Cardiac Single Photon Emission Computed Tomography Imaging Research Articles

Stress Perfusion Cardiac Magnetic Resonance vs SPECT Imaging for Detection of Coronary Artery Disease

BackgroundGadaCAD2 was 1 of 2 international, multicenter, prospective, Phase 3 clinical trials that led to U.S. Food and Drug Administration approval of gadobutrol to assess myocardial perfusion and late gadolinium enhancement (LGE) in adults with known or suspected coronary artery disease (CAD). ObjectivesA prespecified secondary objective was to determine if stress perfusion cardiovascular magnetic resonance (CMR) was noninferior to single-photon emission computed tomography (SPECT) for detecting significant CAD and for excluding significant CAD. MethodsParticipants with known or suspected CAD underwent a research rest and stress perfusion CMR that was compared with a gated SPECT performed using standard clinical protocols. For CMR, adenosine or regadenoson served as vasodilators. The total dose of gadobutrol was 0.1 mmol/kg body weight. The standard of reference was a 70% stenosis defined by quantitative coronary angiography (QCA). A negative coronary computed tomography angiography could exclude CAD. Analysis was per patient. CMR, SPECT, and QCA were evaluated by independent central core lab readers blinded to clinical information. ResultsParticipants were predominantly male (61.4% male; mean age 58.9 ± 10.2 years) and were recruited from the United States (75.0%), Australia (14.7%), Singapore (5.7%), and Canada (4.6%). The prevalence of significant CAD was 24.5% (n = 72 of 294). Stress perfusion CMR was statistically superior to gated SPECT for specificity (P = 0.002), area under the receiver operating characteristic curve (P < 0.001), accuracy (P = 0.003), positive predictive value (P < 0.001), and negative predictive value (P = 0.041). The sensitivity of CMR for a 70% QCA stenosis was noninferior and nonsuperior to gated SPECT. ConclusionsVasodilator stress perfusion CMR, as performed with gadobutrol 0.1 mmol/kg body weight, had superior diagnostic accuracy for diagnosis and exclusion of significant CAD vs gated SPECT.

Attenuation Correction for Dedicated Cardiac SPECT Imaging Without Using Transmission Data.

Attenuation correction (AC) using transmission scanning-like computed tomography (CT) is the standard method to increase the accuracy of cardiac single-photon emission computed tomography (SPECT) images. Recently developed dedicated cardiac SPECT do not support CT, and thus, scans on these systems are vulnerable to attenuation artifacts. This study presented a new method for generating an attenuation map directly from emission data by segmentation of precisely non-rigid registration extended cardiac-torso (XCAT)-digital phantom with cardiac SPECT images. In-house developed non-rigid registration algorithm automatically aligns the XCAT- phantom with cardiac SPECT image to precisely segment the contour of organs. Pre-defined attenuation coefficients for given photon energies were assigned to generate attenuation maps. The CT-based attenuation maps were used for validation with which cardiac SPECT/CT data of 38 patients were included. Segmental myocardial counts of a 17-segment model from these databases were compared based on the basis of the paired t-test. The mean, and standard deviation of the mean square error and structural similarity index measure of the female stress phase between the proposed attenuation maps and the CT attenuation maps were 6.99±1.23% and 92±2.0%, of the male stress were 6.87±3.8% and 96±1.0%. Proposed attenuation correction and computed tomography based attenuation correction average myocardial perfusion count was significantly higher than that in non-AC in the mid-inferior, mid-lateral, basal-inferior, and lateral regions (p<0.001). The proposed attenuation maps showed good agreement with the CT-based attenuation map. Therefore, it is feasible to enable AC for a dedicated cardiac SPECT or SPECT standalone scanners.

Data-driven respiratory signal estimation from temporally finely sampled projection data in conventional cardiac perfusion SPECT imaging.

The aim of this work was to revisit the data-driven approach of axial center-of-mass (COM) measurements to recover a surrogate respiratory signal from finely sampled (100ms) single photon emission computed tomography (SPECT) projection data derived from list-mode acquisitions. For our initial evaluation, we acquired list-mode projection data from an anthropomorphic cardiac phantom mounted on a Quasar respiratory motion platform simulating 15mm amplitude respiratory motion. We also selected 302 consecutive patients (138 males, 164 females) with list-mode acquisitions, external respiratory motion tracking, and written consent to evaluate the clinical efficacy of our data-driven approach. Linear regression, Pearson's correlation coefficient (r), and standard error of the estimates (SEE) between the respiratory signals obtained with a visual tracking system (VTS) and COM measurements were calculated for individual projection data sets and for the patient group as a whole. Both the VTS- and COM-derived respiratory signals were used to estimate and correct respiratory motion. The reconstruction for six-degree of freedom rigid-body motion estimation was done in two ways: (1) using three iterations of ordered-subsets expectation-maximization (OSEM) with four subsets (16 projection angles per subset), or 12 iterations of maximum-likelihood expectation-maximization (MLEM). Respiratory motion compensation was done employing either OSEM with 16 subsets (four projection angles per subset) and five iterations or MLEM and 80 iterations, using the two respiratory estimates, respectively. Polar map quantification was also performed, calculating the percentage count difference (%Diff) between polar maps without and with respiratory motion included. Average % Diff was calculated in 17 segments (defined according to ASNC Guidelines). Paired t-tests were used to determine significance (p-values). The r-value calculated when comparing the VTS and COM respiratory signals varied widely between -0.01 and 0.96 with an average of 0.70, while the SEE varied between 0.80 and 6.48mm with an average of 2.05mm for our patient set, while the same values for the one anthropomorphic phantom acquisition are 0.91 and 1.11mm, respectively. A comparison between the respiratory motion estimates for VTS and COM in the S-I direction yielded an r=0.90 (0.94), and an SEE of 1.56mm (1.20mm) for OSEM (MLEM), respectively. Bland-Altman plots and calculated intraclass correlation coefficients also showed excellent agreement between the VTS and COM respiratory motion estimates. Average S-I respiratory estimates for the VTS (COM) were 9.04 (9.2mm) and 9.01mm (9.14mm) for the OSEM and MLEM, respectively. The paired t-test approached significance when comparing VTS and COM estimated respiratory signals with p-values of 0.069 and 0.051 for OSEM and MLEM. The respiratory estimates from the anthropomorphic cardiac phantom experiment using the VTS (COM) were 12.62 (14.10mm) and 12.55mm (14.29mm) for OSEM and MLEM, respectively. Polar map quantification yielded average % Diff consistently better when employing VTS-derived respiratory estimates to correct for respiration compared to the COM-derived estimates. The results indicate that our COM method has the potential to provide an automated data-driven correction of cardiac respiratory motion without the drawbacks of our VTS methodology. However, it is not generally equivalent to the VTS method in extent of correction.

Prognostic Significance of Cardiac 123I-MIBG SPECT Imaging in Heart Failure Patients With Preserved Ejection Fraction

ObjectivesThe authors sought to elucidate the prognostic value of cardiac sympathetic nerve dysfunction as evaluated using iodine-123-labeled metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) imaging in patients with heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). BackgroundCardiac sympathetic nerve dysfunction assessed by 123I-MIBG imaging is associated with poor outcomes in chronic HF patients with reduced left ventricular ejection fraction (HFrEF). However, no information is available on the prognostic vale of cardiac 123I-MIBG SPECT imaging in patients with HFpEF. MethodsWe studied 148 patients admitted for acute decompensated HF (ADHF) with nonischemic HFpEF and who underwent cardiac 123I-MIBG imaging at discharge. The cardiac 123I-MIBG heart-to-mediastinum ratio (H/M) was measured on the delayed planar image (late H/M). SPECT analysis of the delayed image was conducted, and the tracer uptake in all 17 regions on the polar map was scored on a 5-point scale by comparison with a sex-matched normal control database. The total defect score (TDS) was calculated by summing the score of each of the 17 segments. The primary endpoint was the association between TDS and cardiac events (the composite of emergent HF hospitalization and cardiac death). ResultsDuring a mean follow-up period of 2.4 ± 1.6 years, 61 patients experienced cardiac events. TDS was significantly associated with cardiac events after multivariate Cox adjustment (P < 0.0001). Patients with high TDS levels had a significantly greater risk of cardiac events than those with middle or low TDS levels (63% vs 40% vs 20%, respectively; P < 0.0001; HR: 4.69; 95% CI: 2.29 to 9.61; and HR: 2.46; 95% CI: 1.14 to 5.29). C-statistic of TDS was 0.730 (95% CI: 0.651 to 0.799), which was significantly higher than that of late H/M (0.607; 95% CI: 0.524 to 0.686; P = 0.0228). ConclusionsCardiac 123I-MIBG SPECT imaging provided useful prognostic information in nonischemic ADHF patients with HFpEF. (Clinical Trial: Osaka Prefectural Acute Heart Failure Syndrome Registry [OPAR]: UMIN000015246)

The impact of frame numbers on cardiac ECG-gated SPECT images with interpolated extra frames using echocardiography.

Background: Cardiac echocardiography and cardiac ECG-gated single-photon emission computed tomography (SPECT) are the most common modalities for left ventricle (LV) volumes and function assessment. The temporal resolution of SPECT images is limited and an ECG provides better temporal resolution. This study investigates the impact of frame numbers on images in terms of qualitative and quantitative assessments. Methods: In this study, 5 patients underwent echocardiography and cardiac ECG-gated SPECT imaging, and 5 standard views of the LV were recorded to determine LV walls boundaries and volumes. Also, 2 original images with 8 frames and 16 frames per cardiac cycle were recorded simultaneously in a single gantry orbit. Using the data extracted from the LV model, 8 extra new frames were created with interpolation between existing frames of the original 8-frame image. Three series of images (8 and 16 original and 16 interpolated) were reconstructed separately. LV volumes and ejection fraction (EF) were calculated using Quantitative Gated SPECT (QGS) software. Results: Compared to the original 8-frame gating, original 16-frame gated images resulted in larger end-diastole volume (EDV) (mean ± SD: 68.6 ± 27.11 mL vs 66.2±25.41 mL, p<0.001), smaller end-systole volume (ESV) (mean ± SD: 24.6±8.7 mL vs 26±7.3 mL, p<0.001), and higher EF (64% vs 60.2%, p<0.001). The results for the interpolated series were also different from the original images (closer to the original 16-frame series rather than 8-frame). Conclusion: Changing the frame number from 8 to 16 in cardiac ECG-gated SPECT images caused a significant change in LV volumes and EF. Frame interpolation with sophisticated algorithms can be used to improve the temporal resolution of SPECT images.

Optimization of Accurate Quantification in Single-Photon Emission Computed Tomography Myocardial Imaging

Purpose: The wide availability and reputation for accuracy of the single-photon emission computed tomography (SPECT) of the myocardium has made it a top global choice for nuclear cardiology procedures. The goal of this research is to determine the effectiveness and measurable accuracy of 3D iterative reconstruction algorithms compared to filtered back projection techniques for cardiac SPECT images. Effectiveness is determined by the ability of the various techniques to produce accurate cardiac SPECT images. Materials and Methods: A Siemens Symbia T16 SPECT/CT scanner was used to acquire SPECT/CT images and the Monte Carlo simulations whilst a GATE package was used with the implementation of Infinia™ (GE) dual head SPECT gamma camera–simulated data. The recordings were acquired from point and linear sources and a cardiac insert was created along with a simulation of a computerized phantom XCAT. Result: The results of this study demonstrated an improvement in image quality and the use of a Flash 3D algorithm relative to FBP technique enhances its accuracy. The data presented in this article further show that the image quality of myocardium images and quantification accuracy, particularly for high-resolution studies reconstructed using the Flash 3D algorithm, can be greatly affected by a respiratory-induced motion. Conclusion: Image quality and quantification accuracy can be better improved with respiratory-gating techniques, utilization of ordered-subsets maximization (OSEM) algorithms with attenuation and scatter correction. A simulation of respiratory-induced motion resulted in a reconstructed SPECT recording of 73% reduction in the quantified image resolution for Flash 3D and 43% for FBP. It also caused the underestimation for the left ventricle volume by 18% using FBP and 41% for the Flash 3D. In conclusion, our physical phantom studies and Monte Carlo simulation studies agree with the main hypothesis of our investigation. They showed improvement in image quality with increased accuracy when using the Flash 3D algorithm relative to the FBP technique.

Design of a short nonuniform acquisition protocol for quantitative analysis in dynamic cardiac SPECT imaging - a retrospective 123 I-MIBG animal study.

Our previous works have found that quantitative analysis of 123 I-MIBG kinetics in the rat heart with dynamic single-photon emission computed tomography (SPECT) offers the potential to quantify the innervation integrity at an early stage of left ventricular hypertrophy. However, conventional protocols involving a long acquisition time for dynamic imaging reduce the animal survival rate and thus make longitudinal analysis difficult. The goal of this work was to develop a procedure to reduce the total acquisition time by selecting nonuniform acquisition times for projection views while maintaining the accuracy and precision of estimated physiologic parameters. Taking dynamic cardiac imaging with 123 I-MIBG in rats as an example, we generated time activity curves (TACs) of regions of interest (ROIs) as ground truths based on a direct four-dimensional reconstruction of experimental data acquired from a rotating SPECT camera, where TACs represented as the coefficients of B-spline basis functions were used to estimate compartmental model parameters. By iteratively adjusting the knots (i.e., control points) of B-spline basis functions, new TACs were created according to two rules: accuracy and precision. The accuracy criterion allocates the knots to achieve low relative entropy between the estimated left ventricular blood pool TAC and its ground truth so that the estimated input function approximates its real value and thus the procedure yields an accurate estimate of model parameters. The precision criterion, via the D-optimal method, forces the estimated parameters to be as precise as possible, with minimum variances. Based on the final knots obtained, a new protocol of 30 min was built with a shorter acquisition time that maintained a 5% error in estimating rate constants of the compartment model. This was evaluated through digital simulations. The simulation results showed that our method was able to reduce the acquisition time from 100 to 30 min for the cardiac study of rats with 123 I-MIBG. Compared to a uniform interval dynamic SPECT protocol (1 s acquisition interval, 30 min acquisition time), the newly proposed protocol with nonuniform interval achieved comparable (K1 and k2, P = 0.5745 for K1 and P = 0.0604 for k2) or better (Distribution Volume, DV, P = 0.0004) performance for parameter estimates with less storage and shorter computational time. In this study, a procedure was devised to shorten the acquisition time while maintaining the accuracy and precision of estimated physiologic parameters in dynamic SPECT imaging. The procedure was designed for 123 I-MIBG cardiac imaging in rat studies; however, it has the potential to be extended to other applications, including patient studies involving the acquisition of dynamic SPECT data.

4-D Reconstruction With Respiratory Correction for Gated Myocardial Perfusion SPECT.

Cardiac single photon emission computed tomography (SPECT) images are known to suffer from both cardiac and respiratory motion blur. In this paper, we investigate a 4-D reconstruction approach to suppress the effect of respiratory motion in gated cardiac SPECT imaging. In this approach, the sequence of cardiac gated images is reconstructed with respect to a reference respiratory amplitude bin in the respiratory cycle. To combat the challenge of inherent high-imaging noise, we utilize the data counts acquired during the entire respiratory cycle by making use of a motion-compensated scheme, in which both cardiac motion and respiratory motion are taken into account. In the experiments, we first use Monte Carlo simulated imaging data, wherein the ground truth is known for quantitative comparison. We then demonstrate the proposed approach on eight sets of clinical acquisitions, in which the subjects exhibit different degrees of respiratory motion blur. The quantitative evaluation results show that the 4-D reconstruction with respiratory correction could effectively reduce the effect of motion blur and lead to a more accurate reconstruction of the myocardium. The mean-squared error of the myocardium is reduced by 22%, and the left ventricle (LV) resolution is improved by 21%. Such improvement is also demonstrated with the clinical acquisitions, where the motion blur is markedly improved in the reconstructed LV wall and blood pool. The proposed approach is also noted to be effective on correcting the spill-over effect in the myocardium from nearby bowel or liver activities.

Geometric Calibration and Image Reconstruction for a Segmented Slant-Hole Stationary Cardiac SPECT System.

A dedicated stationary cardiac single-photon emission computed tomography (SPECT) system with a novel segmented slant-hole collimator has been developed. The goal of this paper is to calibrate this new imaging geometry with a point source. Unlike the commercially available dedicated cardiac SPECT systems, which are specialized and can be used only to image the heart, our proposed cardiac system is based on a conventional SPECT system but with a segmented slant-hole collimator replacing the collimator. For a dual-head SPECT system, 2 segmented collimators, each with 7 sections, are arranged in an L-shaped configuration such that they can produce a complete cardiac SPECT image with only one gantry position. A calibration method was developed to estimate the geometric parameters of each collimator section as well as the detector rotation radius, under the assumption that the point source location is calculated using the central-section data. With a point source located off the rotation axis, geometric parameters for each collimator section can be estimated independently. The parameters estimated individually are further improved by a joint objective function that uses all collimator sections simultaneously and incorporates the collimator symmetry information. Estimation results and images reconstructed from estimated parameters are presented for both simulated and real data acquired from a prototype collimator. The calibration accuracy was validated by computer simulations with an error of about 0.1° for the slant angles and about 1 mm for the rotation radius. Reconstructions of a heart-insert phantom did not show any image artifacts of inaccurate geometric parameters. Compared with the detector's intrinsic resolution, the estimation error is small and can be ignored. Therefore, the accuracy of the calibration is sufficient for cardiac SPECT imaging.

Sci—Thur PM: Imaging — 01: Position‐sensitive noise characteristics in multi‐pinhole cardiac SPECT imaging

Myocardial perfusion imaging (MPI) with Single Photon Emission Computed Tomography (SPECT) is invaluable in the diagnosis and management of heart disease. It provides essential information on myocardial blood flow and ischemia. Multi‐pinhole dedicated cardiac‐SPECT cameras offer improved count sensitivity, and spatial and energy resolutions over parallel‐hole camera designs however variable sensitivity across the field‐of‐view (FOV) can lead to position‐dependent noise variations. Since MPI evaluates differences in the signal‐to‐noise ratio, noise variations in the camera could significantly impact the sensitivity of the test for ischemia. We evaluated the noise characteristics of GE Healthcare's Discovery NM530c camera with a goal of optimizing the accuracy of our patient assessment and thereby improving outcomes. Theoretical sensitivity maps of the camera FOV, including attenuation effects, were estimated analytically based on the distance and angle between the spatial position of a given voxel and each pinhole. The standard deviation in counts, σ was inferred for each voxel position from the square root of the sensitivity mapped at that position. Noise was measured experimentally from repeated (N=16) acquisitions of a uniform spherical Tc‐99m‐water phantom. The mean (μ) and standard deviation (σ) were calculated for each voxel position in the reconstructed FOV. Noise increased ∼2.1× across a 12 cm sphere. A correlation of 0.53 is seen when experimental noise is compared with theory suggesting that ∼53% of the noise is attributed to the combined effects of attenuation and the multi‐pinhole geometry. Further investigations are warranted to determine the clinical impact of the position‐dependent noise variation.

An evaluation of data-driven motion estimation in comparison to the usage of external-surrogates in cardiac SPECT imaging

Motion estimation methods in single photon emission computed tomography (SPECT) can be classified into methods which depend on just the emission data (data-driven), or those that use some other source of information such as an external surrogate. The surrogate-based methods estimate the motion exhibited externally which may not correlate exactly with the movement of organs inside the body. The accuracy of data-driven strategies on the other hand is affected by the type and timing of motion occurrence during acquisition, the source distribution, and various degrading factors such as attenuation, scatter, and system spatial resolution. The goal of this paper is to investigate the performance of two data-driven motion estimation schemes based on the rigid-body registration of projections of motion-transformed source distributions to the acquired projection data for cardiac SPECT studies. Comparison is also made of six intensity based registration metrics to an external surrogate-based method. In the data-driven schemes, a partially reconstructed heart is used as the initial source distribution. The partially-reconstructed heart has inaccuracies due to limited angle artifacts resulting from using only a part of the SPECT projections acquired while the patient maintained the same pose. The performance of different cost functions in quantifying consistency with the SPECT projection data in the data-driven schemes was compared for clinically realistic patient motion occurring as discrete pose changes, one or two times during acquisition. The six intensity-based metrics studied were mean-squared difference, mutual information, normalized mutual information (NMI), pattern intensity (PI), normalized cross-correlation and entropy of the difference. Quantitative and qualitative analysis of the performance is reported using Monte-Carlo simulations of a realistic heart phantom including degradation factors such as attenuation, scatter and system spatial resolution. Further the visual appearance of motion-corrected images using data-driven motion estimates was compared to that obtained using the external motion-tracking system in patient studies. Pattern intensity and normalized mutual information cost functions were observed to have the best performance in terms of lowest average position error and stability with degradation of image quality of the partial reconstruction in simulations. In all patients, the visual quality of PI-based estimation was either significantly better or comparable to NMI-based estimation. Best visual quality was obtained with PI-based estimation in one of the five patient studies, and with external-surrogate based correction in three out of five patients. In the remaining patient study there was little motion and all methods yielded similar visual image quality.

Taking the perfect nuclear image: Quality control, acquisition, and processing techniques for cardiac SPECT, PET, and hybrid imaging

Nuclear Cardiology for the past 40 years has distinguished itself in its ability to non-invasively assess regional myocardial blood flow and identify obstructive coronary disease. This has led to advances in managing the diagnosis, risk stratification, and prognostic assessment of cardiac patients. These advances have all been predicated on the collection of high quality nuclear image data. National and international professional societies have established guidelines for nuclear laboratories to maintain high quality nuclear cardiology services. In addition, laboratory accreditation has further advanced the goal of the establishing high quality standards for the provision of nuclear cardiology services. This article summarizes the principles of nuclear cardiology single photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging and techniques for maintaining quality: from the calibration of imaging equipment to post processing techniques. It also will explore the quality considerations of newer technologies such as cadmium zinc telleride (CZT)-based SPECT systems and absolute blood flow measurement techniques using PET.

Ischemic heart disease detection using selected machine learning methods

This article presents a method based on support vector machines (SVMs) and the Osuna–Platt algorithm used to diagnose the ischemic heart disease. It also includes the necessary concepts from the optimization theory which make it possible to formulate the problem for support vectors and the Osuna–Platt algorithm applied. Next, a principal component analysis (PCA) algorithm used is also presented. Heart images acquired using Single Photon Emission Computed Tomography (SPECT) have been used in the experimental part. Results of classifying cardiac SPECT images using SVM, PCA and neural networks are compared here with those obtained using another method of machine learning – CLIP3 – a combination of the decision tree algorithm and the rule induction algorithm. Tests against an SPECT image database have shown that SVMs are generally more accurate and specific, while the PCA algorithm is the most sensitive for all data sets analysed in this research project.

New Software Solutions for Cardiac SPECT Imaging

Recent advances in myocardial perfusion single photon emission computed tomography (SPECT) processing software, incorporating iterative reconstruction, resolution recovery, and noise compensation, now provide the ability to acquire high quality scans despite reduced administered activity, shortened acquisition time, or both. These methods have thereby provided imaging protocol flexibility and facilitated patient-centered imaging. Other software methods allow for improved image quality by prescribing an image acquisition time that will yield optimal SPECT image count density. On some new solid state cameras list mode acquisition is now available, whereby suboptimal acquisition stops such as those with patient motion can be eliminated prior to SPECT reconstruction. Still other methods, incorporating phase analysis of gated perfusion SPECT, provide a quantitative analysis of left ventricular dyssynchrony, aiding in the selection of patients for whom cardiac resynchronization therapy is most beneficial.

Advances in Cardiac SPECT and PET Imaging: Overcoming the Challenges to Reduce Radiation Exposure and Improve Accuracy

Nuclear cardiology came of age in the 1970s and subsequently has expanded so that more than 9 million single-photon emission computed tomography (SPECT) studies are performed annually in North America. Coronary artery disease management has demanded a reliable technique that will detect, risk stratify, and assist with revascularization decisions. Using cardiac SPECT and positron-emission tomography (PET), researchers and clinicians have sought to achieve excellence in coronary artery disease diagnosis and risk stratification, and strive to achieve higher standards in these areas. Developments in other cardiac imaging modalities, however, such as cardiac computed tomography, cardiac magnetic resonance, and echocardiography, have raised expectations in terms of diagnostic accuracy and achieving high quality images with little or no ionizing radiation exposure. The challenge facing nuclear cardiology as it embarks upon a fifth decade of clinical use is whether high quality images can be obtained at lower radiation exposures. In this review we consider current practice in SPECT and PET perfusion imaging. We discuss emerging advances in techniques, technologies, and radiotracers that focus specifically on improvements in image quality that enhance diagnostic accuracy while reducing radiation exposure. We provide a perspective as to the future roles of cardiac SPECT and PET in ischemic heart disease, and consider emerging novel applications beyond perfusion imaging. Although for a number of years nuclear cardiology has shone brightly as a leading light for the imaging of ischemic heart disease, its half-life has not yet been reached. Instead, even with the pressure to reduce radiation exposure, the future continues to look bright for cardiac SPECT and PET.

New Ultrafast Cardiac SPECT Cameras (UCS)

Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) has widespread clinical use because of its well-documented diagnostic accuracy for detecting coronary artery disease (CAD). Cardiac SPECT imaging needs to become shorter and use lower radiation doses in order to compete with other available noninvasive imaging modalities. Recently introduced cadmium zinc telluride (CZT) SPECT cameras have the potential to achieve both of these goals. New SPECT CZT camera technology drastically reduces imaging time for patients while also reducing their radiation exposure compared to previously used technologies, without any loss of image quality. This article describes these innovations, which provide a strong foundation for the continued success of myocardial perfusion SPECT.

Breath-hold CT attenuation correction for quantitative cardiac SPECT

BackgroundAttenuation correction of a single photon emission computed tomography (SPECT) image is possible using computed tomography (CT)-based attenuation maps with hybrid SPECT/CT. CT attenuation maps acquired during breath holding can be misaligned with SPECT, generating artifacts in the reconstructed images. The purpose of this study was to investigate the effects of respiratory phase during breath-hold CT acquisition on attenuation correction of cardiac SPECT imaging.MethodsA series of 201Tl-emission and 99mTc-based transmission computed tomography (TCT) scans was carried out along with CT-attenuation scans on 11 young normal volunteers using a hybrid SPECT/CT scanner. The CT scans were performed at three respiratory phases: end-inspiration (INS), end-expiration (EXP), and the midpoint (MID) between these phases. Using alignment parameters between attenuation maps and SPECT images without attenuation or scatter corrections, quantitative SPECT images were reconstructed, including corrections for attenuation and scatter. Regional radioactivity concentrations normalized by the subjects’ weights were compared between CT- and TCT-based attenuation correction techniques.ResultsSPECT images with CT attenuation maps at the EXP phase showed significant differences in regional weight-normalized radioactivity concentrations relative to the images using the other attenuation maps (p < 0.05), as well as systematic positive bias errors, compared to TCT-based images for all myocardial segments, 5.7% ± 2.7% (1.9% to 10.0%). No significant differences in regional weight-normalized radioactivity concentrations were observed between images with CT attenuation maps at MID and INS phases or between these and the TCT-based images, but regional tendencies were found: for anterior to anterolateral segment, positive bias of 5.0% ± 2.2% (1.3% to 8.1%) and 5.6% ± 1.9% (2.6% to 8.5%) and for inferior to inferoseptal segment, negative bias of −5.3% ± 2.6% (−9.1% to −1.7%) and −4.6% ± 2.5% (−8.8% to −1.5%) for the MID and INS phases, respectively.ConclusionsUse of breath-hold CT attenuation maps at INS and MID phases for attenuation and scatter corrections demonstrated accurate quantitative images that would prove beneficial in cardiac SPECT/CT studies.

Development and evaluation of QSPECT open-source software for the iterative reconstruction of SPECT images

In this study open-source software (QSPECT) suitable for the iterative reconstruction of single-photon emission computed tomography (SPECT) data is presented. QSPECT implements maximum likelihood expectation maximization and ordered subsets expectation maximization algorithms in a user-friendly graphical interface. The software functionality is described and validation results are presented. Maximum likelihood expectation maximization and ordered subsets expectation maximization algorithms are implemented in C++. The Qt toolkit, a standard C++ framework for developing high-performance cross-platform applications, has been used for the graphical user interface development. QSPECT is tested using original projection data from two clinical SPECT systems: (i) APEX SPX-6/6HR and (ii) Millennium MG. Phantom experiments were carried out to evaluate the quality of reconstructed images in terms of (i) spatial resolution, (ii) sensitivity to activity variations, and (iii) the presence of scatter media. A cardiac phantom was used to simulate a normal and abnormal scenario. Finally, clinical cardiac SPECT images were reconstructed. In all cases, QSPECT results were compared with the clinical systems reconstruction software that uses the standard filtered backprojection algorithm. The reconstructed images show that QSPECT, when compared with standard clinical reconstruction, provides images with higher contrast, reduced background, and better separation of small sources located in small distances. In addition, reconstruction with QSPECT provides more quantitative images, and reduces the background created by scatter media. Finally, the phantom and clinical cardiac images are reconstructed with similar quality. QSPECT is a freely distributed, open-source standalone application that provides real-time, high-quality SPECT images. The software can be further modified to improve reconstruction algorithms, and include more correction techniques, such as, scatter and attenuation correction.

Analytic derivation of pinhole collimation sensitivity for a general source model using spherical harmonics

Pinhole collimators are widely used for single photon emission computed tomography (SPECT) imaging of small organs and animals. There has also been renewed interest in using pinhole arrays for clinical cardiac SPECT imaging to achieve high sensitivity and complete data sampling. Overall sensitivity of a pinhole array is critical in determining a system's performance. Conventionally, a point source model has been used to evaluate the sensitivity and optimize the system design. This model is simple but far from realistic. This work addresses the use of more realistic source models to assess the sensitivity performance of pinhole collimation. We have derived an analytical formula for pinhole collimation sensitivity with a general source distribution model using spherical harmonics. As special cases of this general model, we provided the pinhole sensitivity formulae for line, disk and sphere sources. These results show that the point source model is just the zeroth-order approximation of the other source models. The point source model overestimates or underestimates the sensitivity relative to the more realistic model. The sphere source model yields the same sensitivity as a point source located at the center of the sphere when attenuation is not taken into account. In the presence of attenuation, the average path length of emitted gamma rays is 3/4 of the radius of the sphere source. The calculated sensitivities based on these formulae show good agreement with separate Monte Carlo simulations in simple cases. The general and special sensitivity formulae derived here can be useful for the design and optimization of SPECT systems that utilize pinhole collimators.

Advances in Cardiac Single Photon Emission Computed Tomography (SPECT) Imaging

Cardiac single photon emission computed tomography (SPECT) imaging is an established diagnostic and prognostic method for evaluation of suspected and known coronary artery disease. SPECT technology has developed over several decades. Utilization of thallium-201 decreased with the advent of technetium-based perfusion tracers. New cadmium zinc telluride (CZT)-based detectors open a new era of faster imaging and of lower radiation dose to the patient. Appropriate use of the SPECT imaging is regulated by evidence-based guidelines and appropriateness criteria as well as by third-party payers in an effort to curb unsustainable growth of testing seen in recent years. SPECT testing prior to noncardiac surgical procedures is driven by urgency of planned surgery, cardiac risk factors, and perceived risk of surgical procedure. Future of cardiac SPECT imaging will be driven by societal demand for cost effective, accurate, and safe testing, which will improve meaningfully short-term and long-term outcomes.