Attenuation-corrected SPECT Images Research Articles

Deep Learning-Enabled Quantification of 99mTc-Pyrophosphate SPECT/CT for Cardiac Amyloidosis.

Transthyretin cardiac amyloidosis (ATTR CA) is increasingly recognized as a cause of heart failure in older patients, with 99mTc-pyrophosphate imaging frequently used to establish the diagnosis. Visual interpretation of SPECT images is the gold standard for interpretation but is inherently subjective. Manual quantitation of SPECT myocardial 99mTc-pyrophosphate activity is time-consuming and not performed clinically. We evaluated a deep learning approach for fully automated volumetric quantitation of 99mTc-pyrophosphate using segmentation of coregistered anatomic structures from CT attenuation maps. Methods: Patients who underwent SPECT/CT 99mTc-pyrophosphate imaging for suspected ATTR CA were included. Diagnosis of ATTR CA was determined using standard criteria. Cardiac chambers and myocardium were segmented from CT attenuation maps using a foundational deep learning model and then applied to attenuation-corrected SPECT images to quantify radiotracer activity. We evaluated the diagnostic accuracy of target-to-background ratio (TBR), cardiac pyrophosphate activity (CPA), and volume of involvement (VOI) using the area under the receiver operating characteristic curve (AUC). We then evaluated associations with the composite outcome of cardiovascular death or heart failure hospitalization. Results: In total, 299 patients were included (median age, 76 y), with ATTR CA diagnosed in 83 (27.8%) patients. CPA (AUC, 0.989; 95% CI, 0.974-1.00) and VOI (AUC, 0.988; 95% CI, 0.973-1.00) had the highest prediction performance for ATTR CA. The next highest AUC was for TBR (AUC, 0.979; 95% CI, 0.964-0.995). The AUC for CPA was significantly higher than that for heart-to-contralateral ratio (AUC, 0.975; 95% CI, 0.952-0.998; P = 0.046). Twenty-three patients with ATTR CA experienced cardiovascular death or heart failure hospitalization. All methods for establishing TBR, CPA, and VOI were associated with an increased risk of events after adjustment for age, with hazard ratios ranging from 1.41 to 1.84 per SD increase. Conclusion: Deep learning segmentation of coregistered CT attenuation maps is not affected by the pattern of radiotracer uptake and allows for fully automatic quantification of hot-spot SPECT imaging such as 99mTc-pyrophosphate. This approach can be used to accurately identify patients with ATTR CA and may play a role in risk prediction.

A Neck-Thyroid Phantom with Small Sizes of Thyroid Remnants for Postsurgical I-123 and I-131 SPECT/CT Imaging.

Post-surgical I-123 and I-131 SPECT/CT imaging can provide information on the presence and sizes of thyroid remnants and/or metastasis for an accurate re-staging of disease to apply an individualized radioiodine therapy. The purpose of this study was to develop and validate a neck-thyroid phantom with small sizes of thyroid remnants to be utilized for the optimization of post-surgical SPECT/CT imaging. 3D printing and molding techniques were used to develop the hollow human-shaped and -sized phantom which enclosed the trachea, esophagus, cervical spine, clavicle, and multiple detachable sections with different sizes of thyroid remnant in clinically relevant positions. CT images were acquired to evaluate the morphology of the phantom and the sizes of remnants. Triple-energy window scattered and attenuation corrected SPECT images were acquired for this phantom and for a modified RS-542 commercial solid neck-thyroid phantom. The response and sensitivity of the SPECT modality for different administered I-123 and I-131 activities within the equal-size remnants of both phantoms were calculated. When we compared the phantoms, using the same radiopharmaceutical and similar activities, we found that the measured sensitivities were comparable. In all cases, the I-123 counting rate was higher than the I-131 one. This phantom with capabilities to insert different small sizes of remnants and simulate different background-to-remnants activity ratios can be utilized to evaluate postsurgical thyroid SPECT/CT imaging procedures.

Data Management and Network Architecture Effect on Performance Variability in Direct Attenuation Correction via Deep Learning for Cardiac SPECT: A Feasibility Study.

Attenuation correction (AC) is important for accurate interpretation of SPECT myocardial perfusion imaging (MPI). However, it is challenging to perform AC in dedicated cardiac systems not equipped with a transmission imaging capability. Previously, we demonstrated the feasibility of generating attenuation-corrected SPECT images using a deep learning technique (SPECTDL) directly from non-corrected images (SPECTNC). However, we observed performance variability across patients which is an important factor for clinical translation of the technique. In this study, we investigate the feasibility of overcoming the performance variability across patients for the direct AC in SPECT MPI by proposing to develop an advanced network and a data management strategy. To investigate, we compared the accuracy of the SPECTDL for the conventional U-Net and Wasserstein cycle GAN (WCycleGAN) networks. To manage the training data, clustering was applied to a representation of data in the lower-dimensional space, and the training data were chosen based on the similarity of data in this space. Quantitative analysis demonstrated that DL model with an advanced network improves the global performance for the AC task with the limited data. However, the regional results were not improved. The proposed data management strategy demonstrated that the clustered training has potential benefit for effective training.

Direct Image-Based Attenuation Correction using Conditional Generative Adversarial Network for SPECT Myocardial Perfusion Imaging.

Attenuation correction (AC) is important for an accurate interpretation and quantitative analysis of SPECT myocardial perfusion imaging. Dedicated cardiac SPECT systems have invaluable efficacy in the evaluation and risk stratification of patients with known or suspected cardiovascular disease. However, most dedicated cardiac SPECT systems are standalone, not combined with a transmission imaging capability such as computed tomography (CT) for generating attenuation maps for AC. To address this problem, we propose to apply a conditional generative adversarial network (cGAN) for generating attenuation-corrected SPECT images (SPECTGAN ) directly from non-corrected SPECT images (SPECTNC ) in image domain as a one-step process without requiring additional intermediate step. The proposed network was trained and tested for 100 cardiac SPECT/CT data from a GE Discovery NM 570c SPECT/CT, collected retrospectively at Yale New Haven Hospital.The generated images were evaluated quantitatively through the normalized root mean square error (NRMSE), peak signal to noise ratio (PSNR), and structural similarity index (SSIM) and statistically through joint histogram and error maps. In comparison to the reference CT-based correction (SPECTCTAC ), NRMSEs were 0.2258±0.0777 and 0.1410±0.0768 (37.5% reduction of errors); PSNRs 31.7712±2.9965 and 36.3823±3.7424 (14.5% improvement in signal to noise ratio); SSIMs 0.9877±0.0075 and 0.9949±0.0043 (0.7% improvement in structural similarity) for SPECTNC and SPECTGAN , respectively. This work demonstrates that the conditional adversarial training can achieve accurate CT-less attenuation correction for SPECT MPI, that is quantitatively comparable to CTAC. Standalone dedicated cardiac SPECT scanners can benefit from the proposed GAN to reduce attenuation artifacts efficiently.

Towards characterizing the regional cerebral perfusion in evaluating the severity of major depression disorder with SPECT/CT

BackgroundMajor depressive disorder (MDD) is a common mental disorder worldwide, but now there is a lack of clinically effective assessment and management of MDD. In this study, we used technetium-99 m ethylcysteinate dimer ([99mTc]ECD) SPECT/CT to characterize the regional cerebral blood flow (rCBF) status of MDD patients, and to explore an objective image assessment model of MDD which is non- or minimally-invasive, convenient and accurate in a clinical setting.MethodsThe severity of MDD was assessed by three trained psychiatrists, based on scores obtained from HAMD and HAMA. [99mTc]ECD rCBF SPECT/CT was performed in 20 healthy controls and 74 unipolar MDD patients before receiving the treatment. The CT attenuation-corrected SPECT images data were automatically registered, analyzed simultaneously by 3D-SSP and eZIS.ResultsThe mean score of HAMD and HAMA in the MDD patients was 25.49 ± 6.00, and 23.12 ± 5.83, respectively. There was a positive correlation between two scores. The MDD women had higher HAMD scores than MDD men. The decreased rCBF of MDD patients in frontal lobes (bilateral B11, B47 and right B4, B6, B10, B46), temporal lobe (right B21, B41, B42) and cingulated cortex (bilateral B24, B33), while their increased rCBF in occipital lobe (bilateral B17, B19 and left B18). Additionally, the depression severity was negatively correlated with decreased rCBF in left ventral anterior cingulate cortex B24, and was positively correlated with decreased rCBF in left inferior prefrontal gyrus B47 and increased rCBF in right associative visual cortex B19. The anxiety severity was negatively correlated with decreased rCBF in left subgenual cortex B25.ConclusionsAlthough the mechanism underlying the correlation is not yet fully understood, our findings indicated that the rCBF SPECT/CT may provide an objective assessment for MDD severity. It might be used monitoring therapeutic efficacy in the management of MDD.

Impact of the Adaptive Statistical Iterative Reconstruction Technique on Radiation Dose and Image Quality in Bone SPECT/CT.

The purpose of this study was to compare a routine bone SPECT/CT protocol using CT reconstructed with filtered backprojection (FBP) with an optimized protocol using low-dose CT images reconstructed with adaptive statistical iterative reconstruction (ASiR). In this prospective study, enrolled patients underwent bone SPECT/CT, with 1 SPECT acquisition followed by 2 randomized CT acquisitions: FBP CT (FBP; noise index, 25) and ASiR CT (70% ASiR; noise index, 40). The image quality of both attenuation-corrected SPECT and CT images was visually (5-point Likert scale, 2 interpreters) and quantitatively (contrast ratio [CR] and signal-to-noise ratio [SNR]) estimated. The CT dose index volume, dose-length product, and effective dose were compared. Seventy-five patients were enrolled in the study. Quantitative attenuation-corrected SPECT evaluation showed no inferiority for contrast ratio and SNR issued from FBP CT or ASiR CT (respectively, 13.41 ± 7.83 vs. 13.45 ± 7.99 and 2.33 ± 0.83 vs. 2.32 ± 0.84). Qualitative image analysis showed no difference between attenuation-corrected SPECT images issued from FBP CT or ASiR CT for both interpreters (respectively, 3.5 ± 0.6 vs. 3.5 ± 0.6 and 3.6 ± 0.5 vs. 3.6 ± 0.5). Quantitative CT evaluation showed no inferiority for SNR between FBP and ASiR CT images (respectively, 0.93 ± 0.16 and 1.07 ± 0.17). Qualitative image analysis showed no quality difference between FBP and ASiR CT images for both interpreters (respectively, 3.8 ± 0.5 vs. 3.6 ± 0.5 and 4.0 ± 0.1 vs. 4.0 ± 0.2). Mean CT dose index volume, dose-length product, and effective dose for ASiR CT (3.0 ± 2.0 mGy, 148 ± 85 mGy⋅cm, and 2.2 ± 1.3 mSv) were significantly lower than for FBP CT (8.5 ± 3.7 mGy, 365 ± 160 mGy⋅cm, and 5.5 ± 2.4 mSv). The use of 70% ASiR blending in bone SPECT/CT can reduce the CT radiation dose by 60%, with no sacrifice in attenuation-corrected SPECT and CT image quality, compared with the conventional protocol using FBP CT reconstruction technique.

Accuracy and Reproducibility of Absolute Quantification of Myocardial Focal Tracer Uptake from Molecularly Targeted SPECT/CT: A Canine Validation

Accurate and reproducible SPECT quantification of myocardial molecular processes remains a challenge because of the complication of heterogeneous background and extracardiac activity adjacent to the heart, which causes errors in the estimation of myocardial focal tracer uptake. Our aim in this study was to introduce a heuristic method for the correction of extracardiac activity into SPECT quantification and validate the modified quantification method for accuracy and reproducibility using a canine model. Dual-isotope-targeted (99m)Tc and (201)Tl perfusion SPECT images were acquired using a hybrid SPECT/CT camera in 6 dogs at 2 wk after myocardial infarction. Images were reconstructed with and without CT-based attenuation correction, and the reconstructed SPECT images were filtered and quantified simultaneously with incorporation of extracardiac radioactivity correction, gaussian fitting, and total-count sampling. Absolute myocardial focal tracer uptake was quantified from SPECT images using 3 different normal limits (maximum entropy [ME], mean-squared-error minimization [MSEM], and global minimum [GM]). SPECT-quantified percentage injected dose (%ID) was calculated and compared with the well-counted radioactivity measured from the postmortem myocardial tissue. SPECT quantitative processing was performed by 2 different individuals with extensive experience in cardiac image processing, to assess reproducibility of the quantitative analysis. Correlations between SPECT-quantified and well-counted %IDs using 3 different normal limits were excellent (ME: r = 0.82, y = 0.932 x - 0.0102; MSEM: r = 0.73, y = 1.1413 x - 0.0052; and GM: r = 0.7, y = 1.2147 x - 0.0002). SPECT quantification using ME normal limits resulted in an underestimation of %ID, as compared with well-counted %ID. Myocardial focal tracer uptake quantified from SPECT images without CT-based attenuation correction was significantly lower than that with the attenuation correction. The %IDs quantified from attenuation-corrected SPECT images using MSEM and GM normal limits were not significantly different from well-counted %IDs. Reproducibility of the SPECT quantitative analysis was excellent (ME: r = 0.98, y = 0.9221 x + 0.0001; MSEM: r = 0.97, y = 0.9357 x + 0.0004; and GM: r = 0.96, y = 0.9026 x + 0.001). Our SPECT/CT quantification algorithm for the assessment of regional radioactivity may allow for accurate and reproducible serial noninvasive evaluation of molecularly targeted tracers in the myocardium.

Myocardial SPECT Images for Diagnosis of Pulmonary Hypertension and Right Ventricular Hypertrophy

The utility of (99m)Tc-tetrofosmin myocardial SPECT for assessment of pulmonary hypertension and right ventricular thickness has not been well studied. We hypothesized that a ratio of right ventricular activity to left ventricular activity (RV/LV uptake ratio) from SPECT myocardial perfusion images could identify the presence of increased right ventricular wall thickness and elevated systolic pulmonary artery pressure with or without the use of attenuation correction. We identified 33 patients with normal findings on stress (99m)Tc-tetrofosmin left ventricular myocardial perfusion imaging who had a complete 2-dimensional echocardiographic study within 3 wk of the SPECT study. Two 6 × 6 pixel regions of interest were placed in the right and left ventricular free walls of both non-attenuation-corrected and attenuation-corrected SPECT images. We examined the correlation of RV/LV uptake ratio with echocardiographic right ventricular free-wall thickness and with pulmonary artery systolic pressure. RV/LV uptake ratio, measured on non-attenuation-corrected images, correlated significantly with both pulmonary artery systolic pressure (r = 0.63 and P < 0.001) and right ventricular wall thickness (r = 0.6 and P < 0.001). Receiver-operating-characteristic analysis of the use of RV/LV uptake ratio to detect significant pulmonary hypertension showed that the area under the curve was 0.78 (95% confidence interval, 0.62-0.95). However, no significant correlation of RV/LV uptake ratio with pulmonary artery systolic pressure or right ventricular wall thickness was found on attenuation-corrected images. RV/LV uptake ratio measured on SPECT images can be used to identify patients with high pulmonary artery pressure or right ventricular hypertrophy.

Overcorrection of iodinated contrast attenuation in SPECT‐CT: Phantom studies

The authors investigated the effects of iodinated contrast agents on the quantification of radioactivity obtained using a combined single photon emission tomography (SPECT) and high resolution 16 slice computed tomography (CT) scanner. Two conditions were evaluated: Contrast media mixed with radioisotope and the contrast media, and the radioisotope solution confined in adjacent but distinct volumes. Phantoms containing combinations of 99mTc, 111In, and 131I solutions in normal saline and contrast solutions in normal saline corresponding to the two conditions were prepared and scanned. Images were reconstructed by iterative reconstruction (ordered subset expectation maximization), with and without CT-derived attenuation maps. The reconstructed counts encoded in the reconstructed images were compared. Compared to normal saline, the presence of an iodinated contrast agent resulted in the underestimation of reconstructed counts in all nonattenuation corrected SPECT images. Compared to normal saline, the presence of a contrast agent resulted in the overestimation of reconstructed counts in all attenuation corrected SPECT images. The largest underestimation of reconstructed counts was 12.8% and the largest overestimation value was 35.9%. High concentrations of a contrast agent caused errors in the measurement of actual radiotracer reconstructed counts in phantoms. These errors could have important consequences for the use of oral and intravenous contrast in both diagnostic (qualitative) and dosimetric (quantitative) SPECT-CT imaging. The authors' findings suggest that noncontrast imaging or alternative contrast-specific attenuation correction approaches should be considered for optimal SPECT activity quantification.

Noise propagation in SPECT images reconstructed using an iterative maximum-likelihood algorithm

The effects of photon noise in the emission projection data and uncertainty in the attenuation map on the image noise in attenuation-corrected SPECT images reconstructed using a maximum-likelihood expectation-maximization algorithm were investigated. Emission projection data of a physical Hoffman brain phantom and a thorax-like phantom were acquired from a prototype emission-transmission computed tomography (ETCT) scanner being developed at UCSF. Computer-simulated emission projection data from a head-like phantom and a thorax-like phantom were also obtained using a fan-beam geometry consistent with the ETCT system. The simulation assumed a 99Tcm source, included collimator blurring but ignored photon scatter. For each phantom, a region of interest (ROI) at the centre of the reconstructed image was chosen for the purpose of noise analysis. In all cases, the mean value (m) in the ROI approached a constant value after approximately 20 iterations. The standard deviation ( sigma ) generally increased with the number of iterations. The ratio ( sigma /m) was found to be inversely proportional to the square root of the total detected counts and proportional to the relative uncertainty in the attenuation maps. These two noise components contributed independently towards the noise in the reconstructed image. In the ETCT system employing an X-ray tube for attenuation map acquisition, the uncertainty in the reconstructed radionuclide distribution is limited mainly by photon noise in the emission projection data.

Attenuation correction of SPECT imaging by dual energy method--quantification of 111In-labeled monoclonal anti-tumor antibody localization

Application of radiolabeled monoclonal anti-tumor antibodies for diagnosis and therapy has made remarkable progress in the past few years. Quantification of radiopharmaceutical localization is required adequate attenuation correction in SPECT imaging. Attenuation correction by transmission CT (TCT) data is one of the best method at present time. However, if a patient is moved between TCT and SPECT, this method is no more applicable. We developed a new attenuation correction algorithm by dual energy method, using 99mTc and 111In because of similarity of these linear attenuation coefficients. The new algorithm uses data of TCT with an external source of 99mTc, and requires another data from SPECT of 111In labeled monoclonal anti-tumor antibody, which are simultaneously obtained. TCT results in an attenuation map, which then serves as input into the final intrinsic correction algorithm to uncorrected SPECT data. In chest phantom experiment, the attenuation corrected SPECT images revealed nearly same distribution of actual radioactivity of 111In as compared to that of uncorrected one.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)- QUANTITATIVE ASPECTS AND STUDIES IN CANINE PULMONARY PERFUSION

We have evaluated the quantitative aspects of a whole-body SPECT system which consists of 2 large-field-of-view scintillation cameras mounted in a rotatable gantry and interfaced to a minicomputer. Data are continuously collected through a 360 degree rotation and result in 32 contiguous transverse images which can be reorganized into 16 frontal and 16 sagittal images. Pulmonary perfusion studies were performed in dogs to compare the information from SPECT with routine gamma camera images. Five plastic spheres ranging from 2 to 6 cm in diameter were placed in a 22 cm diameter cylinder with technetium-99m distributed in the spheres and cylinder in varying concentration ratios. A semi-automatic region of interest program was used to evaluate the multiple slices from the SPECT data, and the volumes were calculated by computing the total number of voxels within each region of interest. The SPECT measured volumes correlated very well with the actual volumes. To evaluate the ability of SPECT to determine radionuclide concentrations in an object, elliptical and cylindrical phantoms were uniformly filled with technetium-99m in concentrations from 0.05 to 1.5 μCi/ml. Using attenuation corrected data, the SPECT concentrations correlated very well with the actual concentrations over the entire range tested. We also evaluated the concentration ratios of the spheres to the cylinder using attenuation corrected SPECT images. The concentration ratios were derived from the measured SPECT image contrast by correcting for attenuation, scattered photons and image degradation resulting from finite system spatial resolution. Using this procedure, the SPECT measured concentration ratios correlated well with the actual concentration ratios. Perfusion defects from normal anatomic structures, as well as perfusion abnormalities secondary to occlusion of a bronchus or pulmonary artery are better defined on the SPECT images than the gamma camera images. Thus, SPECT gives additional information concerning pulmonary perfusion.