart, lung, liver and blood were estimated with a well-type scintillation counter (WC) and represented as the percentage of the injected dose per gram of tissue (%ID/g). The regions of interest (ROIs) were placed on planar images (PI) and the uptake in each organ was estimated as the percentage of the injected dose per pixel (%ID/pixel). The ratios of PI-to-WC and heart-to-organ were also evaluated. Cardiac uptake with WC was maximum (1.581%+/-1.893%) at 10 min post-injection. On the other hand, that with PI was maximum (1.493%+/-0.598%) at 45 min post-injection, but there were significant differences between both measurements (PI/WC ratio: about 1.0 time). Pulmonary uptake with WC was the maximum at 5 min (0.808%+/-0.015%) post-injection, and decreased gradually. PI measurement showed the maximum value at 45 min (0.760%+/-0.012%). Hepatic uptake with WC was the maximum at 30 min (0.594%+/-0.254%). On the other hand, PI measurement showed the same pattern with WC, but these values were higher value than WC as the whole. PI measurement showed higher uptakes in each organ than WC measurement. It was concluded that uptakes or the heart-to-organ ratio obtained clinically with PI might not represent a value that is always accurate.

Performance evaluation of OSEM reconstruction algorithm incorporating three-dimensional distance-dependent resolution compensation for brain SPECT: a simulation study

Iterative reconstruction techniques such as an ordered subsets-expectation maximization (OSEM) algorithm can easily incorporated various physical models of attenuation or scatter. We implemented OSEM reconstruction algorithm incorporating compensation for distance-dependent blurring due to the collimator in SPECT. The algorithm was examined by computer simulation to estimate the accuracy for brain perfusion study.

METHODS

The detector response was assumed to be a two-dimensional Gauss function and the width of the function varied linearly with the source-to-detector distance. The attenuation compensation (AC) was also included. To investigate the properties of the algorithm, we performed computer simulations with the point source and digital brain phantoms. In the point source phantom, the uniformity of FWHM for the radial, tangential and longitudinal directions was evaluated on the reconstruction image. As for the brain phantom, quantitative accuracy was estimated by comparing the reconstructed images with the true image by the mean square error (MSE) and the ratio of gray and white matter counts (G/W). Both noise free and noisy simulations were examined.

RESULTS

In the point source simulation, FWHM in radial, tangential and longitudinal directions were 14.7, 14.7 and 15.0 mm at the image center and were 15.9, 9.83 and 10.6 mm at a distance of 15 cm from the center by using FBP, respectively. On the other hand, they were 8.12, 8.12 and 7.83 mm at the image center, and were 7.45, 7.44 and 7.01 mm at 15 cm from the center by OSEM with distance-dependent resolution compensation (DRC). An isotropic and stationary resolution was obtained at any location by OSEM with DRC. The spatial resolution was also improved about 6.5 mm by OSEM with DRC at the image center. In the brain phantom simulation, the blurring at the edge of the brain structure was eliminated by using OSEM with both DRC and AC. The G/W was 2.95 and 2.68 for noise free and noisy cases, respectively, when no compensation was performed. But the values for G/W without and with noise became 3.45 and 3.21 with AC only and were improved to 3.75 and 3.71 with both AC and DRC. The G/W approached the true value (4.00) by using OSEM with both AC and DRC even when there was statistical noise.

CONCLUSION

In conclusion, OSEM reconstruction including the distance-dependent resolution compensation algorithm was reasonably successful in achieving isotropic and stationary resolution and improving the quantitative accuracy for brain perfusion SPECT.

Comparison of99mTc-tetrofosmin uptakes on planar images with those in excised rats organs with those in excised rats organs

The radioactivity in the organs adjacent to the heart causes interference with the quantitative assessment of myocardial uptake of tracer on scintigraphy. In order to investigate how much the functions of these organs affect myocardial uptake seen in imaging, we compared the myocardial uptake measured by means of a gamma camera with the actual activity in the excised organs.

METHODS

Thirty-three rats were imaged at 5, 10, 15, 30, 45, 60, 90 and 120 min after the administration of 99mTc-tetrofosmin, and % injected dose per pixel (%ID/pixel) for each organ was assessed on planar images (PI measurement). Percent injected dose per gram of tissue (%ID/g) in the heart as well as lungs, liver, gastrointestines and blood was measured by means of a well scintillation counter (WC measurement). Comparison between PI and WC measurements was performed with % uptake, the PI-to-WC ratio and heart-to-organ ratios.

RESULTS

Our WC measurement showed an increase in cardiac uptake until 30 min (1.67 +/- 0.31%) postinjection and subsequent gradual decrease, whereas PI measurement showed maximum activity of 1.81 +/- 0.52% at 15 min postinjection. There was a prominent difference between the two measurements, particularly at 10 min, with a PI/WC ratio of about 1.6 times. Our WC measurement showed maximum pulmonary uptake at 15 min (0.87 +/- 0.31%) and a gradual decrease over 15 min, whereas PI measurement showed maximum uptake at 10 min (1.14 +/- 0.38%). There was hardly any variation in activity observed later than at 10 min. Our WC measurement showed hardly any variance in hepatic activity from 5 min (0.77 +/- 0.19%) to 30 min (0.69 +/- 0.27%) with a subsequent gradual decrease. The percent uptake in PI measurement was generally greater than that in WC measurement, and high values were found at 10 min and 15 min with PI/WC ratios of about 3.3 times and 2.3 times, respectively.

CONCLUSION

Percent uptakes in PI measurement were greater than those in WC measurement. The difference between the two measurements was prominent in the early phases. The cardiac uptake in PI measurement was significantly greater than that in WC measurement at 10 min. It was considered that this discrepancy between the two measurements was caused by the Compton scatter from the organs adjacent to the heart.

Combined corrections for attenuation, depth-dependent blur, and motion in cardiac SPECT: a multicenter trial

BACKGROUND

The diagnostic accuracy of cardiac single photon emission computed tomography (SPECT) is limited by image-degrading factors, such as heart or subject motion, depth-dependent blurring caused by the collimator, and photon scatter and attenuation. We developed correction approaches for motion, depth-dependent blur, and attenuation and performed a multicenter validation.

METHODS AND RESULTS

Motion was corrected both transversely and axially with a cross-correlation technique. Depth-dependent blurring was corrected by first back-projecting each projection and then applying a depth-dependent Wiener filter row by row. Attenuation was corrected with an iterative, nonuniform Chang algorithm, based on a transmission scan-generated attenuation map. We validated these approaches in 112 subjects, including 36 women (20 healthy volunteers, 8 angiographically normal patients, and 8 patients with coronary artery disease [CAD] found by means of angiography) and 76 men (23 healthy volunteers, 10 angiographically normal patients, and 43 patients with CAD found by means of angiography). Either technetium 99m or thallium 201 was used for emission; either gadolinium 153 or Tc-99m was used for transmission. Images were reconstructed and blindly interpreted with a 5-point scale for receiver operating characteristic analysis in 2 ways: motion correction plus a Butterworth filter, and combined motion and blur and attenuation corrections. The interpretation by means of consensus was for the overall presence of CAD and vascular territory. The receiver operating characteristic curves for overall presence and each of the 3 main coronary arteries were all shifted upward and to the left and had larger areas under the curve, for combined corrections compared with motion correction and Butterworth. Sensitivity/specificity for motion correction and Butterworth were 84/69, 64/71, 32/94, and 71/81 overall for the left anterior descending, the right coronary artery, and circumflex territories, respectively, compared with 88/92, 77/93, 50/97, and 74/95, respectively, for the combined corrections.

CONCLUSIONS

The proposed combined corrections for motion, depth-dependent blur, and attenuation significantly improve diagnostic accuracy, when compared with motion correction alone.

Attenuation and scatter compensation in myocardial perfusion SPECT

Nonuniform attenuation, Compton scatter, and limited, spatially varying resolution degrade both the qualitative and quantitative nature of myocardial perfusion SPECT. Physicians must recognize and understand the effects of these factors on myocardial perfusion SPECT for optimal interpretation and use of this important imaging technique. Recent developments in the design and implementation of compensation algorithms and transmission-based imaging promise to provide clinically realistic solutions to these effects and provide the framework for truly quantitative imaging. This achievement should improve the diagnostic accuracy and cost-effectiveness of myocardial perfusion SPECT.