SPECT/CT Imaging: Clinical Utility of an Emerging Technology

Bybel, Bohdan; Brunken, Richard C.; DiFilippo, Frank P.; Neumann, Donald R.; Wu, Guiyun; Cerqueira, Manuel D.

doi:10.1148/rg.284075203

Cited by 95 publications

(55 citation statements)

References 58 publications

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“…More recently, automated software for image coregistration has become commercially available and has shown success in fusing brain images [2]. Software coregistration of neck and body imaging has encountered a number of challenges that are yet to be overcome.…”

Section: Technique and Basic Sciencementioning

confidence: 99%

“…The benefits of using CT for attenuation correction as opposed to a radionuclide transmission source include less noise, faster acquisition, the lack of influence on the CT data by the SPECT radionuclide and avoidance of the need to replace decayed transmission sources [10]. However, the potential disadvantage comes from sequential acquisition of the CT and then the potential allowance of SPECT data sets for misregistration in functional images from patient motion artefact [2]. In addition to superior attenuation correction, integrated SPECT/CT provides added value by generating coregistered images that are obtained during the same study [11,12].…”

Section: Technique and Basic Sciencementioning

confidence: 99%

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SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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This article reviews the technique, basic science principles and applications of integrated single photon emission CT (SPECT)-CT in musculoskeletal radiology. A review of the current evidence on the topic was undertaken, and selected clinical cases from the authors' institution have been used for illustration. SPECT-CT is a technology with emerging applications that offers technical advantages to image fusion of separately acquired SPECT and CT studies. The prevailing evidence indicates that there may be benefit in adding SPECT-CT to conventional imaging algorithms during the evaluation of some malignant and benign musculoskeletal conditions. SPECT-CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. The evidence base for SPECT-CT in musculoskeletal radiology is still evolving. There is a lack of evidence comparing SPECT-CT with MRI in many key indications, and further research is required in these areas.A wide range of pathological conditions may affect the musculoskeletal system, including infection, trauma and malignant disease. Advances in MRI, multidetector CT (MDCT) and high-frequency ultrasound have provided considerable improvements in imaging musculoskeletal disease over the past decade. There are, however, limitations associated with each of these techniques. MRI image acquisition remains relatively time consuming and, particularly in musculoskeletal radiology, image quality can be degraded significantly by metal artefact from internal fixation and prostheses. MDCT offers exquisite characterisation of bone and can rapidly generate highquality three-dimensional reconstructions; however, the contrast resolution for soft tissues is limited and the modality can also suffer metal-related artefact, although like MRI, imaging parameters can be adjusted to reduce this artefact. High-frequency ultrasound, although operator dependent, provides excellent spatial and contrast resolution for superficial structures but is suboptimal for deeper structures and is unable to penetrate cortical bone.Bone scintigraphy remains an important and highly sensitive tool to the musculoskeletal radiologist but this is frequently criticized for its lack of specificity. Radionuclide imaging, however, may be the only modality to demonstrate pathology before it becomes evident on anatomical imaging. Developments in gamma camera technology now allow high-resolution imaging with shortened scan times, and single photon emission CT (SPECT) imaging has become commonplace in the UK. SPECT is able to increase sensitivity further and improves lesion localisation, but the paucity of anatomical markers on radionuclide imaging remains a constant challenge. Thus, the importance of correlating anatomical and functional imaging has become increasingly recognised [1].Use of a combined SPECT/CT system allows for sequential acquisition of both anatomical and functional information with a high degree of image fusion accuracy.

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Section: Technique and Basic Sciencementioning

confidence: 99%

Section: Technique and Basic Sciencementioning

confidence: 99%

SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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“…The integration of CT with SPECT has allowed for attenuation correction that has improved the image quality, and the CT also provides fair anatomical images [12]. The CT image is acquired prior to the SPECT image and produces an attenuation map of the spatial distribution of the attenuation coefficients.…”

Section: Image Qualitymentioning

confidence: 99%

Radiotracers for SPECT imaging: current scenario and future prospects

Adak¹,

Bhalla

Raj

et al. 2012

Ract

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Summary. Single photon emission computed tomography (SPECT) has been the cornerstone of nuclear medicine and today it is widely used to detect molecular changes in cardiovascular, neurological and oncological diseases. While SPECT has been available since the 1980s, advances in instrumentation hardware, software and the availability of new radiotracers that are creating a revival in SPECT imaging are reviewed in this paper.The biggest change in the last decade has been the fusion of CT with SPECT, which has improved attenuation correction and image quality. Advances in collimator design, replacement of sodium iodide crystals in the detectors with cadmium zinc telluride (CZT) detectors as well as advances in software and reconstruction algorithms have all helped to retain SPECT as a much needed and used technology.Today, a wide spectrum of radiotracers is available for use in cardiovascular, neurology and oncology applications. The development of several radiotracers for neurological disorders is briefly described in this review, including [123 I]FP-CIT (DaTSCAN™) available for Parkinson's disease. In cardiology, while technetium-99m labeled tetrofosmin and technetium-99m labeled sestamibi have been well known for myocardial perfusion imaging, we describe a recently completed multicenter clinical study on the use of [ 123 I]mIBG (AdreView™) for imaging in chronic heart failure patients. For oncology, while bone scanning has been prevalent, newer radiotracers that target cancer mechanisms are being developed. Technetium-99m labeled RGD peptides have been reported in the literature that can be used for imaging angiogenesis, while technetium-99m labeled duramycin has been used to image apoptosis.While PET/CT is considered to be the more advanced technology particularly for oncology applications, SPECT continues to be the modality of choice and the workhorse in many hospitals and nuclear medicine centers. The cost of SPECT instruments also makes them more attractive in developing countries where the cost of a scan is still prohibitive for many patients.

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“…Our pilot experience in 456 patients evaluated on the Infinia™ Hawkeye™ 4 slice (HWK-4, GE Healthcare) indicates that SPECT/low-dose multislice CT is useful in a large spectrum of clinical indications. SPECT/CT is currently implemented worldwide for clinical applications, especially for [20,29,36,37]. For these oncological indications using medium-energy and high-energy isotopes, accurate 3D localisation of ill-defined hot-spots is critical.…”

Section: Wbc (N=38)mentioning

confidence: 99%

“…In this setting, our initial experience with Infinia-Hawkeye -4 opens the possibility of developing individualised IRT based on patient-specific attenuation maps, especially for 131 I therapy of benign multinodular goiters and Graves' disease. Standardised uptake value scores (SUVs) dedicated to SPECT/CT imaging will also be useful for accurate semi-quantification of tracer uptake within normal and abnormal structures [28,37,42,43]. SUVs may be of interest in clinical routine and research for complementing the qualitative interpretation as demonstrated for Onco-PET and PET-CT with 18 FDG [44].…”

Section: Wbc (N=38)mentioning

confidence: 99%

How Useful is an Integrated SPECT/CT in Clinical Setting and Research?: Evaluation of a Low Radiation Dose 4 Slice System§

Belhocine¹,

Rachinsky²,

Akincioğlu³

et al. 2008

TOMIJ

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Hybrid imaging is becoming a popular technology in nuclear medicine. We have evaluated the added value of an integrated SPECT/low-dose multislice CT over conventional planar/SPECT nuclear imaging. Phantom and clinical studies were performed on the Infinia™ Hawkeye™ 4 slice (HWK-4) with an upgraded software package (Xeleris 2.05v) from GE Heatlthcare to assess 1) the benefit of CT for contrast-resolution, attenuation correction, and anatomic localisation; 2) the impact of hybrid imaging in 456 consecutive patients in a clinical setting. SPECT/CT data were compared to conventional planar/SPECT data and correlated to clinical, biochemical, morphological imaging, angiography, and pathology findings. SPECT/CT was well tolerated by the patients with minimal CT irradiation dose (< 2mSv). HWK-4 provided useful attenuation correction for its routine use in MPI and accurate anatomic localisation of physiological and pathological foci in Tc-HMPAO-WBC, 131/123 I-MIBG, Octreoscan ® , and 67 Ga studies. Low-dose multislice CT also helped detect gross morphological abnormalities. Hybrid imaging had a significant impact in ProstaScint ® and parathyroid imaging for image-guided intervention. In bone imaging and differentiated thyroid cancers, SPECT/CT was able to clarify equivocal findings from planar whole-body scan. SPECT/CT was also found useful to precisely localize sentinel lymph nodes. Research protocols are being evaluated for half-time acquisition with resolution recovery and quantification of tracer distribution. SPECT/low-dose multislice CT has been successfully implemented in routine clinical practice. CT provided added value for effective attenuation correction and accurate anatomic localisation of disease with an impact on patient management.

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SPECT/CT Imaging: Clinical Utility of an Emerging Technology

Cited by 95 publications

References 58 publications

SPECT-CT: applications in musculoskeletal radiology

SPECT-CT: applications in musculoskeletal radiology

Radiotracers for SPECT imaging: current scenario and future prospects

How Useful is an Integrated SPECT/CT in Clinical Setting and Research?: Evaluation of a Low Radiation Dose 4 Slice System§

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