Estimating ROI activity concentration with photon-processing and photon-counting SPECT imaging systems

A list-mode multi-energy window low-count SPECT reconstruction method for isotopes with multiple emission peaks

BACKGROUND

Single-photon emission computed tomography (SPECT) provides a mechanism to perform absorbed-dose quantification tasks for [Formula: see text]-particle radiopharmaceutical therapies ([Formula: see text]-RPTs). However, quantitative SPECT for [Formula: see text]-RPT is challenging due to the low number of detected counts, the complex emission spectrum, and other image-degrading artifacts. Towards addressing these challenges, we propose a low-count quantitative SPECT reconstruction method for isotopes with multiple emission peaks.

METHODS

Given the low-count setting, it is important that the reconstruction method extracts the maximal possible information from each detected photon. Processing data over multiple energy windows and in list-mode (LM) format provide mechanisms to achieve that objective. Towards this goal, we propose a list-mode multi energy window (LM-MEW) ordered-subsets expectation-maximization-based SPECT reconstruction method that uses data from multiple energy windows in LM format and include the energy attribute of each detected photon. For computational efficiency, we developed a multi-GPU-based implementation of this method. The method was evaluated using 2-D SPECT simulation studies in a single-scatter setting conducted in the context of imaging [[Formula: see text]Ra]RaCl[Formula: see text], an FDA-approved RPT for metastatic prostate cancer.

RESULTS

The proposed method yielded improved performance on the task of estimating activity uptake within known regions of interest in comparison to approaches that use a single energy window or use binned data. The improved performance was observed in terms of both accuracy and precision and for different sizes of the region of interest.

CONCLUSIONS

Results of our studies show that the use of multiple energy windows and processing data in LM format with the proposed LM-MEW method led to improved quantification performance in low-count SPECT of isotopes with multiple emission peaks. These results motivate further development and validation of the LM-MEW method for such imaging applications, including for [Formula: see text]-RPT SPECT.

Development and task-based evaluation of a scatter-window projection and deep learning-based transmission-less attenuation compensation method for myocardial perfusion SPECT

Attenuation compensation (AC) is beneficial for visual interpretation tasks in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). However, traditional AC methods require the availability of a transmission scan, most often a CT scan. This approach has the disadvantages of increased radiation dose, increased scanner cost, and the possibility of inaccurate diagnosis in cases of misregistration between the SPECT and CT images. Further, many SPECT systems do not include a CT component. To address these issues, we developed a Scatter-window projection and deep Learning-based AC (SLAC) method to perform AC without a separate transmission scan. To investigate the clinical efficacy of this method, we then objectively evaluated the performance of this method on the clinical task of detecting perfusion defects on MPI in a retrospective study with anonymized clinical SPECT/CT stress MPI images. The proposed method was compared with CT-based AC (CTAC) and no-AC (NAC) methods. Our results showed that the SLAC method yielded an almost overlapping receiver operating characteristic (ROC) plot and a similar area under the ROC (AUC) to the CTAC method on this task. These results demonstrate the capability of the SLAC method for transmission-less AC in SPECT and motivate further clinical evaluation.

Development and task-based evaluation of a scatter-window projection and deep learning-based transmission-less attenuation compensation method for myocardial perfusion SPECT

Attenuation compensation (AC) is beneficial for visual interpretation tasks in single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). However, traditional AC methods require the availability of a transmission scan, most often a CT scan. This approach has the disadvantage of increased radiation dose, increased scanner costs, and the possibility of inaccurate diagnosis in cases of misregistration between the SPECT and CT images. Further, many SPECT systems do not include a CT component. To address these issues, we developed a Scatter-window projection and deep Learning-based AC (SLAC) method to perform AC without a separate transmission scan. To investigate the clinical efficacy of this method, we then objectively evaluated the performance of this method on the clinical task of detecting perfusion defects on MPI in a retrospective study with anonymized clinical SPECT/CT stress MPI images. The proposed method was compared with CT-based AC (CTAC) and no-AC (NAC) methods. Our results showed that the SLAC method yielded an almost overlapping receiver operating characteristic (ROC) plot and a similar area under the ROC (AUC) to the CTAC method on this task. These results demonstrate the capability of the SLAC method for transmission-less AC in SPECT and motivate further clinical evaluation.

A Projection-Domain Low-Count Quantitative SPECT Method for α-Particle-Emitting Radiopharmaceutical Therapy

Single-photon emission-computed tomography (SPECT) provides a mechanism to estimate regional isotope uptake in lesions and at-risk organs after administration of α-particle-emitting radiopharmaceutical therapies (α-RPTs). However, this estimation task is challenging due to the complex emission spectra, the very low number of detected counts (~20 times lower than in conventional SPECT), the impact of stray-radiation-related noise at these low counts, and the multiple image-degrading processes in SPECT. The conventional reconstruction-based quantification methods are observed to be erroneous for α-RPT SPECT. To address these challenges, we developed a low-count quantitative SPECT (LC-QSPECT) method that directly estimates the regional activity uptake from the projection data (obviating the reconstruction step), compensates for stray-radiation-related noise, and accounts for the radioisotope and SPECT physics, including the isotope spectra, scatter, attenuation, and collimator-detector response, using a Monte Carlo-based approach. The method was validated in the context of 3-D SPECT with 223Ra, a commonly used radionuclide for α-RPT. Validation was performed using both realistic simulation studies, including a virtual clinical trial, and synthetic and 3-D-printed anthropomorphic physical-phantom studies. Across all studies, the LC-QSPECT method yielded reliable regional-uptake estimates and outperformed the conventional ordered subset expectation-maximization (OSEM)-based reconstruction and geometric transfer matrix (GTM)-based post-reconstruction partial-volume compensation methods. Furthermore, the method yielded reliable uptake across different lesion sizes, contrasts, and different levels of intralesion heterogeneity. Additionally, the variance of the estimated uptake approached the Cramér-Rao bound-defined theoretical limit. In conclusion, the proposed LC-QSPECT method demonstrated the ability to perform reliable quantification for α-RPT SPECT.

Effect on null spaces of list-mode imaging systems due to increasing the number of attributes

There are two types of uncertainty in image reconstructions from list-mode data: statistical and deterministic. One source of statistical uncertainty is the finite number of attributes of the detected particles, which are sampled from a probability distribution on the attribute space. A deterministic source of uncertainty is the effect that null functions of the imaging operator have on reconstructed pixel or voxel values. Quantifying the reduction in this deterministic source of uncertainty when more attributes are measured for each detected particle is the subject of this work. Specifically, upper bounds on an error metric are derived to quantify the error introduced in the reconstruction by the presence of null functions, and these upper bounds are shown to be reduced when the number of attributes is increased. These bounds are illustrated with an example of a two-dimensional single photon emission computed tomography (SPECT) system where the depth of interaction in the scintillation crystal is added to the attribute vector.

Objective Task-Based Evaluation of Artificial Intelligence-Based Medical Imaging Methods:: Framework, Strategies, and Role of the Physician

Artificial intelligence-based methods are showing promise in medical imaging applications. There is substantial interest in clinical translation of these methods, requiring that they be evaluated rigorously. We lay out a framework for objective task-based evaluation of artificial intelligence methods. We provide a list of available tools to conduct this evaluation. We outline the important role of physicians in conducting these evaluation studies. The examples in this article are proposed in the context of PET scans with a focus on evaluating neural network-based methods. However, the framework is also applicable to evaluate other medical imaging modalities and other types of artificial intelligence methods.

Effect on null spaces of list-mode imaging systems due to increasing the size of attribute space

An upper bound is derived for a figure of merit that quantifies the error in reconstructed pixel or voxel values induced by the presence of null functions for any list-mode system. It is shown that this upper bound decreases as the region in attribute space occupied by the allowable attribute vectors expands. This upper bound allows quantification of the reduction in this error when this type of expansion is implemented. Of course, reconstruction error is also caused by system noise in the data, which has to be treated statistically, but we will not be addressing that problem here. This method is not restricted to pixelized or voxelized reconstructions and can in fact be applied to any region of interest. The upper bound for pixelized reconstructions is demonstrated on a list-mode 2D Radon transform example. The expansion in the attribute space is implemented by doubling the number of views. The results show how the pixel size and number of views both affect the upper bound on reconstruction error from null functions. This reconstruction error can be averaged over all pixels to give a single number or can be plotted as a function on the pixel grid. Both approaches are demonstrated for the example system. In conclusion, this method can be applied to any list-mode system for which the system operator is known and could be used in the design of the systems and reconstruction algorithms.

A physics and learning-based transmission-less attenuation compensation method for SPECT

Attenuation compensation (AC) is a pre-requisite for reliable quantification and beneficial for visual interpretation tasks in single-photon emission computed tomography (SPECT). Typical AC methods require the availability of an attenuation map, which is obtained using a transmission scan, such as a CT scan. This has several disadvantages such as increased radiation dose, higher costs, and possible misalignment between SPECT and CT scans. Also, often a CT scan is unavailable. In this context, we and others are showing that scattered photons in SPECT contain information to estimate the attenuation distribution. To exploit this observation, we propose a physics and learning-based method that uses the SPECT emission data in the photopeak and scatter windows to perform transmission-less AC in SPECT. The proposed method uses data acquired in the scatter window to reconstruct an initial estimate of the attenuation map using a physics-based approach. A convolutional neural network is then trained to segment this initial estimate into different regions. Pre-defined attenuation coefficients are assigned to these regions, yielding the reconstructed attenuation map, which is then used to reconstruct the activity distribution using an ordered subsets expectation maximization (OSEM)-based reconstruction approach. We objectively evaluated the performance of this method using highly realistic simulation studies conducted on the clinically relevant task of detecting perfusion defects in myocardial perfusion SPECT. Our results showed no statistically significant differences between the performance achieved using the proposed method and that with the true attenuation maps. Visually, the images reconstructed using the proposed method looked similar to those with the true attenuation map. Overall, these results provide evidence of the capability of the proposed method to perform transmission-less AC and motivate further evaluation.

Task-based assessment of binned and list-mode SPECT systems

In SPECT, list-mode (LM) format allows storing data at higher precision compared to binned data. There is significant interest in investigating whether this higher precision translates to improved performance on clinical tasks. Towards this goal, in this study, we quantitatively investigated whether processing data in LM format, and in particular, the energy attribute of the detected photon, provides improved performance on the task of absolute quantification of region-of-interest (ROI) uptake in comparison to processing the data in binned format. We conducted this evaluation study using a DaTscan brain SPECT acquisition protocol, conducted in the context of imaging patients with Parkinson's disease. This study was conducted with a synthetic phantom. A signal-known exactly/background-known-statistically (SKE/BKS) setup was considered. An ordered-subset expectation-maximization algorithm was used to reconstruct images from data acquired in LM format, including the scatter-window data, and including the energy attribute of each LM event. Using a realistic 2-D SPECT system simulation, quantification tasks were performed on the reconstructed images. The results demonstrated improved quantification performance when LM data was used compared to binning the attributes in all the conducted evaluation studies. Overall, we observed that LM data, including the energy attribute, yielded improved performance on absolute quantification tasks compared to binned data.

Fisher information analysis of list-mode SPECT emission data for joint estimation of activity and attenuation distribution

The potential to perform attenuation and scatter compensation (ASC) in single-photon emission computed tomography (SPECT) imaging without a separate transmission scan is highly significant. In this context, attenuation in SPECT is primarily due to Compton scattering, where the probability of Compton scatter is proportional to the attenuation coefficient of the tissue and the energy of the scattered photon and the scattering angle are related. Based on this premise, we investigated whether the SPECT scattered-photon data acquired in list-mode (LM) format and including the energy information can be used to estimate the attenuation map. For this purpose, we propose a Fisher-information-based method that yields the Cramer-Rao bound (CRB) for the task of jointly estimating the activity and attenuation distribution using only the SPECT emission data. In the process, a path-based formalism to process the LM SPECT emission data, including the scattered-photon data, is proposed. The Fisher information method was implemented on NVIDIA graphics processing units (GPU) for acceleration. The method was applied to analyze the information content of SPECT LM emission data, which contains up to first-order scattered events, in a simulated SPECT system with parameters modeling a clinical system using realistic computational studies with 2-D digital synthetic and anthropomorphic phantoms. The method was also applied to LM data containing up to second-order scatter for a synthetic phantom. Experiments with anthropomorphic phantoms simulated myocardial perfusion and dopamine transporter (DaT)-Scan SPECT studies. The results show that the CRB obtained for the attenuation and activity coefficients was typically much lower than the true value of these coefficients. An increase in the number of detected photons yielded lower CRB for both the attenuation and activity coefficients. Further, we observed that systems with better energy resolution yielded a lower CRB for the attenuation coefficient. Overall, the results provide evidence that LM SPECT emission data, including the scattered photons, contains information to jointly estimate the activity and attenuation coefficients.

A LIST-MODE OSEM-BASED ATTENUATION AND SCATTER COMPENSATION METHOD FOR SPECT

Reliable attenuation and scatter compensation (ASC) is a pre-requisite for quantification and beneficial for visual interpretation tasks in SPECT. In this paper, we develop a reconstruction method that uses the entire SPECT emission data, i.e. data in both the photopeak and scatter windows, acquired in list-mode format and including the energy attribute of the detected photon, to perform ASC. We implemented a GPU-based version of this method using an ordered subsets expectation maximization (OSEM) algorithm. The method was objectively evaluated using realistic simulation studies on the task of estimating uptake in the striatal regions of the brain in a 2-D dopamine transporter (DaT)-scan SPECT study. We observed that inclusion of data from the scatter window and using list-mode data yielded improved quantification compared to using data only from the photopeak window or using binned data. These results motivate further development of list-mode-based ASC methods that include scatter-window data for SPECT.

Towards continuous-to-continuous 3D imaging in the real world

Imaging systems are often modeled as continuous-to-discrete mappings that map the object (i.e. a function of continuous variables such as space, time, energy, wavelength, etc) to a finite set of measurements. When it comes to reconstruction, some discretized version of the object is almost always assumed, leading to a discrete-to-discrete representation of the imaging system. In this paper, we discuss a method for single-photon emission computed tomography (SPECT) imaging that avoids discrete representations of the object or the imaging system, thus allowing reconstruction on an arbitrarily fine set of points.

A no-gold-standard technique for objective assessment of quantitative nuclear-medicine imaging methods

The objective optimization and evaluation of nuclear-medicine quantitative imaging methods using patient data is highly desirable but often hindered by the lack of a gold standard. Previously, a regression-without-truth (RWT) approach has been proposed for evaluating quantitative imaging methods in the absence of a gold standard, but this approach implicitly assumes that bounds on the distribution of true values are known. Several quantitative imaging methods in nuclear-medicine imaging measure parameters where these bounds are not known, such as the activity concentration in an organ or the volume of a tumor. We extended upon the RWT approach to develop a no-gold-standard (NGS) technique for objectively evaluating such quantitative nuclear-medicine imaging methods with patient data in the absence of any ground truth. Using the parameters estimated with the NGS technique, a figure of merit, the noise-to-slope ratio (NSR), can be computed, which can rank the methods on the basis of precision. An issue with NGS evaluation techniques is the requirement of a large number of patient studies. To reduce this requirement, the proposed method explored the use of multiple quantitative measurements from the same patient, such as the activity concentration values from different organs in the same patient. The proposed technique was evaluated using rigorous numerical experiments and using data from realistic simulation studies. The numerical experiments demonstrated that the NSR was estimated accurately using the proposed NGS technique when the bounds on the distribution of true values were not precisely known, thus serving as a very reliable metric for ranking the methods on the basis of precision. In the realistic simulation study, the NGS technique was used to rank reconstruction methods for quantitative single-photon emission computed tomography (SPECT) based on their performance on the task of estimating the mean activity concentration within a known volume of interest. Results showed that the proposed technique provided accurate ranking of the reconstruction methods for 97.5% of the 50 noise realizations. Further, the technique was robust to the choice of evaluated reconstruction methods. The simulation study pointed to possible violations of the assumptions made in the NGS technique under clinical scenarios. However, numerical experiments indicated that the NGS technique was robust in ranking methods even when there was some degree of such violation.