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Single-photon emission computed tomography
From Wikipedia, the free encyclopedia
Single-photon emission computed tomography.
SPECT Slice of Brain using Tc-99m Ceretec.jpg
A SPECT slice of the distribution of technetium exametazime within a patient's
brain
ICD-9-CM 92.0-92.1
MeSH D01589
OPS-301 code 3-72
[edit on Wikidata]

SPECT image (bone tracer) of a mouse MIP

File:Animation of a SPECT implementation using a six-axis arm robot - 2191-219X-1-
32-S1.ogv
Animation of a SPECT scanning procedure.
Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a
nuclear medicine tomographic imaging technique using gamma rays.[1] It is very
similar to conventional nuclear medicine planar imaging using a gamma camera (that
is, scintigraphy).[2] However, it is able to provide true 3D information. This
information is typically presented as cross-sectional slices through the patient,
but can be freely reformatted or manipulated as required.
The technique requires delivery of a gamma-emitting radioisotope (a radionuclide)
into the patient, normally through injection into the bloodstream. On occasion, the
radioisotope is a simple soluble dissolved ion, such as an isotope of gallium(III).
Most of the time, though, a marker radioisotope is attached to a specific ligand to
create a radioligand, whose properties bind it to certain types of tissues. This
marriage allows the combination of ligand and radiopharmaceutical to be carried and
bound to a place of interest in the body, where the ligand concentration is seen by
a gamma camera.
Contents [hide]
1 Principles
2 Application
2.1 Myocardial perfusion imaging
2.2 Functional brain imaging
2.3 Applications in nuclear technology
3 Reconstruction
4 Typical SPECT acquisition protocols
5 SPECT/CT
6 Use in court
7 Quality control
8 See also
9 References
10 Further reading
11 External links
Principles[edit]

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A Siemens brand SPECT scanner, consisting of two gamma cameras.

Instead of just "taking a picture of anatomical structures," a SPECT scan monitors
level of biological activity at each place in the 3-D region analyzed. Emissions
from the radionuclide indicate amounts of blood flow in the capillaries of the
imaged regions. In the same way that a plain X-ray is a 2-dimensional (2-D) view of
a 3-dimensional structure, the image obtained by a gamma camera is a 2-D view of 3-
D distribution of a radionuclide.
SPECT imaging is performed by using a gamma camera to acquire multiple 2-D images
(also called projections), from multiple angles. A computer is then used to apply a
tomographic reconstruction algorithm to the multiple projections, yielding a 3-D
data set. This data set may then be manipulated to show thin slices along any
chosen axis of the body, similar to those obtained from other tomographic
techniques, such as magnetic resonance imaging (MRI), X-ray computed tomography (X-
ray CT), and positron emission tomography (PET).
SPECT is similar to PET in its use of radioactive tracer material and detection of
gamma rays. In contrast with PET, however, the tracers used in SPECT emit gamma
radiation that is measured directly, whereas PET tracers emit positrons that
annihilate with electrons up to a few millimeters away, causing two gamma photons
to be emitted in opposite directions. A PET scanner detects these emissions
"coincident" in time, which provides more radiation event localization information
and, thus, higher spatial resolution images than SPECT (which has about 1 cm
resolution). SPECT scans, however, are significantly less expensive than PET scans,
in part because they are able to use longer-lived more easily obtained
radioisotopes than PET.
Because SPECT acquisition is very similar to planar gamma camera imaging, the same
radiopharmaceuticals may be used. If a patient is examined in another type of
nuclear medicine scan, but the images are non-diagnostic, it may be possible to
proceed straight to SPECT by moving the patient to a SPECT instrument, or even by
simply reconfiguring the camera for SPECT image acquisition while the patient
remains on the table.

SPECT machine performing a total body bone scan. The patient lies on a table that
slides through the machine, while a pair of gamma cameras rotate around her.
To acquire SPECT images, the gamma camera is rotated around the patient.
Projections are acquired at defined points during the rotation, typically every 36
degrees. In most cases, a full 360-degree rotation is used to obtain an optimal
reconstruction. The time taken to obtain each projection is also variable, but
1520 seconds is typical. This gives a total scan time of 1520 minutes.
Multi-headed gamma cameras can provide accelerated acquisition. For example, a
dual-headed camera can be used with heads spaced 180 degrees apart, allowing two
projections to be acquired simultaneously, with each head requiring 180 degrees of
rotation. Triple-head cameras with 120-degree spacing are also used.
Cardiac gated acquisitions are possible with SPECT, just as with planar imaging
techniques such as Multi Gated Acquisition Scan (MUGA). Triggered by
electrocardiogram (EKG) to obtain differential information about the heart in
various parts of its cycle, gated myocardial SPECT can be used to obtain
quantitative information about myocardial perfusion, thickness, and contractility
of the myocardium during various parts of the cardiac cycle, and also to allow
calculation of left ventricular ejection fraction, stroke volume, and cardiac
output.
Application[edit]
SPECT can be used to complement any gamma imaging study, where a true 3D
representation can be helpful, e.g., tumor imaging, infection (leukocyte) imaging,
thyroid imaging or bone scintigraphy.
Because SPECT permits accurate localisation in 3D space, it can be used to provide
information about localised function in internal organs, such as functional cardiac
or brain imaging.
Myocardial perfusion imaging[edit]

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Main article: Myocardial perfusion imaging
Myocardial perfusion imaging (MPI) is a form of functional cardiac imaging, used
for the diagnosis of ischemic heart disease. The underlying principle is that under
conditions of stress, diseased myocardium receives less blood flow than normal
myocardium. MPI is one of several types of cardiac stress test.
A cardiac specific radiopharmaceutical is administered, e.g., 99mTc-tetrofosmin
(Myoview, GE healthcare), 99mTc-sestamibi (Cardiolite, Bristol-Myers Squibb) or
Thallium-201 chloride. Following this, the heart rate is raised to induce
myocardial stress, either by exercise on a treadmill or pharmacologically with
adenosine, dobutamine, or dipyridamole (aminophylline can be used to reverse the
effects of dipyridamole).
SPECT imaging performed after stress reveals the distribution of the
radiopharmaceutical, and therefore the relative blood flow to the different regions
of the myocardium. Diagnosis is made by comparing stress images to a further set of
images obtained at rest which are normally acquired prior to the stress images.
MPI has been demonstrated to have an overall accuracy of about 83% (sensitivity:
85%; specificity: 72%),[3] and is comparable with (or better than) other non-
invasive tests for ischemic heart disease.
Functional brain imaging[edit]

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Main article: Neuroimaging
Usually, the gamma-emitting tracer used in functional brain imaging is 99mTc-HMPAO
(hexamethylpropylene amine oxime). 99mTc is a metastable nuclear isomer that emits
gamma rays that can be detected by a gamma camera. Attaching it to HMPAO allows
99mTc to be taken up by brain tissue in a manner proportional to brain blood flow,
in turn allowing cerebral blood flow to be assessed with the nuclear gamma camera.
Because blood flow in the brain is tightly coupled to local brain metabolism and
energy use, the 99mTc-HMPAO tracer (as well as the similar 99mTc-EC tracer) is used
to assess brain metabolism regionally, in an attempt to diagnose and differentiate
the different causal pathologies of dementia. Meta-analysis of many reported
studies suggests that SPECT with this tracer is about 74% sensitive at diagnosing
Alzheimer's disease vs. 81% sensitivity for clinical exam (cognitive testing,
etc.). More recent studies have shown the accuracy of SPECT in Alzheimer's
diagnosis may be as high as 88%.[4] In meta analysis, SPECT was superior to
clinical exam and clinical criteria (91% vs. 70%) in being able to differentiate
Alzheimer's disease from vascular dementias.[5] This latter ability relates to
SPECT's imaging of local metabolism of the brain, in which the patchy loss of
cortical metabolism seen in multiple strokes differs clearly from the more even or
"smooth" loss of non-occipital cortical brain function typical of Alzheimer's
disease. Another recent review article showed that multi-headed SPECT cameras with
quantitative analysis result in an overall sensitivity of 84-89% and an overall
specificity of 83-89% in cross sectional studies and sensitivity of 82-96% and
specificity of 83-89% for longitudinal studies of dementia.[6]
99mTc-HMPAO SPECT scanning competes with fludeoxyglucose (FDG) PET scanning of the
brain, which works to assess regional brain glucose metabolism, to provide very
similar information about local brain damage from many processes. SPECT is more
widely available, because the radioisotope used is longer-lasting and far less
expensive in SPECT, and the gamma scanning equipment is less expensive as well.
While 99mTc is extracted from relatively simple technetium-99m generators, which
are delivered to hospitals and scanning centers weekly to supply fresh
radioisotope, FDG PET relies on FDG, which is made in an expensive medical
cyclotron and "hot-lab" (automated chemistry lab for radiopharmaceutical
manufacture), and then delivered immediately to scanning sites because of the
natural short 110-minute half-life of Fluorine-18.
Applications in nuclear technology[edit]
In nuclear power, the SPECT technique has been applied to image fission product
concentrations produced in irradiated nuclear fuels. Due to the operation of
nuclear fuel (e.g. uranium) in a nuclear reactor, a wide array of gamma-emitting
radionuclides are created, such as cesium-137, barium-140 and europium-154. These
may be imaged using SPECT in order to verify the presence of fuel rods in a stored
fuel assembly for IAEA safeguards purposes,[7] to validate predictions of core
simulation codes,[8] or to study the behavior of the nuclear fuel in accident
scenarios.
Reconstruction[edit]

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Coded aperture mask for gamma camera

Reconstructed images typically have resolutions of 6464 or 128128 pixels, with
the pixel sizes ranging from 36 mm. The number of projections acquired is chosen
to be approximately equal to the width of the resulting images. In general, the
resulting reconstructed images will be of lower resolution, have increased noise
than planar images, and be susceptible to artifacts.
Scanning is time consuming, and it is essential that there is no patient movement
during the scan time. Movement can cause significant degradation of the
reconstructed images, although movement compensation reconstruction techniques can
help with this. A highly uneven distribution of radiopharmaceutical also has the
potential to cause artifacts. A very intense area of activity (e.g., the bladder)
can cause extensive streaking of the images and obscure neighboring areas of
activity. This is a limitation of the filtered back projection reconstruction
algorithm. Iterative reconstruction is an alternative algorithm that is growing in
importance, as it is less sensitive to artifacts and can also correct for
attenuation and depth dependent blurring.
Attenuation of the gamma rays within the patient can lead to significant
underestimation of activity in deep tissues, compared to superficial tissues.
Approximate correction is possible, based on relative position of the activity.
However, optimal correction is obtained with measured attenuation values. Modern
SPECT equipment is available with an integrated X-ray CT scanner. As X-ray CT
images are an attenuation map of the tissues, this data can be incorporated into
the SPECT reconstruction to correct for attenuation. It also provides a precisely
registered CT image, which can provide additional anatomical information.
Scatter of the gamma rays as well as the random nature of gamma rays can also lead
to the degradation of quality of SPECT images and cause loss of resolution. Scatter
correction and resolution recovery are also applied to improve resolution of SPECT
images.[9]
Typical SPECT acquisition protocols[edit]

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Study Radioisotope Emission energy (keV) Half-life Radiopharmaceutical
Activity (MBq) Rotation (degrees) Projections Image resolution Time
per projection (s)
Bone scan technetium-99m 140 6 hours Phosphonates / Bisphosphonates
800 360 120 128 x 128 30
Myocardial perfusion scan technetium-99m 140 6 hours tetrofosmin;
Sestamibi 700 180 60 64 x 64 25
Sestamibi parathyroid scan technetium-99m 140 6 hours Sestamibi

Brain scan technetium-99m 140 6 hours HMPAO; ECD 555-1110 360 64

128 x 128 30
Neuroendocrine or neurological tumor scan iodine-123 or iodine-131 159 13
hours or 8 days MIBG 400 360 60 64 x 64 30
White cell scan indium-111 & technetium-99m 171 & 245 67 hours in vitro
labelled leucocytes 18 360 60 64 x 64 30
SPECT/CT[edit]
In some cases a SPECT gamma scanner may be built to operate with a conventional CT
scanner, with coregistration of images. As in PET/CT, this allows location of
tumors or tissues which may be seen on SPECT scintigraphy, but are difficult to
locate precisely with regard to other anatomical structures. Such scans are most
useful for tissues outside the brain, where location of tissues may be far more
variable. For example, SPECT/CT may be used in sestamibi parathyroid scan
applications, where the technique is useful in locating ectopic parathyroid
adenomas which may not be in their usual locations in the thyroid gland.[10]
Use in court[edit]

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In 2013 SPECT was used in the Belgian Dendermonde nursery attack case in an attempt
to assess whether or not Kim de Gelder was accountable for his actions. He was on
trial for the murder of two infants and one nanny in 2009. The defense argued that
De Gelder was suffering from schizoid psychosis, which in their opinion could be
inferred from a SPECT scan of his brain. There was a sizable public debate over
whether neuroimaging techniques of this kind have a place in the courtroom. On
March 22, 2013 Kim de Gelder was found guilty of four counts of murder and was
sentenced to life imprisonment.
Quality control[edit]
The overall performance of SPECT systems can be performed by quality control tools
such as the Jaszczak phantom.[11]
See also[edit]
Daniel Amen, psychiatrist who uses SPECT for diagnoses
Functional neuroimaging
Gamma camera
Magnetic resonance imaging
Neuroimaging
Positron emission tomography
ISAS (Ictal-Interictal SPECT Analysis by SPM)
References[edit]
Jump up ^ SPECT at the US National Library of Medicine Medical Subject Headings
(MeSH)
Jump up ^ "A CdTe detector for hyperspectral SPECT imaging". Journal of
Instrumentation. IOP Journal of Instrumentation. 7: P08027. doi:10.1088/1748-
0221/7/08/P08027.
Jump up ^ Elhendy, A; Bax, JJ; Poldermans, D (2002). "Dobutamine stress myocardial
perfusion imaging in coronary artery disease.". Journal of Nuclear Medicine. 43
(12): 163446. PMID 12468513.
Jump up ^ Bonte FJ, Harris TS, Hynan LS, Bigio EH, White CL (2006). "Tc-99m HMPAO
SPECT in the differential diagnosis of the dementias with histopathologic
confirmation". Clin Nucl Med. 31 (7): 3768. PMID 16785801.
doi:10.1097/01.rlu.0000222736.81365.63.
Jump up ^ Dougall NJ, Bruggink S, Ebmeier KP (2004). "Systematic review of the
diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia". Am J Geriatr Psychiatry. 12
(6): 55470. PMID 15545324. doi:10.1176/appi.ajgp.12.6.554.
Jump up ^ Henderson, Theodore (December 2012). "The diagnosis and evaluation of
dementia and mild cognitive impairment with emphasis on SPECT perfusion
neuroimaging". CNS Spectrums. 17 (4): 18889. PMID 22929226.
doi:10.1017/S1092852912000636.
Jump up ^
http://www.iaea.org/inis/collection/NCLCollectionStore/_Public/25/037/25037535.pdf
Jump up ^ "A computerized method (UPPREC) for quantitative analysis of irradiated
nuclear fuel assemblies with gamma emission tomography at the Halden reactor".
Annals of Nuclear Energy. 110: 8897. doi:10.1016/j.anucene.2017.06.025.
Jump up ^ "D. Boulfelfel, R.M. Rangayyan, L.J. Hahn, R. Kloiber, Restoration of
Single Photon Emission Computed Tomography Images". Retrieved 10 January 2016.
Jump up ^ Neumann DR, Obuchowski NA, Difilippo FP. "Preoperative 123I/99mTc-
sestamibi subtraction SPECT and SPECT/CT in primary hyperparathyroidism". J Nucl
Med. 49: 20127. PMID 18997051. doi:10.2967/jnumed.108.054858.
Jump up ^ Jennifer Prekeges. Nuclear Medicine Instrumentation. Jones & Bartlett
Publishers. 2012. ISBN 1449645372 p.189
M. D. Cerqueira, A. F. Jacobson: Assessment of myocardial viability with SPECT and
PET imaging. In: American Journal of Roentgenology. Band 153, Nr. 3, 1989, S.
477483
Further reading[edit]
Bruyant, P.P. "Analytic and iterative reconstruction algorithms in SPECT" Journal
Of Nuclear Medicine 43(10):1343-1358, 2002
Herman, Gabor T. (2009). Fundamentals of Computerized Tomography: Image
Reconstruction from Projections (2nd ed.). Springer. ISBN 978-1-85233-617-2..
Elhendy et al., Dobutamine Stress Myocardial Perfusion Imaging in Coronary Artery
Disease, J Nucl Med 2002 43: 16341646
A review on brain-imaging applications of SPECT: W. Gordon Frankle, Mark Slifstein,
Peter S. Talbot, and Marc Laruelle (2005). "Neuroreceptor Imaging in Psychiatry:
Theory and Applications". International Review of Neurobiology, 67: 385440.
doi:10.1016/S0074-7742(05)67011-0
Practical SPECT/CT In Nuclear Medicine - Jones / Hogg / Seeram - Release Date: 31
Mar 2013 ISBN 978-1447147022 Edition: 2013
Willowson K, Bailey DL, Baldock C, 2008. Quantitative SPECT reconstruction using
CT-derived corrections. Phys. Med. Biol. 53 3099-3112.
External links[edit]
Wikimedia Commons has media related to Single photon emission computed
tomography.
Human Health Campus, The official website of the International Atomic Energy Agency
dedicated to Professionals in Radiation Medicine. This site is managed by the
Division of Human Health, Department of Nuclear Sciences and Applications
National Isotope Development Center Reference information on radioisotopes
including those for SPECT; coordination and management of isotope production,
availability, and distribution
Isotope Development & Production for Research and Applications (IDPRA) U.S.
Department of Energy program for isotope production and production research and
development
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