Use Of Single Photon Emission Computerized Tomography Research Articles

SPECT/CT and PET/CT for the Evaluation of Persistent or Recurrent Pain After Spine Surgery: A Systematic Review and Case Series

ObjectiveThe differential diagnosis for postoperative back pain is broad, and conventional imaging modalities are not always conclusive. Therefore, we performed a systematic review of the literature and present case studies describing the use of single-photon emission CT (SPECT)/CT or positron emission tomography (PET)/CT in the diagnosis of back pain following spine surgery. MethodsA systematic review was conducted according to PRISMA guidelines across 5databases. Relevant keywords included PET/CT, bone SPECT/CT, and pseudarthrosis. The studies were assessed for diagnostic accuracy of the imaging technologies. ResultsA total of 2444 studies were screened, 91 were selected for full-text review, and 21 were ultimately included. Six retrospective studies investigated the use of SPECT/CT with a total sample size of 309 patients. Two of these studies used SPECT/CT to predict screw loosening in over 50% of patients. Eight studies examined the use of 18-fluoride sodium fluoride (18F-NaF) PET/CT. Among these studies, measures of diagnostic accuracy varied but overall demonstrated the ability of 18F-NaF PET/CT to detect screw loosening and pseudarthrosis. Seven studies examined 18F-fluorodeoxyglucose (FDG) PET/CT and supported its utility in the diagnosis of postoperative infections in the spine. ConclusionsPET/CT and SPECT/CT are useful in the evaluation of postoperative pain of the spine, especially in patients for whom conventional imaging modalities yield inconclusive results. More diagnostic accuracy studies with strong reference standards are needed to compare hybrid imaging to conventional imaging.

From the Reading Room to the Courtroom—The Use of Molecular Radionuclide Imaging in Criminal Trials

Recent years have witnessed an expanded use of single-photon emission CT and PET for a wide range of clinical applications, including imaging of brain abnormalities. As a result, molecular brain imaging is now being more extensively utilized in criminal cases, in particular in the sentencing phase of a trial. This perspective aims to provide a brief overview for the practicing radiologist of this expanded use of single-photon emission CT and PET in criminal cases and will discuss the role of radiology in this field.

Single-Photon Emission CT to Access Outcomes in Children with Moyamoya Syndrome and Sickle Cell Disease Before and After Encephaloduroarteriosynagiosis

Abstract▪2143▪This icon denotes a clinically relevant abstract Background:About 11% of patients with sickle cell disease (SCD) will develop and ischemic stroke by 20 years. Patients with SCD and Moyamoya Syndrome (MMS) are at an especially high risk for developing stroke. Encephaloduroarteriosynagiosis (EDAS) is emerging as a safe and effective method for the treatment of MMS in Pediatric patients with SCD since it provides improved revascularization. Single-photon emission CT (SPECT) has been used in pediatric MMS patients to demonstrate regions of decreased cerebral perfusion and cerebrovascular reserve. The use of SPECT in SCD patients with MMS undergoing EDAS has not been evaluated. Methods:Between 2001 and 2011 we had 45 patients with SCD who developed clinical evidence of cerebrovascular accident (CVA), transient ischemic attack (TIA), or seizure with radiologic evidence (magnetic resonance and or angiography) of MMS. 20 underwent surgical revascularization with EDAS. Vascular reserve and cerebral perfusion was assessed with SPECT before and after EDAS in 9 patients. Results:6/9 patients had bilateral EDAS while 3/9 had unilateral EDAS. The postoperative clinical outcome of each patient was assigned to one of the following 3 categories based on the SPECT reports: (1) improved if there was increased perfusion and vascular reserve after EDAS, (2) stable if there were no new areas of decreased perfusion or vascular reserve after EDAS and (3) worsened if there were new areas of decreased perfusion or vascular reserve with increased risk for future infarct after EDAS. 6/9 patients showed improvement, 2/9 patients showed stable cerebral perfusion and vascular reserve and 1 patient showed additional areas at risk for future infarct. SPECT was performed on average 5.7 (range 1.5–16.1) months before EDAS and 16.2 (range 1–47.1) months after EDAS. Conclusions:SPECT performed before and after EDAS of the involved cerebral hemispheres can assess effectiveness of revascularization surgery and may predict the further clinical outcomes of pediatric patients with SCD and MMS. Disclosures:No relevant conflicts of interest to declare.

Functional imaging of the brain using single photon emission computerized tomography (SPECT).

The use of tracers is an important technique available for studying cerebral function. Changes in 'signal' are large, but as a result of its photon limited nature, the measurement of this signal is limited: spatially, temporally and in terms of accuracy. The most commonly used single photon (SPECT) system (as apposed to positron) is that with a rotating gamma camera, although multi-headed devices and special purpose rings are now also commonly available. The problems of obtaining good functional information are however identical. Firstly the devices need to be optimised in terms of resolution and sensitivity. Secondly several sources of error, notably those associated with scatter, attenuation and limited spatial resolution, need to be corrected, with the aim of obtaining quantitative estimates of radioactivity concentration. Finally such quantitative estimates need to be converted into meaningful estimates of physiological variables by use of an appropriate model. The general aim of many SPECT measurements is to estimate blood flow for example using Tc-99m labelled HMPAO as a tracer. Good results have been obtained in many clinical conditions: stroke, dementia, tumour and epilepsy, for example. Many other tracers are also available, for example to measure density of receptor sites. The use of SPECT in conjunction with other techniques after image registration is suggested as being an essential tool in extracting maximal clinical information.