Dual-Modality Imaging with SPECT/CT

Seminar Report

SUBMITTED BY

CONTENTS

1. INTRODUCTION. 2. INSTRUMENTATION FOR SPECT/CT. 3. MATERIALS AND METHODS. 4. SPECT/CT IMAGING. I. IMAGE ACQUISITION. II. IMAGE REGISTRATION AND IMAGE FUSION. 5. SPECT/CT DUAL MODALITY IMAGING. 6. CHALLENGES FOR SPECT/CT IMAGING. 7. ADVANTAGES OF SPECT/CT 8. APPLICATIONS OF SPECT/CT REFERENCES.

1. Introduction
Dual-modality imaging is an in vivo diagnostic technique that obtains structural and functional information directly from patient studies in a way that cannot be achieved with separate imaging systems alone. Dual-modality imaging systems are configured by combining Computed tomography (CT) with radionuclide imaging (using single-photon emission computed tomography (SPECT)) on a single gantry which allows both functional and structural imaging to be performed during a single imaging session without having the patient leave the imaging system. SPECT is a tomographic scintigraphic technique in which a computergenerated image of local radioactive tracer distribution in tissues is produced through the detection of single-photon emissions from radionuclides introduced into the body. CT is a tomographic imaging technique that uses an external x-ray source to produce 3-dimensional anatomic image data. Combined SPECT/CT devices provide both the functional information from SPECT and the anatomic information from CT in a single examination. Some studies have demonstrated that the information obtained by SPECT/CT is more accurate in evaluating patients than that obtained from either SPECT or CT alone. To facilitate the process of correlating structural and functional information, investigators at UCSF, have developed a new class of diagnostic instrumentation that combines x-ray CT and radionuclide imaging with SPECT.

2. Instrumentation for SPECT/CT

The dual-modality systems use separate detectors for x -ray and radionuclide imaging, with the detectors integrated on a common gantry to simplify patient handling, data acquisition, and coregistration of the CT and radionuclide image data. A SPECT/CT scanner is an integrated device containing both a CT scanner and a SPECT g-camera with a single patient table and therefore capable of obtaining a CT scan, a SPECT scan, or both. If the patient does not move on the bed between the scans, the reconstructed SPECT and CT images will be spatially registered. CT and radionuclide scans are acquired by translating the patient from one detector to the other while the patient remains on the patient table. This allows the CT and radionuclide images to be acquired with a consistent scanner geometry and body habitus, and with minimal delay between the two acquisitions.

SPECT

CT

SPECT/CT
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3. Materials and Methods

The radionuclide image is obtained using a GE 600 XR/T scintillation camera with a large rectangular field of view (approximately 400 mm 500 mm). SPECT images are acquired as 128 128 image matrices. The SPECT images are reconstructed with a filtered back projection algorithm. CT images are obtained with a GE 9800 Quick CT scanner using a standard technique (140 kVp, 120 mA). Images acquired with a 512 512 matrix with field of view (FOV) of 400450 mm and are reconstructed using filtered-backprojection. Patients were instructed to breathe normally and the intention was to acquire the CT during tidal breathing. Total imaging time for most studies was approximately 35 minutes, with the SPECT acquisition requiring approximately 25 minutes and the CT acquisition, approximately 10 minutes. CT studies were reconstructed using a slice thickness of 4 mm, which is reduced to 1.52mm for imaging small structures such as parathyroid and sentinel node imaging. CT and SPECT studies were acquired with the patients arms above the head in all cases and with the arms at the patients side in two cases.

4. SPECT/CT Imaging I. Image Acquisition

The patient to be scanned first in the CT scanner. CT and SPECT scanning can be performed without moving the patient. The CT bed moves with ease along a track, which can be locked in either the CT position or SPECT position. This reduces misregistration artifacts as no change in patient positioning is required between studies. Then the bed positioned so that the SPECT study could be done immediately after the CT acquisition. CT and SPECT studies were acquired with the patients arms above the head. A critical benefit of SPECT/CT and other dual-modality imaging techniques is that radionuclide and anatomical images are acquired with minimal delay between the two image data sets. This occurs because the two scanners are fixed relative to one another and function as an integrated system with a common patient table.

II. Image Registration and Image Fusion

The CT and radionuclide data are acquired with the patient in the same position to facilitate image correlation between the CT and SPECT. After both sets of images are acquired and reconstructed, image registration software is used to fuse the X-ray and radionuclide images in a way that accounts for differences in scanner geometry and image format between the two data sets. Images are reconstructed using an iterative maximum-likelihood expectationmaximization (ML-EM) algorithm. SPECT/CT registration is the process of
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aligning SPECT and CT images for the purposes of combined image display (fusion) and image analysis. For image registration, patients are imaged by placing fiducial markers on the patient table and on the patients surface to provide a common set of coordinates for the SPECT and CT systems. The fiducial markers contain a small volume (0.2 ml) of a solution containing 300 mg/ml of K2HPO4 that can be visualized with CT, and 33 Ci/ml of 99mTc that can be visu alized with SPECT. After the images are acquired, they are reviewed by an observer who identifies the approximate centers of the fiducial markers on both the CT and SPECT images. A computer program has been developed to calculate the centroid of the markers based on the pixel values in both the CT and SPECT images (31). The measured coordinates of the markers then are used to derive a transformation matrix that translates, rotates, and magnifies the coordinates of the SPECT image so that they match corresponding points in the CT image. The transformed SPECT data are reformatted so that they have the same image matrix size, slice thickness, and dimensions as the original CT image to account for differences in scanner geometry and image format (e.g., 128 128 vs. 512 512) between the two data sets. Image registration technique is accurate to well within one pixel for both the standard reconstructed x-ray CT images (0.94 mm for a 512 512 large field-ofview CT image) and reconstructed radionuclide images (4.32 mm for 128 128 images). Once the SPECT and CT coordinate systems are registered as described above, image fusion then can be performed with in-house software that displays the radionuclide data in color superimposed on a grayscale CT image.

Displays the radionuclide data in color superimposed on a grayscale CT image.

This shows the coronal and sagittal plane of SPECT/CT images.

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6. Challenges for SPECT/CT Imaging

There are several sources of error in the application of SPECT/CT, depending on the system configuration. These errors include misregistration, truncation, scatter, and beam hardening artifacts. A major issue for CT type systems is misregistration between the emission and transmission data, resulting in incorrect matching of the attenuation map to the emission data. This may occur for a number of reasons, including sagging of the emission table, respiratory and cardiac motion, and patient motion. Patients were instructed to breathe normally. Truncation is also a great challenge. Current low-dose CT devices have an x-ray field of view of 40 cm and hence are unable to adequately image patients with a chest circumference of greater than 55 cm. Therefore part of the patient is beyond the field of view. Artifacts from metal or beam hardening can also affect CT image quality and may lead to artifactual focal uptake on attenuation-corrected SPECT images, which is caused by incorrect scaling of the Hounsfield units into the SPECT attenuation map.

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7. Advantages of SPECT/CT
Anatomic imaging techniques allow accurate detection and localization of morphologic abnormalities. Fusion of SPECT and CT in single examination. More accurate. Improved sensitivity and specificity. Improved spatial resolution compared to SPECT or CT alone.

8.APPLICATIONS of SPECT/CT
Cardiac imaging Tumors Thyroid disorders Parathyroid disorders Skeleton disorders Inflammation or infection Brain disorders

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References
Dual-Modality Imaging with SPECT/ CT : University of California San Francisco. Technology in Cancer Research & Treatment .Volume 1, Number 6, December (2002) SPECT/CT: Basic Instrumentation and Innovations.Seminars in Nuclear medicine (2006). Michael K.OConnor and Brad J. Kemp. SPECT/CT imaging for anatomical localization: Nuclear medicine communications. July 2006, Vol 27 No 12. SPECT/CT Imaging : Clinical Utility of an Emerging Technology. RadioGraphics. July- August 2008. www.rsnajnls.org Applications of SPECT/CT in Nuclear Radiology: Nuclear Medicine. September 2008. http://www.pdfsearchengine.org/

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