IMPROVEMENTS IN RADIONUCLIDE IMAGING OF THE ADRENALS

A. Kh. Mirkhodzhaev and Yu. N. Shvetsov UDC 616.45-073.916

Radionuclide imaging of the adrenals is extensively used in clinical practice. The data
of scans and scintigrams are suitable only for qualitative analysis. The use of computers in
conjunction with gamma-cameras has led to development of a quantitative method of determining
the concentration of 13~I-labeled cholesterol in the adrenals. In most cases this approach is
used to compare radioactivity levels in the adrenals. It is used less frequently to determine
the relative percentage of a radiopharmaceutical (RP) in each adrenal.
The initial stage of the method, irrespective of the final aim, includes evalution of
background. The difficulty of this process is due to theirregular distribution of the RP in
the body and its relatively low concentration in the adrenals. Subtraction of the background
is particularly important during imaging~of the liver, which takes up the RP actively. Sever-
al methods of subtracting the background during adrenal imaging have now been suggested and
used. The best may be considered to be the method of averaging over a zone rather larger than
the "zone of interest" of the adrenal [i].
However, even this method has its disadvantages, due to the subjective definition of
the extra-adrenal zone and the high radioactivity of the liver. The need has thus arisen for
the most appropriate method of determination of the background to be worked out, allowing for
the indeterminacy of the initial information.

MATERIAL AND METHODS

The method of averaging [i] and the su~gested method of determination of the background
were used for comparison. With the averaging method, outlines of the adrenal (the "zone of
interest" in the region of the adrenal) were first traced on a matrix (64 × 64) and the total
count (Ai) of RP pulses and the total number of cells (BI) in this zone were determined. The
outlines were then traced at a distance of 2-4 cells from the zone of the adrenals (the "zone
of interest" around the region of the adrenals, or the extra-adrenal zone) and the total count
(A2) of RP pulses and the total number of cells in the extra-adrenal zone were determined.
The number of RP-pulses in the background (~) was calculated by the equation:
¢ = p ~i, (i)

where P is the number of RP pulses in the background per single cell of the matrix:

P = A~-- A I (2)
B~-- B, '

Hence it is easy to determine the "pure count" (A) of RP pulses in the "zone of interest"
(after subtracting the number of background pulses) [i]:
B1
A = A t - - (A~--AI)'-~~--_B I . (3)

Let us now dwell in more detail on the theoretical and technical aspects of this work.
The task of determining the level of background radioactivity during imaging of the adrenals
is incorrect for the following reasons.
First, in some cases the outlines of the location of the adrenals and liver are not known
beforehand on scintigrams obtained by means of a gamma-camera.
Second, the flat picture of the scintigram is only the projectionof the spatial distribu-
tion of the RP in that part of the body that lies in the field of "visibility" of the detector

Institute of Experimental Endocrinology and Hormone Chemistry, Academy of Medical Seien-

ces of the USSR, Moscow. Translated from Meditsinskaya Tekhnika, No.l, pp. 50-53, January-
February, 1986. Original article submitted April I, 1985.

30 0006-3398/86/2001-0030512.50 © 1986 PlenumPublishlng Corporatlon

of the gamma-camera. This introduces an additional ambiguity and inaccuracy into the task of
determination of the outlines both of the adrenals and of the liver.
One possible way of reducing the degree of indeterminary of the task, which was suggested
in [i], can be ultimately reduced to a marked reduction in size of the extra-adrenal zone in
which the background level is determined. In some cases this does really allow the effect of
the liver on the nonuniformity of determination of the background to be reduced. In many cas-
es, however, the projection of the liver is superposed on the projection of the right adrenal»
which leads to considerable systematic errors in determination of the background level. Fur-~
thermore, becauseof thereduction involume of the sample processed, the reliability of the re-
sults also is reduced.
Our suggested method of subtracting the background in order to determine radioactivity
of the adrenals is based on the fundamental theory of solution of incorrect problems, elabor-
ated by Academician A. N. Tikhonov's school. Essentially this involves reducing the degree
of indeterminacy of the problem through the use of certain sufficie~tly reliable extra informa-
tion on the character of distribution of the b a c k g r o u n d o n the scintigram, allowing for the ef-
fect of radioactivity of the liver.
Analysis of analogous patterns of distribution of RP obtained for patients after adrenal-
~ctomy showed that the character of distribution of RP, because of the influence of the liver,
has a tendency toward a marked increase in RP accumulation, starting from the point where the
left adrenal ought to be, and toward the zone of the liver. It must be stated at once that re-
lationships determining the increase in accumulation of RP in this direction are subject to
scatter because of the irregularity of distribution of RP in the body, and also due to indi-
vidual differences between patients. For these reasons , we can state that the additional in-
formation which we used is qualitative in character. This applies also to the general methods
used to solve incorrect problems.
A photograph of a scintigram of the adrenal region, obtained from the display screen of
the PDP 11/34 computer, is shown in Fig. i. The whole of this flat picture of distribution of
the intensity of RP is a matrix consisting of 64 × 64 cells.
A graph of distribution of the intensity of an RP along a horizontal coordinate x of the
matrix mentioned above, for one horizontal layer consisting of 64 cells, is shown in Fig. 2.
As this graph shows, the value of P(x) for one fixed horizontal layer is very unstable in char-
acter, with high random variations. We therefore picked out a bandconsisting of 9-12 (m) hori-

Fig. 1 Fig. 2
Fig. I. Scintigram of the adrenal region obtained from the display screen of the PDP
11/34 computer. Just above the center of the film two bright spots of light, which are
two-dimensional images of the adrenals, can be seen.
Fig. 2. Scintigram of adrenal region obtained from the display screen of the PDP Ii/
34 computer. Horiziontal white line indicates section along which graph of distribu-
tion of intensity of RP, shown in the bottom part of the film, was plotted along a
horizontal coordinate.

31
 at» F............................. ~,

,oot / ~ Iii

B ,'6 24 31 ~ t,8 S6 6i

Fig. 3. Graph showing dependence of total

number of RP pulses z(x). At e a c h p o i n t sum-
marion was carried out for all nine sections
included in the chosen layer.

zontal layers, and for each value of x (the numbers along the horizontal axis), added together
all values of P(x) for all the horizontal layers:

m
z (x) = ~ Ph (x). (4)

Dependence of the total number of RP pulses in cells in the vertical direction (z) for
each fixed number along the horizontal axis (x) is shown in Fig. 3. The band is chosen visual-
ly so that outlines of at least one of the adrenals lay inside it. In this case a more stable
pattern of distribution of the intensity of RP along the horizontal coordinate z = f(x) is
obtained. It will be clear from Fig. 3 that the background arising due to the effect of the
liver has the character of an increasing exponent. This is confirmed by results obtained for
patients after bilateral adrenalectomy.
It is assumed that the function z(x) is formed as two functions: a function of distribu-
tion of intensity of RP in the adrenals only, namely A(x), and in the remaining tissues includ-
ing the liver, namely y(x). This last function will be called the background distribution
function:
z(x) = A ( x ) + y ( x ). (5)

The second assumption is that outside the outlines of the adrenals the total count of
RP coincides with the background count, i.e.,

z (x)=v (x).

Taking these assumptions into account the distribution of the background along the x co-
ordinate can be represented theoretically by the exponent:

y = yo.e ~x, (6)

where the parameters yo and X are chosen from the condition of best description of the ex-
perimental dependence obtained for the given patient, the typical character of which is il-
lustrated in Fig. 3.
To change to the standard linear regression procedure, let us examine the experimental
dependence of the background obtained in a logarithmic scale along the two axes of coordin-
ates:
u = uo + ~ , (7)

where u = In y, v = in x, and uo = In yo.

Taking the sec0nd assumption into account, the standard linear regression procedures can
thus be used for all values of x for which z(x) = y(x), i.e., for

xé[o, xOU]~, ~lU[x~, ~l. (8)

Intervals ]xz, x2[ and ]x3, xt[, on which the outlines of the left and right adrenals
are projected, are excluded from the linear regression procedure. These intervals must be
chosen in each separate case with a certain margin (one or two cells to the left and to the

32
 TABLE i. Comparison of Known and Suggested Methods of Subtrac-
tion of the Background during Radionuclide Imaging of the Adren-
als
Count in adrenals, % of
"pure"
Character of scintigrams known meth- suggested
od method
"Pure" adrenals i00 I00
Without adrenals (group i) from--i Ifrom +i
to + 26 | to + 5
Low level of radioactivity of
adrenals (group 2) 86 + 34 i 96 + 7
High level of radioactivity of
adrenals (group 3) 97 + 9 99 + 4
right of each projection), so that determination of the background does not depend on activity
of the adrenals.
The regression coefficient ~ in Eq. (7) is calculated by the formula:
M (u.v) - - M (u).M (v)
~"= D (v) , (9)

and the initial value of Uo by the formula:

M (vD.M (u) - - M (v).Æ (u.v)
Uo = D (v)
(io)

Thus the method of determination of the background of the adrenals was reduced to extrap-
olation of the radioactivity curves along a horizontal axis; moreover, visual control of the"
extrapolation was used. For comparison the method of tracing the outlines of the adrenals and
the suggested method were used.
Scintigrams of~three patients, who had undergone total resection of both adrenals (group
i), were used for the experiments. Images of the adrenals were superposed on these scinti-
grams; in one group Ehe level of radioactivity of the adrenals did not exceed the background
level (group 2), whereas in the other group it exceeded it threefold (group 3).

DISCUSSION OF RESULTS
The results obtained for the different groups, after statistical analysis, are given in
Table i. They show that in the absence of the adrenals, tracing the outlines by the known
method on scintigrams of group 1 gives on average results that are too low. Meanwhile consid-
erable scatter of the data may be observed. With the low level of radioactivity of the adre-
nals (group 2) some decrease in the average results was obtained, accompanied by considerable
scatter. With a high level of radioactivity of the adrenals (group 3) this method gives ac-
ceptable results. Analysis showed that the results of the tracing of outlines method, with
subtraction of the background, depend on the accuracy of definition of the "zones of interest"
of the adrenals and around them. In other words, gi~en good visualization of the adrenals on
the scintigram, the accuracy of the known method of subtraction of the background is enhanced.
The suggested method of subtraction of the background (Table i) is free from these disad-
vantages, for in this case the resultant curve of radioactivity along the section is used,
and this increases the accuracy of the method.
The suggested method of subtraction of the background along the section is thus more ac-
curate, but it requires the compiling of a special program for "manual" processing of the sec-
tion.

LITERATURE CITED
i. L. A. Hawkins, K. E. Britton, and B. Shapiro, Brit. J. Radiol., 53, 883-889 (1980).

33