Three-dimensional brain phantom containing bone and grey matter structures with a realistic head contour

Introduction

A physical 3-dimensional phantom that simulates PET/SPECT images of static regional cerebral blood flow in grey matter with a realistic head contour has been developed. This study examined the feasibility of using this phantom for evaluating PET/SPECT images.

Methods

The phantom was constructed using a transparent, hydrophobic photo-curable polymer with a laser-modelling technique. The phantom was designed to contain the grey matter, the skull, and the trachea spaces filled with a radioactive solution, a bone-equivalent solution of K₂HPO₄, and air, respectively. The grey matter and bone compartments were designed to establish the connectivity. A series of experiments was performed to confirm the accuracy and reproducibility of the phantom using X-ray CT, SPECT, and PET.

Results

The total weight was 1997 ± 2 g excluding the inner liquid, and volumes were 563 ± 1 and 306 ± 2 mL, corresponding to the grey matter and bone compartments, respectively. The apparent attenuation coefficient averaged over the whole brain was 0.168 ± 0.006 cm^?1 for Tc-99 m, which was consistent with the previously reported value for humans (0.168 ± 0.010 cm^?1). Air bubbles were well removed from both grey-matter and bone compartments, as confirmed by X-ray CT. The phantom was well adapted to experiments using PET and SPECT devices.

Conclusion

The 3-dimensional brain phantom constructed in this study may be of use for evaluating the adequacy of SPECT/PET reconstruction software programs.     

Dual-energy perfusion CT of non-diseased lung segments using dual-source CT: correlation with perfusion SPECT

Purpose

To determine the utility of dual-energy perfusion CT (DEpCT) of non-diseased lung segments, using dual-source CT, in comparison with perfusion single-photon emission computed tomography (SPECT).

Materials and methods

28 patients (18 male and 10 female; mean age 63 years; age range 18–86 years) underwent DEpCT and SPECT within a 3-day interval. The presence and location of perfusion defects in each segment of the lungs were evaluated.

Results

Perfusion defects were noted in 7 of 361 segments (1.9 %) by DEpCT and in 19 of 361 segments (5.3 %) by perfusion SPECT. DEpCT was in good agreement with perfusion SPECT for 338 of 361 segments (93.6 %). Intraobserver agreement was also good, ranging from 93.4 to 93.6 % (κ = 0.64–0.75, p < 0.01).

Conclusion

For non-diseased lung segments, DEpCT correlated well with SPECT.     

Performance of a semiconductor SPECT system: comparison with a conventional Anger-type SPECT instrument

Objective

The performance of a new single photon emission computed tomography (SPECT) scanner with a cadmium-zinc-telluride (CZT) solid-state semiconductor detector (Discovery NM 530c; D530c) was evaluated and compared to a conventional Anger-type SPECT with a dual-detector camera (Infinia).

Methods

Three different phantom studies were performed. Full width at half maximum (FWHM) was measured using line sources placed at different locations in a cylindrical phantom. Uniformity was measured using cylindrical phantoms with 3 different diameters (80, 120, and 160 mm). Spatial resolution was evaluated using hot-rod phantoms of various diameters (5, 9, 13, 16, and 20 mm). Three different myocardial phantom studies were also performed, acquiring projection data with and without defects, and evaluating the interference of liver and gallbladder radioactivity. In a clinical study, the D530c employed list-mode raw data acquisition with electrocardiogram (ECG)-gated acquisition over a 10-min period. From the 10-min projection data, 1-, 3-, 5-, 7- and 10-min SPECT images were reconstructed.

Results

The FWHM of the D503c was 1.73–3.48 mm (without water) and 3.88–6.64 mm (with water), whereas the FWHM of the Infinia was 8.17–12.63 mm (without water) and 15.48–16.28 mm (with water). Non-uniformity was larger for the D530c than for the Infinia. Truncation artifacts were also observed with the D530c in a Φ160 mm phantom. The contrast ratio, as defined by myocardial defect/non-defect ratio, was better for the D530c than for the Infinia, and the influence from liver and gallbladder radioactivities was less. Quantitative gated SPECT (QGS) software demonstrated significant differences between data captured over a 10-min period, relative to those acquired over periods of <5 min; there was no difference between ejection fractions calculated using data capture for periods ≥5 min (p < 0.05).

Conclusions

The D530c is superior to the Infinia, with regard to both spatial resolution and sensitivity. In this study, these advantages were confirmed by the myocardial phantom and in a clinical setting, using the QGS software.     

Prognostic value of left ventricular dyssynchrony by myocardial perfusion-gated SPECT in patients with normal and abnormal left ventricular functions

Background

Left ventricular (LV) dyssynchrony by phase analysis has been studied by myocardial perfusion imaging (MPI)-gated SPECT in patients with LV dysfunction in various clinical settings. We aimed to investigate the routine use of phase analysis with gated SPECT for predicting cardiac outcome.

Methods

Patients referred to a tertiary medical center in 2010-2011 prospectively underwent a gated SPECT and phase analysis, and follow-up for cardiac events. The values of clinical variables, MPI, LV function, and LV dyssynchrony in predicting cardiac events were tested by univariate and multivariate analyses.

Results

The study group included 787 patients (66.5 ± 11 years, 81% men) followed for a mean duration of 18.3 ± 6.2 months. There were 45 (6%) cardiac events defined as composite endpoint; cardiac death occurred in 26 patients, and the rest had new-onset or worsening heart failure and life-threatening arrhythmias. In multivariate analysis, it was shown that NYHA class, diabetes mellitus, and LVEF <50% were the independent predictors for composite endpoint. However, the independent predictors for cardiac mortality were NYHA class (for each increment in class) and phase standard deviation (SD) (for each 10° increment).

Conclusion

Gated SPECT with phase analysis for the assessment of LV dyssynchrony can successfully predict cardiac death together with NYHA class, in patients with LV dysfunction.     

The performance of phase analysis of gated SPECT myocardial perfusion imaging in the presence of perfusion defects: A simulation study

Background

Phase analysis has been developed and validated to measure left-ventricular dyssynchrony from gated SPECT myocardial perfusion imaging. The purpose of this study is to evaluate its performance in regions with perfusion defects.

Methods

A special version of the eXtended CArdiac Torso digital phantom was developed to track B-spline points in each temporal frame. A region of 35 B-spline points in the inferior wall with normal and abnormal perfusion uptakes were simulated. Phase shifts were simulated in the same region, representing dyssynchronous contraction. Gated SPECT data were analyzed using a modified phase analysis algorithm, which tracked the same 35 B-spline points to calculate their phases.

Results

Phases and phase shifts measured in the B-spline points with perfusion uptake in the range of 50%-10% did not significantly differ from those measured in the same B-spline points with normal perfusion uptake.

Conclusion

Phase analysis can accurately measure phases in regions with abnormal perfusion uptake as low as 10% of the perfusion uptake in the normal regions, which corresponded to a regional signal-to-noise ratio (SNR) of 12.0 or greater. In 42 consecutive patients with myocardial infarction >20% of the left ventricle, only two patients had a SNR within the perfusion defects below that threshold.     

Head-to-head comparison of a 2-day myocardial perfusion gated SPECT protocol and cardiac magnetic resonance late gadolinium enhancement for the detection of myocardial infarction

Background

The aim was to determine the sensitivity and specificity of gated myocardial perfusion SPECT (MPS) with a technetium-labelled (Tc) perfusion tracer to detect myocardial infarction (MI) in a clinical population referred for assessment of stress-induced ischemia using late gadolinium enhancement cardiac magnetic resonance (CMR) as reference method.

Methods

119 patients referred for evaluation of stress-induced ischemia with MPS were included. 108 patients (age 62 ± 10 years, 39% females) completed MPS and CMR. A 2-day protocol for MPS was used for most patients (n = 105).

Results

MI was found in 31 patients (29%) using MPS and in 30 patients using CMR (28%). The sensitivity and specificity on a patient basis were 93% and 96%, respectively. Positive predictive value (PPV) was 90% and negative predictive value (NPV) was 97%. Per territory, the sensitivity and specificity for LAD infarcts were 83% and 97%, respectively. PPV was 77% and NPV was 98% for LAD infarcts. The sensitivity and specificity for RCA/LCx infarcts were 95% and 95%, respectively. PPV was 84% and NPV was 99% for RCA/LCx infarcts. The MI size on CMR was 12.0 ± 7.3% of the LV and mean transmurality was 66.3 ± 12.0%. All MI > 3% were detected on gated SPECT.

Conclusion

This study has demonstrated high sensitivity and specificity for gated Tc-MPS detecting subendocardial and transmural MI.     

A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT

Objectives

Wide Beam Reconstruction (WBR) (UltraSPECT, Ltd) uses resolution recovery and noise modeling to cope with decreased SPECT count statistics. Because WBR processing reconstructs half the usual SPECT count statistics, we postulate that image quality equivalent to a full-time acquisition can be achieved in either half the time or with half the radiopharmaceutical activity.

Methods

In 156 consecutive patients (pts) rest and 8-frame gated post-stress myocardial perfusion SPECT was performed following 333-444 and 1184-1480 MBq (9-12 and 32-40 mCi) Tc-99m sestamibi injections, respectively, with full-time (rest = 14 min; stress = 12.3 min) acquisitions processed with OSEM and also separate “half-time” acquisitions processed with WBR. A subsequent group of 160 consecutive pts matched in gender, weight, and chest circumference received “half-dose” rest and stress injections 214.6 ± 22.2 and 647.5 ± 92.5 MBq (5.8 ± 0.6 and 17.5 ± 2.5 mCi) with full-time SPECT acquisitions. Image quality (1 = poor to 5 = excellent) was judged by myocardial count density and uniformity, endocardial edge definition, perfusion defect delineation, right ventricular visualization, and background noise.

Results

Mean image quality for rest, stress, and post-stress gated images were 3.6 ± 0.7, 3.8 ± 0.7, and 3.9 ± 1.0, respectively, for “full-time OSEM; 3.7 ± 0.8, 4.0 ± 0.7, and 4.8 ± 0.4 for “half-time” WBR; and 4.3 ± 0.8, 4.6 ± 0.6, and 4.7 ± 0.6 for “half-dose” WBR. “Half-time” and “half-dose” WBR image quality were both superior to standard full-time OSEM (P’s < .001). There was no significant difference between the summed stress and rest scores for “full-time” OSEM vs “half-time” WBR in 82 patients with perfusion defects.

Conclusions

Both “half-time” and “half-dose” WBR provide myocardial perfusion SPECT quality superior to full-time OSEM, with an associated decrease in scan acquisition time and patient radiation exposure, respectively.     

Cardiac risk assessment by gated single-photon emission computed tomography in asymptomatic end-stage renal disease patients at the start of dialysis

Objectives

This study assessed the impact of cardiac risk assessment using gated single-photon emission computed tomography (SPECT) on cardiac events in end-stage renal disease (ESRD) patients.

Methods

We evaluated 215 asymptomatic patients who began dialysis between January 2005 and April 2009. Baseline electrocardiography and echocardiography were performed in all the patients. The subjects were stratified into low- and high-risk groups according to the baseline cardiac status, and gated SPECT was additionally recommended for the high-risk patients.

Results

The study population consisted of 50 low- and 165 high-risk patients undergoing SPECT. Among the high-risk patients, 75 (45.5%) showed perfusion defects on SPECT and their overall cardiac-event rate per person-year of follow-up was 15.0%, significantly higher than 4.5% in high-risk group without perfusion defect and 1.2% in low-risk group. The presence of perfusion defect was a significant independent predictor of adverse cardiac events [hazard ratio (HR) 2.11; 95% confidence interval (CI) 1.05-4.24; P?=?.035]. When gated SPECT was added to the clinical and the echocardiographic variables, the prognostic stratification significantly improved (P?P?=?.296).

Conclusions

Gated SPECT may provide additional prognostic information for cardiac risk stratification, particularly among high-risk patients starting dialysis.     

Validation of an automated method to quantify stress-induced ischemia and infarction in rest-stress myocardial perfusion SPECT

Background

Myocardial perfusion SPECT (MPS) is one of the frequently used methods for quantification of perfusion defects in patients with known or suspected coronary artery disease. This article describes open access software for automated quantification in MPS of stress-induced ischemia and infarction and provides phantom and in vivo validation.

Methods and Results

A total of 492 patients with known or suspected coronary artery disease underwent both stress and rest MPS. The proposed perfusion analysis algorithm (Segment) was trained in 140 patients and validated in the remaining 352 patients using visual scoring in MPS by an expert reader as reference standard. Furthermore, validation was performed with simulated perfusion defects in an anthropomorphic computer model. Total perfusion deficit (TPD, range 0-100), including both extent and severity of the perfusion defect, was used as the global measurement of the perfusion defects. Mean bias ± SD between TPD by Segment and the simulated TPD was 3.6 ± 3.8 (R ² = 0.92). Mean bias ± SD between TPD by Segment and the visual scoring in the patients was 1.2 ± 2.9 (R ² = 0.64) for stress-induced ischemia and ?0.3 ± 3.1 (R ² = 0.86) for infarction.

Conclusion

The proposed algorithm can detect and quantify perfusion defects in MPS with good agreement to expert readers and to simulated values in a computer phantom.     

Magnetic resonance imaging to assess the effect of exercise training on pulmonary perfusion and blood flow in patients with pulmonary hypertension

Objectives

To evaluate whether careful exercise training improves pulmonary perfusion and blood flow in patients with pulmonary hypertension (PH), as assessed by magnetic resonance imaging (MR).

Methods

Twenty patients with pulmonary arterial hypertension or inoperable chronic thromboembolic PH on stable medication were randomly assigned to control (n?=?10) or training groups (n?=?10). Training group patients received in-hospital exercise training; patients of the sedentary control group received conventional rehabilitation. Medication remained unchanged during the study period. Changes of 6-min walking distance (6MWD), MR pulmonary flow (peak velocity) and MR perfusion (pulmonary blood volume) were assessed from baseline to week 3.

Results

After 3 weeks of training, increases in mean 6MWD (P?=?0.004) and mean MR flow peak velocity (P?=?0.012) were significantly greater in the training group. Training group patients had significantly improved 6MWD (P?=?0.008), MR flow (peak velocity ?9.7?±?8.6 cm/s, P?=?0.007) and MR perfusion (pulmonary blood volume +2.2?±?2.7 mL/100 mL, P?=?0.017), whereas the control group showed no significant changes.

Conclusion

The study indicates that respiratory and physical exercise may improve pulmonary perfusion in patients with PH. Measurement of MR parameters of pulmonary perfusion might be an interesting new method to assess therapy effects in PH. The results of this initial study should be confirmed in a larger study group.

Key Points

? Quantification of magnetic resonance perfusion is feasible in patients with pulmonary hypertension. ? Quantified magnetic resonance perfusion may become useful for non-invasive monitoring of treatment. ? Quantification of lung perfusion allows new insights into lung (patho-)physiology of PH. ? Careful exercise training improves pulmonary perfusion and blood flow in patients with PH.     

Importance of gated CT acquisition for the quantitative improvement of the gated PET/CT in moving phantom

Objective

The aim of this study was to investigate the utility of gated PET/CT and CT attenuation correction (AC) for the quantitation of radioactivity.

Methods

An ellipse phantom containing six spheres, ranging from 10 to 37 mm in diameter, was filled with 36.7 kBq/mL of F-18. The respiratory motion was simulated by a motor-driven plastic platform to move the phantom with a displacement of 2 cm in the craniocaudal direction at a frequency of 15/min. With the phantom at rest, PET/CT data were acquired and used as a standard (nonmotion). With the phantom in motion, PET data were acquired in both the static and gated modes (sPET and gPET, respectively). Helical CT (HCT), slow CT (SCT), average CT (ACT), and four-dimensional CT (4DCT) were acquired and used to correct attenuation. On both PET and CT images, the maximum radioactivity, dimensions, and CT numbers were measured on the central slices.

Results

In nonmotion, recovery coefficients whose spheres were 22 mm or smaller gradually decreased. Regarding motion, the PET counts of the spheres in the static acquisition were lower than those acquired in nonmotion with either type of CTAC (sPET–HCT: ?43.8%, sPET–SCT: ?51.4%, sPET–ACT: ?49.5%). Gated acquisition of PET significantly improved the PET counts (gPET–HCT: ?30.1%) (p < 0.05), while additional gated acquisition of CT significantly improved them further (gPET–4DCT: ?15.2%) (p < 0.01). The dimensions of sPET were overestimated, but those of gPET were close to the standard values. The SCT significantly overestimated the dimensions, and the water density area decreased (p < 0.01). The 4DCT images were similar to the HCT images.

Conclusions

In respiratory motion, PET acquisition in the static mode underestimated the radioactivity and overestimated the dimensions. Neither SCT nor ACT improved these errors. Although PET acquisition in the gated mode improved the quantification of PET/CT images, the additional gated CT acquisition using 4DCT is required for further improvement.     

Simulation study on a stationary data acquisition SPECT system with multi-pinhole collimators attached to a triple-head gamma camera system

Objectives

The aim of the study was to develop a new SPECT system that makes it possible to acquire projection data stationary using a triple-head gamma camera system.

Methods

We evaluated several data acquisition geometry with multi-pinhole collimators attached to a triple-head gamma camera system. The number of pinholes for each camera was three to twelve, and we located these holes on collimator plates adequately. These collimator holes were tilted by predefined angles to efficiently cover the field of view of the data acquisition system. Acquired data were reconstructed with the OS-EM method. In the simulations, we used a three-dimensional point source phantom, brain phantom, and myocardial phantom. Attenuation correction was conducted with the x-ray CT image of the corresponding slice.

Results

Reconstructed images of the point source phantom showed that the spatial resolution could be improved with the small number of pinholes. On the other hand, reconstructed images of the brain phantom showed that the large number of pinholes yielded images with less artifact. The results of the simulations with the myocardial phantom showed that more than eight pinholes could yield an accurate distribution of activity when the source was distributed only in the myocardium.

Conclusions

The results of the simulations confirmed that more than eight pinholes for each detector were required to reconstruct an artifact free image in the triple-head SPECT system for imaging of brain and myocardium.     

Tetrofosmin early time gated post-stress single-photon emission computed tomography imaging: Feasibility and potential benefits

Background

The purpose of this study is to evaluate the feasibility, the image quality, and the clinical relevance of an early gated post-stress (GPS) single-photon emission computed tomography (SPECT) tetrofosmin (Myoview^?—GE Healthcare) acquisition protocol. Time delay between myocardial technetium-labeled tracer administration and SPECT acquisition is usually about 30 minutes after stress, and 45 to 60 minutes at rest: because of the absence of significant redistribution, perfusion images are related to stress even 30 minutes after stress injection, while function and thickening data obtained with gated acquisition 30 minutes after stress are mainly related to rest conditions.

Methods

194 patients were prospectively included and analyzed, in a multicenter registry. Three gated-SPECT 99^mTc-Tetrofosmin studies were performed per patient: GPS-SPECT, 30 minutes post-stress (GS30), and at rest (GR30).

Results

GPS image quality was excellent/good (93.9%), and similar to GS30 images (96.6%). The presence of adjacent myocardial sub-diaphragmatic activity on GPS images was similar to GS30 images (24% vs 22%), and less frequent than on GR30 images (31%). For perfusion, thickening, and motion scores, there was no significant difference between early and 30 minute post-stress in the global patient population, but significant differences were observed between GPS and GS30 for LVEF (65% ± 15% vs 63% ± 14%). In the ischemic patients, with the stress-rest protocol, the perfusion score was 14.2 on GPS images and 12.4 on GS30 images (P = .002).

Conclusions

Tetrofosmin early GPS-SPECT is feasible without impairment of image quality (better count rate). Ischemic defect size on early post-stress images is slightly more pronounced than at 30 minutes: this could modify therapeutic decision. This technique produces reliable function information during early post-stress period, and might be useful for disclosing transient motion abnormalities.     

Optimization of iterative reconstruction parameters with attenuation correction,scatter correction and resolution recovery in myocardial perfusion SPECT/CT

Objective

The aim of this study was to characterize the optimal reconstruction parameters for ordered-subset expectation maximization (OSEM) with attenuation correction, scatter correction, and depth-dependent resolution recovery (OSEM_ACSCRR). We assessed the optimal parameters for OSEM_ACSCRR in an anthropomorphic torso phantom study, and evaluated the validity of the reconstruction parameters in the groups of normal volunteers and patients with abnormal perfusion.

Methods

Images of the anthropomorphic torso phantom, 9 normal volunteers and 7 patients undergoing myocardial perfusion SPECT were acquired with a SPECT/CT scanner. SPECT data comprised a 64 × 64 matrix with an acquisition pixel size of 6.6 mm. A normalized mean square error (NMSE) of the phantom image was calculated to determine both optimal OSEM update and a full width at half maximum (FWHM) of Gaussian filter. We validated the myocardial count, contrast and noise characteristic for clinical subjects derived from OSEM_ACSCRR processing. OSEM with depth-dependent resolution recovery (OSEM_RR) and filtered back projection (FBP) were simultaneously performed to compare OSEM_ACSCRR.

Results

The combination of OSEM_ACSCRR with 90–120 OSEM updates and Gaussian filter with 13.2–14.85 mm FWHM yielded low NMSE value in the phantom study. When we used OSEM_ACSCRR with 120 updates and Gaussian filter with 13.2 mm FWHM in the normal volunteers, myocardial contrast showed significantly higher value than that derived from 120 updates and 14.85 mm FWHM. OSEM_ACSCRR with the combination of 90–120 OSEM updates and 14.85 mm FWHM produced lowest % root mean square (RMS) noise. Regarding the defect contrast of patients with abnormal perfusion, OSEM_ACSCRR with the combination of 90–120 OSEM updates and 13.2 mm FWHM produced significantly higher value than that derived from 90–120 OSEM updates and 14.85 mm FWHM. OSEM_ACSCRR was superior to FBP for the % RMS noise (8.52 ± 1.08 vs. 9.55 ± 1.71, p = 0.02) and defect contrast (0.368 ± 0.061 vs. 0.327 ± 0.052, p = 0.01), respectively.

Conclusions

Clinically optimized the number of OSEM updates and FWHM of Gaussian filter were (1) 120 updates and 13.2 mm, and (2) 90–120 updates and 14.85 mm on the OSEM_ACSCRR processing, respectively. Further assessment may be required to determine the optimal iterative reconstruction parameters in a larger patient population.     

Radius dependence of FP-CIT quantification: a Monte Carlo-based simulation study

Objective

Dopamine transporter imaging with SPECT is a valuable tool for both clinical routine and research studies. Semi-quantitative analysis plays a key role in interpreting the scans, but is dependent on numerous factors, rotational radius being one of them. This study systematically evaluates the potential influence of radius of rotation on apparent tracer binding and describes methods for correction.

Methods

Monte Carlo simulation scans of a digital brain phantom with various disease states and various radii of rotation ranging from 13 to 30 cm were analyzed using 4 different methods of semi-quantification. Different volumes of interest as well as a method with partial volume correction were applied.

Results

For conventional 3D semi-quantification methods the decrease of measured striatal binding per cm additional radius rotation lied in the range between 2.5 and 3.1 %, whereas effects were negligible when applying recovery-corrected quantification. Effects were independent of disease state.

Conclusion

Partial volume effects with increasing radius of rotation can lead to considerable decrease of measured binding ratios, particularly when applying dopamine transporter imaging in a research setting. Standardization of acquisition radius can avoid the effect; correction seems feasible, but the correction factors depend on the quantification approach applied.     

A randomized study of the effect of carbonated water prior to myocardial SPECT

Objective

In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies.

Methods

A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semi-quantitative analysis was performed in the adenosine subgroup, using a count ratio of the inferior myocardial wall and adjacent abdominal activity.

Results

The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p < 0.001). The effect of carbonated water during rest and after exercise was not significant.

Conclusions

This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI.     

The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease

Background

Prior studies show that left ventricular mechanical dyssynchrony (LVD), measured by gated SPECT myocardial perfusion imaging (MPI), identifies patients with end-stage renal disease (ESRD) at higher risk for all-cause mortality but these were in small number of patients. We sought to assess the interaction between LVD and LV perfusion pattern in risk-stratification of a large sample size of patients with ESRD.

Methods

From the renal transplantation database maintained at the University of Alabama at Birmingham, we identified consecutive patients with ESRD who had gated SPECT MPI between 2003 and 2007. MPIs were reprocessed to derive LV ejection fraction (EF), perfusion defect size, and LVD [phase bandwidth (BW) and phase standard deviation (SD)]. The primary end-point was all-cause mortality, which was prospectively collected and verified against the social security death index database.

Results

There were 828 patients aged 52.6 ± 0.36 years (45% were women and 60% had diabetes mellitus). The LVEF was 54.8 ± 0.4% and the perfusion pattern was abnormal in 334 patients (41%). During a follow-up period of 61 ± 0.9 months, 230 patients (28%) received renal transplants and 290 patients (35%) died. The phase BW (73.1 ± 2.6° vs 66.3 ± 1.8°, P = .02) and SD (25.2 ± 0.8° vs 23.4 ± 0.5°, P = .06) were greater in patients who died than those who survived indicating greater dyssynchrony. Patients with phase BW >56° or SD ≥21° (median values) had worse 5-year survival (64% vs 72%, and 66% vs 71%, log-rank P = .005 and P = .07, respectively). After adjusting for demographics, co-morbidities, LVEF, and perfusion pattern, phase BW was associated with worse outcome (hazard ratio 1.289 95% CI 1.010-1.644, P = .04).

Conclusions

LVD by phase analysis of gated SPECT MPI provides prognostic value in ESRD beyond myocardial perfusion and EF.     

Evaluation of chronic ischemic heart disease with myocardial perfusion and regional contraction analysis by contrast-enhanced 256-MSCT

Purpose

To investigate myocardial viability in chronic ischemic heart disease by myocardial perfusion and regional contraction analysis using 256-slice MSCT coronary angiography (CCTA).

Methods

In 30 patients with prior myocardial infarction (MI), CCTA with retrospective ECG-gating and stress-redistribution thallium-201 SPECT were performed. Using the same raw data as used for CCTA, myocardial perfusion imaging (CT-MPI) was reconstructed at four phases during the cardiac cycle. Mean myocardial attenuation and wall thickness at end-systole and end-diastole were measured in the MI areas depicted by SPECT, and they were compared between viable and non-viable segments categorized by SPECT.

Results

End-systolic thickness was significantly greater for viable than for non-viable segments (12.0 ± 3.2 vs. 9.6 ± 3.5 mm, p = 0.0017). There was no difference in end-diastolic thickness. Myocardial attenuation was significantly higher for viable than for non-viable segments in the subendocardium (62 ± 13 vs. 70 ± 11 HU, p = 0.003) and the epicardium (65 ± 13 vs. 80 ± 15 HU, p = 0.0002).

Conclusion

The systolic wall thinning and epicardial low-attenuation areas were the indicative findings of CT-MPI for non-viable segments in the prior MI.     

Simultaneous dual-radionuclide myocardial perfusion imaging with a solid-state dedicated cardiac camera

Purpose

We compared simultaneous dual-radionuclide (DR) stress and rest myocardial perfusion imaging (MPI) with a novel solid-state cardiac camera and a conventional SPECT camera with separate stress and rest acquisitions.

Methods

Of 27 consecutive patients recruited, 24 (64.5±11.8 years of age, 16 men) were injected with 74 MBq of ²⁰¹Tl (rest) and 250 MBq ^99mTc-MIBI (stress). Conventional MPI acquisition times for stress and rest are 21 min and 16 min, respectively. Rest ²⁰¹Tl for 6 min and simultaneous DR 15-min list mode gated scans were performed on a D-SPECT cardiac scanner. In 11 patients DR D-SPECT was performed first and in 13 patients conventional stress ^99mTc-MIBI SPECT imaging was performed followed by DR D-SPECT. The DR D-SPECT data were processed using a spill-over and scatter correction method. DR D-SPECT images were compared with rest ²⁰¹Tl D-SPECT and with conventional SPECT images by visual analysis employing the 17-segment model and a five-point scale (0 normal, 4 absent) to calculate the summed stress and rest scores. Image quality was assessed on a four-point scale (1 poor, 4 very good) and gut activity was assessed on a four-point scale (0 none, 3 high).

Results

Conventional MPI studies were abnormal at stress in 17 patients and at rest in 9 patients. In the 17 abnormal stress studies DR D-SPECT MPI showed 113 abnormal segments and conventional MPI showed 93 abnormal segments. In the nine abnormal rest studies DR D-SPECT showed 45 abnormal segments and conventional MPI showed 48 abnormal segments. The summed stress and rest scores on conventional SPECT and DR D-SPECT were highly correlated (r=0.9790 and 0.9694, respectively). The summed scores of rest ²⁰¹Tl D-SPECT and DR-DSPECT were also highly correlated (r=0.9968, p<0.0001 for all). In six patients stress perfusion defects were significantly larger on stress DR D-SPECT images, and five of these patients were imaged earlier by D-SPECT than by conventional SPECT.

Conclusion

Fast and high-quality simultaneous DR MPI is feasible with D-SPECT in a single imaging session with comparable diagnostic performance and image quality to conventional SPECT and to a separate rest ²⁰¹Tl D-SPECT acquisition.     

Aperture correction with an asymmetrically trimmed Gaussian weight in SPECT with a fan-beam collimator

Objectives

The aim of the study is to improve the spatial resolution of SPECT images acquired with a fan-beam collimator.

Methods

The aperture angle of a hole in the fan-beam collimator depends on the position of the collimator. To correct the aperture effect in an iterative image reconstruction, an asymmetrically trimmed Gaussian weight was used for a model. To confirm the validity of our method, point source phantoms and brain phantom were used in the simulation, and we applied the method to the clinical data.

Results

The results of the simulation showed that the spatial resolution of point sources improved from about 6 to 2 pixels full width at half maximum, and the corrected point sources were isotropic. The results of the simulation with the brain phantom showed that our proposed method could improve the spatial resolution of the phantom, and our method was effective for different fan-beam collimators with different focal lengths. The results of clinical data showed that the quality of the reconstructed image was improved with our proposed method.

Conclusions

Our proposed aperture correction method with the asymmetrically trimmed Gaussian weighting function was effective in improving the spatial resolution of SPECT images acquired with the fan-beam collimator.