Abstract
BackgroundNovel 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 presentationIn 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.ConclusionWhile 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.
Highlights
Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine
SPECT/computed tomography (CT) has been shown to be useful in the postoperative setting to evaluate healing or complications like infection, loosening or non-union after implantation of various metallic implants for arthrodesis, fracture stabilization or joint replacement with arthroplasties (Gnanasegaran et al, 2018; Kampen et al, 2018; Van den Wyngaert et al, 2018b; van der Bruggen et al, 2018)
With xSPECT Bone, the reconstructed emission volume is partitioned into segments defined by the Hounsfield units obtained from the CT image
Summary
Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. SPECT iterative reconstruction is widely used in clinical practice and has contributed to significant improvement in image quality in the recent years. XSPECT Bone belongs to this group of new generation of SPECT reconstruction methods.
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