Quantitative CBF measurement using an integrated SPECT/CT system: validation of three-dimensional ordered-subset expectation maximization and CT-based attenuation correction by comparing with O-15 water PET

Cerebral blood flow and Alzheimer's disease-related biomarkers in cerebrospinal fluid in idiopathic normal pressure hydrocephalus

AIM

Alzheimer's disease (AD) pathology is highly prevalent in patients with idiopathic normal pressure hydrocephalus (iNPH), and the presence of AD pathology may involve regional cerebral blood flow (rCBF). In this study, we examined the relationship between rCBF and AD-related biomarkers in the cerebrospinal fluid of iNPH patients.

METHODS

Patients with iNPH (n = 39) were classified into groups with (iNPH/AD+) (n=15) and without (iNPH/AD-) (n=24) high biomarker probability of AD (i.e. combined low amyloid β 42 and high total tau in the cerebrospinal fluid). rCBF was quantified in 17 regions of interest by N-isopropyl-p-[¹²³ I]iodoamphetamine single-photon emission computed tomography with the autoradiography method. We compared rCBF between the iNPH/AD- and iNPH/AD+ groups at baseline using a t-test and then compared changes in rCBF after shunt surgery between the groups using a paired t-test and two-way repeated measures ANOVA.

RESULTS

At baseline, there were no significant differences in rCBF between the groups in most regions apart from the putamen. After shunt surgery, a significant increase in rCBF in the putamen, amygdala, hippocampus, and parahippocampal gyrus was observed in iNPH/AD- patients. In iNPH/AD+ patients, no significant improvement in rCBF was observed in any region. In repeated measures analysis of variance, a significant group × shunt interaction was observed in the parietal lobe, frontal lobe, posterior cingulate cortex, precuneus, lateral temporal lobe, amygdala, hippocampus, parahippocampal gyrus, and putamen.

CONCLUSIONS

Improvement in rCBF after shunt surgery in iNPH/AD+ patients may be poorer than that in iNPH AD- patients.

[Development of a Striatal and Skull Phantom for Quantitative 123I-FP-CIT SPECT]

BACKGROUND

¹²³Iodine-labelled N-(3-fluoropropyl) -2β-carbomethoxy-3β-(4-iodophenyl) nortropane (¹²³I-FP-CIT) single photon emission computerized tomography (SPECT) images are used for differential diagnosis such as Parkinson's disease (PD). Specific binding ratio (SBR) is affected by scattering and attenuation in SPECT imaging, because gender and age lead to changes in skull density. It is necessary to clarify and correct the influence of the phantom simulating the the skull.

PURPOSE

The purpose of this study was to develop phantoms that can evaluate scattering and attenuation correction.

METHODS

Skull phantoms were prepared based on the measuring the results of the average computed tomography (CT) value, average skull thickness of 12 males and 16 females. ¹²³I-FP-CIT SPECT imaging of striatal phantom was performed with these skull phantoms, which reproduced normal and PD. SPECT images, were reconstructed with scattering and attenuation correction. SBR with partial volume effect corrected (SBR_act) and conventional SBR (SBR_Bolt) were measured and compared.

RESULTS

The striatum and the skull phantoms along with ¹²³I-FP-CIT were able to reproduce the normal accumulation and disease state of PD and further those reproduced the influence of skull density on SPECT imaging. The error rate with the true SBR, SBR_act was much smaller than SBR_Bolt.

CONCLUSION

The effect on SBR could be corrected by scattering and attenuation correction even if the skull density changes with ¹²³I-FP-CIT on SPECT imaging. The combination of triple energy window method and CT-attenuation correction method would be the best correction method for SBR_act.

Effect of resolution recovery using graph plots on regional cerebral blood flow in healthy volunteers

PURPOSE

We evaluated the effect of resolution recovery (RR) using graph plots on regional cerebral blood flow (rCBF) in brain perfusion single-photon emission computed tomography (SPECT) images derived from healthy volunteers and patients diagnosed with probable Alzheimer's disease.

METHOD

We acquired brain perfusion SPECT images with scatter correction (SC), computed tomography-based attenuation correction (CTAC), and RR from a three-dimensional brain phantom and from healthy volunteers. We then compared contrast-to-noise ratio, count density ratios, increase maps, and rCBF using statistical parametric mapping 8.

RESULTS

Regional brain counts were significantly increased from 20-24% with SC, CTAC, and RR compared with SC and CTAC. Mean CBF in healthy volunteers was 42.5 ± 5.4 mL/100 g/min. Average rCBF determined using SC, CTAC and RR increased 7.5, 2.0, and 3.7% at the thalamus, posterior cingulate, and whole brain, respectively, compared with SC and CTAC.

CONCLUSION

Resolution recovery caused variations in normal rCBF because counts increased in cerebral regions.

Does applying resolution recovery to normal databases confer an advantage over conventional 3D-stereotactic surface projection techniques?

We evaluated a novel normal database (NDB) generated using single photon emission computed tomography (SPECT) data obtained from healthy brains by using a SPECT/CT system, analyzed using a resolution recovery (RR) technique applied to the three-dimensional stereotactic surface projection (3D-SSP) technique. We used a three-dimensional ordered subset expectation maximization method (3D-OSEM) with applied scatter correction (SC), attenuation correction, and RR to reconstruct the data. We verified the accuracy of the novel NDB's values (Z, extent, and error scores), and compared the novel NDB to the 3D-SSP technique by using simulated misery perfusion-related patient data from a conventional NDB. In addition, Z, extent, and error scores at the precuneus, cuneus, and posterior cingulate were compared under different reconstruction conditions by using the patient data. In the simulation, Z scores decreased when using the novel NDB corrected using computed tomography-based attenuation correction (CTAC), SC, and RR. The extent scores of the posterior cingulate increased using the novel NDB, relative to the other NDBs. The error score with the novel NDB without RR decreased by 15% compared to that of the conventional NDB. Z scores generated from patient data decreased in the novel NDB with RR. The extent scores tended to decrease in the novel NDB with RR. The extent scores in the novel NDB with RR improved at the posterior cingulate, compared to the scores with the other NDBs. However, applying RR to the novel NDB conferred no advantage because the cut-off of the current Z score must be reconsidered when using the additive RR technique.

Evaluation of Resolution Recovery for Each Collimator in Brain Perfusion Image

PURPOSE

This study aimed to verify the resolution recovery for each collimator in the brain perfusion image.

METHOD

To verify the effect of the resolution recovery for each collimator, we evaluated via the three-dimensional brain phantom (phantom) and the normal brain perfusion single photon emission computed tomography (SPECT) data. These data were reconstructed using the three-dimensional ordered subset expectation maximization method (3D-OSEM) (Evolution for bone^TM) that was performed with scatter correction, attenuation correction, and resolution recovery (RR). The performance of resolution recovery was evaluated in the two collimator systems (ELEGP and MEGP) reconstruction condition via the contrast value, mean counts, normalized mean square error (NMSE), and regional brain activity.

RESULT

In the "with resolution recovery (+RR)", the NMSE indicated minimum value with SI (subset×iteration) = 100, cut-off frequency (Fc) = 0.50 cycles/cm. The contrast value in the "+RR" increased 20% for the cortical region and decreased 28% and 6% at ELEGP collimator and MEGP collimator for the central region, as compared to the "without resolution recovery (-RR)". In the phantom study, the error of the brain activity using MEGP collimator at the temporal lobe and sub-lobar decreased 15%, compared with ELEGP collimator in the + RR. In the clinical study, the error of the regional brain activity using MEGP collimator in the "+RR" increased from 3% to 8%, compared with "-RR".

DISCUSSION

The accurate resolution recovery was obtained at SI = 100 and Fc = 0.50 cycles/cm. The contrast value and regional brain activity at the central region decreased due to incomplete resolution recovery by use of ELEGP collimator.

CT-Based Attenuation Correction in Brain SPECT/CT Can Improve the Lesion Detectability of Voxel-Based Statistical Analyses

Background

Integrated SPECT/CT enables non-uniform attenuation correction (AC) using built-in CT instead of the conventional uniform AC. The effect of CT-based AC on voxel-based statistical analyses of brain SPECT findings has not yet been clarified. Here, we assessed differences in the detectability of regional cerebral blood flow (CBF) reduction using SPECT voxel-based statistical analyses based on the two types of AC methods.

Subjects and Methods

N-isopropyl-p-[123I]iodoamphetamine (IMP) CBF SPECT images were acquired for all the subjects and were reconstructed using 3D-OSEM with two different AC methods: Chang’s method (Chang’s AC) and the CT-based AC method. A normal database was constructed for the analysis using SPECT findings obtained for 25 healthy normal volunteers. Voxel-based Z-statistics were also calculated for SPECT findings obtained for 15 patients with chronic cerebral infarctions and 10 normal subjects. We assumed that an analysis with a higher specificity would likely produce a lower mean absolute Z-score for normal brain tissue, and a more sensitive voxel-based statistical analysis would likely produce a higher absolute Z-score for in old infarct lesions, where the CBF was severely decreased.

Results

The inter-subject variation in the voxel values in the normal database was lower using CT-based AC, compared with Chang’s AC, for most of the brain regions. The absolute Z-score indicating a SPECT count reduction in infarct lesions was also significantly higher in the images reconstructed using CT-based AC, compared with Chang’s AC (P = 0.003). The mean absolute value of the Z-score in the 10 intact brains was significantly lower in the images reconstructed using CT-based AC than in those reconstructed using Chang’s AC (P = 0.005).

Conclusions

Non-uniform CT-based AC by integrated SPECT/CT significantly improved sensitivity and the specificity of the voxel-based statistical analyses for regional SPECT count reductions, compared with conventional uniform Chang's AC.

Development of a simple non-invasive microsphere quantification method for cerebral blood flow using I-123-IMP

OBJECTIVE

In clinical practice, measurement of the rCBF has mainly been conducted by I-123-N-isopropyl-p-iodoamphetamine ((123)I-IMP) SPECT using the microsphere (MS) method, with continuous arterial blood sampling. While several non-invasive (123)I-IMP quantification methods have been developed, their accuracy has been shown to be lower than that of the MS method. Therefore, a non-invasive quantification method for use in routine clinical practice is being sought. The purpose of this study was to develop a simple non-invasive (123)I-IMP quantification method (SIMS method) with a simple input function-determining protocol based on the MS method.

METHOD

The input function for the SIMS method was determined using the administered dose and the integrated lung washout ratio obtained by analyzing the count-time activity curve of the pulmonary artery and lung on dynamic chest images. The mean CBF (mCBF) and input function measured in 80 patients by the SIMS method was compared with those determined using the MS method.

RESULT

A good correlation was observed between the counts measured by continuous arterial blood sampling in the MS method and the estimated counts by image analysis in the new method (r = 0.94, p < 0.01). Similarly, a good correlation was observed between the mCBF values determined by the MS method and the SIMS method (r = 0.83, p < 0.01).

CONCLUSION

The mCBF values determined by the SIMS method were closely consistent with the values obtained by the MS method. This finding indicates the possibility of use of the SIMS method for routine clinical study.

CT-based attenuation and scatter correction compared with uniform attenuation correction in brain perfusion SPECT imaging for dementia

This study investigated if the appearance and diagnostic accuracy of HMPAO brain perfusion SPECT images could be improved by using CT-based attenuation and scatter correction compared with the uniform attenuation correction method. A cohort of subjects who were clinically categorized as Alzheimer's Disease (n = 38), Dementia with Lewy Bodies (n = 29) or healthy normal controls (n = 30), underwent SPECT imaging with Tc-99m HMPAO and a separate CT scan. The SPECT images were processed using: (a) correction map derived from the subject's CT scan or (b) the Chang uniform approximation for correction or (c) no attenuation correction. Images were visually inspected. The ratios between key regions of interest known to be affected or spared in each condition were calculated for each correction method, and the differences between these ratios were evaluated. The images produced using the different corrections were noted to be visually different. However, ROI analysis found similar statistically significant differences between control and dementia groups and between AD and DLB groups regardless of the correction map used.We did not identify an improvement in diagnostic accuracy in images which were corrected using CT-based attenuation and scatter correction, compared with those corrected using a uniform correction map.