The clinical value of xSPECT/CT Bone versus SPECT/CT. A prospective comparison of 200 scans

Duncan, Iain; Ingold, Nicholas

doi:10.1186/s41824-017-0024-9

Cited by 35 publications

(20 citation statements)

References 9 publications

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“…And since the counts are assumed to belong to the whole segmented region, metal implants become associated with significantly increased activity. Duncan et al reported that the presence of these artefacts is rare (Duncan & Ingold, 2018). In the preliminary evaluation of our data, we observed the "shining metal artefact" in 11 of 47 cases (23.4%) of bone and joint SPECT/CT with metallic hardware.…”

Section: Introductionsupporting

confidence: 47%

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Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Lima

Lago

Thali

et al. 2020

European J Hybrid Imaging

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Background Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. Case presentation In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated “shining metal artefacts” in xSPECT Bone reconstruction. Conclusion While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific “shining metal artefacts” caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction.

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Section: Introductionsupporting

confidence: 47%

“…xSPECT Bone is capable of improving the final radiopharmaceutical uptake images with enhanced delineation of the boundaries and better anatomic representation of radiotracer activity (Duncan & Ingold, 2018;Vija, 2013).…”

Section: Introductionmentioning

confidence: 99%

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Lima

Lago

Thali

et al. 2020

European J Hybrid Imaging

View full text Add to dashboard Cite

show abstract

“…Because the SUV peak is less susceptible to statistical noise compared to SUV max [37], SUV peak showed a more significant difference (p = 0.001). The clinical xB image with high resolution reveals not only shows bone microlesions but also improves diagnostic confidence [23]. Therefore, we considered that clinical evaluation for xB images with SUV peak could provide more accurate and reliable diagnostics.…”

Section: Regardless Of the Reconstruction Models The Maximum Activitmentioning

confidence: 99%

“…Therefore, xB produces images of tracer distribution with far better quality than F3D [22]. Some clinical reports have described that xB images for bone SPECT are more precise in terms of localization and offer better diagnostic confidence in staging malignant disease [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm

Miyaji

Miwa

Tokiwa

et al. 2020

Preprint

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Abstract Background Two novel methods of image reconstruction, xSPECT Quant (xQ) and xSPECT Bone (xB) that use an ordered subset conjugate gradient minimizer (OSCGM) for bone SPECT/CT have been proposed. The present study compares the performance characteristics of xQ, xB and conventional Flash3D (F3D) reconstruction using images derived from phantoms and patients. Methods A custom-designed body phantom for bone SPECT was scanned using a Symbia Intevo (Siemens Healthineers) and reconstructed xSPECT images were evaluated. The phantom experiments proceeded twice in different activity concentrations and sphere sizes. A phantom with 28-mm spheres containing a 99mTc background and having tumor-to-normal bone ratios (TBR) of 1, 2, 4 and 10, were generated and its convergence property was evaluated across 96 iterations. A phantom with four spheres (13-, 17-, 22-, and 28-mm diameters), containing a 99mTc-background at TBR4, was also generated. The full width at half maximum of an imaged spinous process (10 mm), coefficients of variance (CV), contrast-to-noise ratio (CNR) and recovery coefficients (RC) of an imaged spine were evaluated with F3D, xQ and xB.Images from 20 patients with suspected bone metastases (male, n = 13) were acquired using 99mTc-(H)MDP SPECT/CT, then the CV and standardized uptake value (SUV) at the 4th vertebral body (L4) were compared with xQ and xB in a clinical setup. Results Mean activity concentrations with various TBR converged accordance to increasing numbers of iterations. Spatial resolution was improved in the order of xB, xQ and F3D regardless of the number of iterations during reconstruction. The CV and RC were better for xQ and xB than for F3D. The CNR peaked at 24 iterations for xQ and 48 iterations for F3D and xB, respectively. The RC significantly differed between xQ and xB at lower numbers of iterations, whereas those of xQ and xB became almost equivalent at higher numbers of iterations. Significant differences in the clinical patients’ SUVmax and SUVpeak were observed in the reconstructed xQ and xB images. Conclusions The reconstructed xQ and xB images were more accurate than those conventionally reconstructed using F3D. Bone SPECT xB imaging offered essentially unchanged spatial resolution even when the numbers of iterations did not converge. The xB further enhanced SPECT image quality using CT data. Our findings provide important evidence for understanding the performance characteristics of the novel xQ and xB algorithms.

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“…Therefore, xB produces images of tracer distribution with far better resolution than F3D [22]. Some clinical reports have described that xB bone SPECT images are more precise in terms of localization and offer better diagnostic con dence in staging malignant disease [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm

Miyaji

Miwa

Tokiwa

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background Two novel methods of image reconstruction, xSPECT Quant (xQ) and xSPECT Bone (xB) that use an ordered subset conjugate gradient minimizer (OSCGM) for SPECT/CT reconstruction have been proposed. The present study compares the performance characteristics of xQ, xB and conventional Flash3D (F3D) reconstruction using images derived from phantoms and patients. Methods A custom-designed body phantom for bone SPECT was scanned using a Symbia Intevo (Siemens Healthineers) and reconstructed xSPECT images were evaluated. The phantom experiments proceeded twice with different activity concentrations and sphere sizes. A phantom with 28-mm spheres containing a 99m Tc-background and tumor-to-normal bone ratios (TBR) of 1, 2, 4 and 10, were generated and convergence property against various TBR was evaluated across 96 iterations. A phantom with four spheres (13-, 17-, 22-, and 28-mm diameters), containing a 99m Tc-background at TBR4, was also generated. The full width at half maximum of an imaged spinous process (10 mm), coefficients of variance (CV), contrast-to-noise ratio (CNR) and recovery coefficients (RC) were evaluated after reconstructing images of a spine using Flash 3D (F3D), xQ and xB. We retrospectively analyzed images from 20 patients with suspected bone metastases (male, n = 13) were acquired using [ 99m Tc]Tc-(H)MDP SPECT/CT, then CV and standardized uptake values (SUV) at the 4 th vertebral body (L4) were compared after xQ and xB reconstruction in a clinical setup. Results Mean activity concentrations with various TBR converged according to increasing numbers of iterations. The spatial resolution of xB was considerably superior to xQ and F3D, and it approached almost the actual size regardless of the iteration numbers during reconstruction. The CV and RC were better for xQ and xB than for F3D. The CNR peaked at 24 iterations for xQ and 48 iterations for F3D and xB, respectively. The RC between xQ and xB significantly differed at lower numbers of iterations but were almost equivalent at higher numbers of iterations. The reconstructed xQ and xB images of the clinical patients showed a significant difference in the SUVmax and SUVpeak. Conclusions The reconstructed xQ and xB images were more accurate than those reconstructed conventionally using F3D. The xB for bone SPECT imaging offered essentially unchanged spatial resolution even when the numbers of iterations did not converge. The xB reconstruction further enhanced SPECT image quality using CT data. Our findings provide important information for understanding the performance characteristics of the novel xQ and xB algorithms.

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The clinical value of xSPECT/CT Bone versus SPECT/CT. A prospective comparison of 200 scans

Cited by 35 publications

References 9 publications

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Impact of metal implants on xSPECT/CT Bone reconstruction: the “shining metal artefact”

Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm

Phantom and clinical evaluation of bone SPECT/CT image reconstruction with xSPECT algorithm

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