Correction of nonuniform attenuation and image fusion in SPECT imaging by means of separate X-ray CT

Improvements in image quality and quantitation measurement, and the addition of detailed anatomical structures are important topics for single-photon emission tomography (SPECT). The goal of this study was to develop a practical system enabling both nonuniform attenuation correction and image fusion of SPECT images by means of high-performance X-ray computed tomography (CT). A SPECT system and a helical X-ray CT system were placed next to each other and linked with Ethernet. To avoid positional differences between the SPECT and X-ray CT studies, identical flat patient tables were used for both scans; body distortion was minimized with laser beams from the upper and lateral directions to detect the position of the skin surface. For the raw projection data of SPECT, a scatter correction was performed with the triple energy window method. Image fusion of the X-ray CT and SPECT images was performed automatically by auto-registration of fiducial markers attached to the skin surface. After registration of the X-ray CT and SPECT images, an X-ray CT-derived attenuation map was created with the calibration curve for 99mTc. The SPECT images were then reconstructed with scatter and attenuation correction by means of a maximum likelihood expectation maximization algorithm. This system was evaluated in torso and cylindlical phantoms and in 4 patients referred for myocardial SPECT imaging with Tc-99m tetrofosmin. In the torso phantom study, the SPECT and X-ray CT images overlapped exactly on the computer display. After scatter and attenuation correction, the artifactual activity reduction in the inferior wall of the myocardium improved. Conversely, the incresed activity around the torso surface and the lungs was reduced. In the abdomen, the liver activity, which was originally uniform, had recovered after scatter and attenuation correction processing. The clinical study also showed good overlapping of cardiac and skin surface outlines on the fused SPECT and X-ray CT images. The effectiveness of the scatter and attenuation correction process was similar to that observed in the phantom study. Because the total time required for computer processing was less than 10 minutes, this method of attenuation correction and image fusion for SPECT images is expected to become popular in clinical practice.     

Estimation of scatter component in SPECT planar image using a Monte Carlo method

A Monte Carlo simulation was performed to estimate quantitatively the scattered photons in planar images of SPECT. As a phantom we used a water-filled cylinder with a line source and calculated the energy spectra of primary and multiple scattered photons separately at each pixel of the planar images. The energy spectra of primary and scattered photons were studied on following parameters: the size of the phantom; the location of the source; the width of the energy window centered at 72.3 (Tl-201), 141 (Tc-99m), and 159 keV (I-123); and the view angle of the planar images. Obtained results were; (1) the energy spectra of Compton scattered photon varied with the phantom size, the source location, and the photopeak energy, (2) the scattered photons within energy windows of 10-30% centered at the photopeak energy were mainly composed by Compton scatter of the first order, (3) the higher order scattering component of the Compton photons did not represent the location of the line source on the planar image, and (4) the scatter fraction defined by the ratio of the scattered photons to the primary photons increased with increasing the size of the phantom and the width of energy window at the low photopeak energy. From the results, we discussed on the scatter subtraction methods.     

Compton scatter image simulating jugular venous reflux

In a radionuclide cerebral angiographic study, Tc-99m photons from the subclavian vein may scatter in the superficial tissues of the neck and head, resulting in an image simulating the jugular venous reflux. In a scintillation camera peaked at 140 keV with a 20% window, any scattered photons with a scatter angle of less tha 53.5 degrees may be counted in the Tc-99m window. This scatter angle is large enough to allow counting of many secondary photons from Compton collisions in an area quite distant from the radioactive source to be counted, provided the scatter area and source are separated by air.     

Correction of scattered photons in Tc-99m imaging by means of a photopeak dual-energy window acquisition

We are proposing a new method for correcting of scattered photons in technetium-99m (99mTc) imaging by means of photopeak dual-energy window acquisition. This method consists of the simultaneous acquisition of two images and estimation of a scatter image included in the symmetric energy window (SW) image by the difference between these images. The scatter corrected image is obtained by subtracting the scatter image from the SW image. In order to evaluate this method, we imaged a planar and a SPECT phantom with cold lesions and calculated the contrast value with and without the scatter correction. In addition, we performed asymmetric energy window (ASW) imaging to compare with this scatter correction method for planar images. In the planar image with the tissue-equivalent material of 10 cm, the scatter correction method removed 32% of the counting rate of the SW image and improved from 0.81 to 0.94 of the contrast value for a 4 cm-diameter cold lesion, while the contrast value with the ASW was 0.87 for such a cold lesion. The scatter corrected SPECT image had a reduction of 18% of the counting rate of the SW SPECT image and improvement of approximately 11% in contrast for cold spot sizes larger than a 3 cm-diameter, compared with the SW SPECT image. In addition, a perfusion defect could be well visualized by this scatter correction method on 99mTc-HMPAO regional cerebral blood flow SPECT of a patient. Our proposed scatter correction method can improve both planar and SPECT images qualitatively and quantitatively.     

Simulation study of triple-energy-window scatter correction in combined Tl-201, Tc-99m SPECT

In a quantitative SPECT study with multiple radionuclides, it is very important to eliminate the counts of scattered photons from planar images. In this paper, the triple energy window (TEW) method, which has developed to eliminate the counts of scatter photons in measured counts, was applied to a multiradionuclide SPECT study and its effect was examined in a simulation study. In the simulation, we used Tc-99m and Tl-201, and we assumed their photopeak energies to be 141 and 73 keV, respectively. For two different activity distributions in a cylinder phantom, simulation tests with Tl-201 and Tc-99m gave good agreement between the activity distributions reconstructed from primary photons and those from corrected data. The contrast of a cold spot area in images with and without correction improved around 70% to more than 96%.     

Endocrine neoplasm scintigraphy: added value of fusing SPECT/CT images compared with traditional side-by-side analysis

PURPOSE: Positron emission tomography (PET)/computed tomography (CT) imaging integrates physiology and anatomy, providing a powerful dual-modality approach. Analogously, fusing independently acquired single photon emission computed tomography (SPECT) and CT images can overcome interpretive challenges in characterizing and localizing abnormalities by either modality alone, potentially enhancing diagnostic confidence. This study explores the added value of SPECT/CT image fusion compared with traditional "side-by-side" SPECT/CT image review for a variety of endocrine neoplasms. METHODS AND MATERIALS: We identified 11 abnormal endocrine neoplasm SPECT scans in 10 patients with contemporary relevant CT scans. These cases included: 4 I-131 (posttherapy thyroid cancer), 2 I-123 (pretherapy thyroid cancer), 2 In-111 OctreoScan (neuroendocrine neoplasm), one Tc-99m sestamibi (thyroid cancer), one Tc-99m tetrofosmin (parathyroid adenoma), and one I-123 MIBG (adrenergic neoplasm). SPECT and CT images were uploaded onto side-by-side workstations, one with fusion software. Two experienced nuclear radiologists first reviewed "side-by-side" SPECT/CT images followed by fused SPECT/CT images. They scored 2 parameters-anatomic localization and diagnostic confidence-using a 4-point scale (1 "not helpful" to 4 "very helpful"). Score differences > or =1 indicated "added value"; < or =0 indicated "lack of added value." RESULTS: Compared with "side-by-side" SPECT/CT images, fused SPECT/CT images yielded "added value" for anatomic localization and diagnostic confidence in two thirds of cases. Fusion led to altered diagnoses in 4 of 11 examinations. Greater confidence was also achieved in 3 of 4 when the interpretation was changed and in 4 of 7 cases when it was not. CONCLUSIONS: CT correlation can be helpful in interpreting endocrine neoplasm SPECT imaging. SPECT/CT image fusion outperformed "side-by-side" SPECT/CT analysis for neoplasm anatomic localization and diagnostic confidence. Therefore, SPECT/CT fusion should be performed routinely because it potentially influences clinical decision-making and patient management.     

Body-contour versus circular orbit acquisition in cardiac SPECT: assessment of defect detectability with channelized Hotelling observer

BACKGROUND: The resolution of a gamma camera is depth-dependent and worsens with increasing distance to the camera resulting in a loss of fine details in SPECT images. A common approach to reduce the effects of this resolution loss is to utilize body-contour acquisition orbits. Even though body-contour orbits can improve resolution of reconstructed images their effect on lesion detection is not well known. OBJECTIVE: To investigate whether body-contour orbits offer better defect detection performance than circular orbits in cardiac SPECT. METHODS: The mathematical cardiac torso (MCAT) phantom was used to model Tc-sestamibi uptake. A total of four phantoms (two male and two female) with eight defects (four locations and two sizes) were generated and projection data were simulated using an analytical projector with attenuation, scatter, collimator response and acquisition orbit modelling. The circular and body-contour projections were reconstructed using the OSEM algorithm with/without collimator response compensation. Defect detection performance was assessed by calculating area under the receiver operating characteristic (ROC) curve for channelized Hotelling observer. RESULTS: The defect detection performance of circular and body-contour acquisition was very similar and the difference in the area under the ROC curve between the orbits was not statistically significant with or without collimator response compensation. The collimator response compensation, on the other hand, was noticed to be valuable and it provided significantly better defect detection performance than reconstruction without it regardless of the acquisition orbit type. CONCLUSIONS: We conclude that by replacing circular orbit with more complex body-contour orbit will not lead to statistically significant increase in defect detection performance in cardiac SPECT.     

Development of a new method of high-speed rotation multiplied projection single photon emission computed tomography of the triple-headed type: lung MAA SPECT based on phantom study

PURPOSE: A chest phantom study was conducted to evaluate the image quality of newly developed high-speed rotation multiplied projection-single photon emission computed tomography (HSRMP-SPECT) images. MATERIALS AND METHODS: HSRMP-SPECT images of a chest phantom consisting of a simulated lung structure filled with 5000 ml of water containing 185 MBq Tc-99m-pertechnetate, and several small 11 mm simulated lung nodules of glass balls and one large 35 mm simulated lung nodule of a plastic sphere filled with water were obtained using a triple-headed SPECT system. During image acquisition, this phantom was regularly moving in the head-to-caudal direction with a range of 12 mm at a frequency of 15 cycles/min to simulate respiratory motion, and 360 degrees projection data of this moving phantom was acquired with an image acquisition time of 20 sec, which was repeated 10 times. To eliminate the setting time between projection and acquisition of multiple temporal samples of data, each detector was continuously rotated in the clockwise direction for 20 sec around a 120-degree arc. On the perspective SPECT images reconstructed from various numbers of the 20-sec projection data, the perfusion heterogeneity of the simulated lungs and perfusion defect clarity of the simulated nodules were assessed by the coefficient of variation (CV) of pixel counts and the defect-to-lung radioactivity ratios, respectively. The results were compared with those on conventional SPECT images of the moving phantom obtained with a data acquisition time of 8 min, and SPECT images of the standing phantom obtained with the same data acquisition time. RESULTS: The average CV value of 0.28+/-0.01 on the SPECT image reconstructed from 5 projection data sets was not significantly different from that of 0.27+/-0.01 on the SPECT image reconstructed from 10 projection data sets (p<0.05). The perfusion defect contrast of the simulated nodules obtained from 5 projection data was significantly higher than that on conventional SPECT images (0.50 vs. 0.73) . CONCLUSIONS: The present phantom study indicated that HSRMP-SPECT could be a useful technique for quickly obtaining high-quality SPECT images of a moving subject, thereby improving perfusion defect clarity in comparison with the conventional technique. This technique may have potential utility for obtaining high-quality breath-hold SPECT images of the chest in clinical practice.     

Characterization of septal penetration in 511 keV SPECT

BACKGROUND: Single photon emission computed tomography (SPECT) with 511 keV photons is a challenging modality and collimators for this purpose require trade-offs among resolution, sensitivity and septal penetration. While PET is the modality of choice for imaging at 511 keV, there are some procedures, e.g., dual-isotope imaging, in which 511 keV SPECT has a role. AIM: To measure the imaging properties of a VPC-93 SPECT collimator designed for imaging at 511 keV and to isolate the effects of septal penetration. METHODS: NaI gamma camera projection images of (18)F (511 keV) and (99m)Tc (140 keV) point sources were measured and the corresponding modulation transfer functions calculated. The projection images were reconstructed via filtered back-projection to obtain the tomographic three-dimensional (3-D) point spread function. Differences between the 511 and 140 keV results were attributed mainly to septal penetration. Contrast measurements were made separately using (18)F and (99m)Tc of a 20 cm phantom containing hot spheres and a warm background. Both isotopes were also used in imaging studies of a 3-D Hoffman brain phantom. RESULTS: Reconstructed 511 keV point source images were spatially extended with more than half of the total reconstructed counts appearing away from the point source region. The number of false counts contained in the image as a function of distance from the true source location remains approximately constant for large distances out to at least 14 cm. Septal penetration results in a rapid roll-off with spatial frequency of collimator response. The response of the collimator to 511 keV photons falls to half of its 0-frequency response at 0.03 cm(-1). For 140 keV photons this value is 0.20 cm(-1). A result is reduced image contrast as measured in the phantom sphere studies. Septal penetration causes image degradation through large-scale blurring. Image noise characteristics are modified and correlations are extended into many transaxial planes. CONCLUSIONS: Both 2-D and 3-D point spread functions for 511 and 140 keV photons using the VPC-93 collimator have been measured. Septal penetration unfavourably affects image resolution and changes image noise characteristics. Without compensation, the effects of septal penetration are readily apparent in images of real objects.     

Increased uptake of technetium-99m-hexamethylpropyleneamine oxime related to primary leptomeningeal melanoma

We present an autopsy case of primary leptomeningeal melanoma visualized with technetium-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO) single photon emission CT (SPECT) of the brain. Increased uptake of Tc-99m-HMPAO coincided with leptomeningeal enhancement on MR images and with the tumor location of the autopsy findings. It was thought that Tc-99m-HMPAO could correlate closely with melanoma. Tc-99m-HMPAO SPECT clearly showed primary leptomeningeal melanoma and severe hypoperfusion induced by intracranial hypertension and tumor proliferation.     

Attenuation correction using asymmetric fanbeam transmission CT on two-head SPECT system

For transmission computed tomography (TCT) systems using a centered transmission source with a fan-beam collimator, the transmission projection data are truncated. To achieve sufficiently large imaging field of view (FOV), we have designed the combination of an asymmetric fan-beam (AsF) collimator and a small uncollimated sheet-source for TCT, and implemented AsF sampling on a two-head SPECT system. The purpose of this study is to evaluate the feasibility of our TCT method for quantitative emission computed tomography (ECT) in clinical application. Sequential Tc-99m transmission and Tl-201 emission data acquisition were performed in a cardiac phantom (30 cm in width) with a myocardial chamber and a patient study. Tc-99m of 185 MBq was used as the transmission source. Both the ECT and TCT images were reconstructed with the filtered back-projection method after scatter correction with the triple energy window (TEW) method. The attenuation corrected transaxial images were iteratively reconstructed with the Chang algorithm utilizing the attenuation coefficient map computed from the TCT data. In this AsF sampling geometry, an imaging FOV of 50 cm was yielded. The attenuated regions appeared normal on the scatter and attenuation corrected (SAC) images in the phantom and patient study. The good quantitative accuracy on the SAC images was also confirmed by the measurement of the Tl-201 radioactivity in the myocardial chamber in the phantom study. The AsF collimation geometry that we have proposed in this study makes it easy to realize TCT data acquisition on the two-head SPECT system and to perform quantification on Tl-201 myocardial SPECT.     

Comparison of Tc-99m HMPAO fast SPECT with Tc-99m HMPAO conventional SPECT in patients with acute stroke.

Tc-99m HMPAO SPECT is more likely to detect a stroke in early stages than CT. However, a conventional HMPAO SPECT study takes at least 30 minutes to complete. This paper compares fast Tc-99m HMPAO SPECT scans and conventional Tc-99m HMPAO SPECT scans with respect to spatial resolution and diagnostic efficacy in vitro and in a small series of patients, respectively. The spatial resolution of fast Tc-99m HMPAO SPECT did not match that of images obtained from conventional SPECT, though the difference proved to be of no clinical significance. Since fast SPECT requires only one-fourth to one-fifth the time necessary for conventional SPECT, it may be more suitable for investigating cases of acute stroke in critical clinical situations.     

Coregistered ventilation and perfusion SPECT using krypton-81m and Tc-99m-labeled macroaggregated albumin with multislice CT utility for prediction of postoperative lung function in non-small cell lung cancer patients

RATIONALE AND OBJECTIVE: Co-registered SPECT and CT imaging (SPECT-CT) has potential for more precise evaluation of regional pulmonary function and may be useful for prediction of postoperative lung function in non-small cell lung cancer (NSCLC) patients. The purpose of the present study was to prospectively assess the capability of co-registered SPECT-CT using krypton-81m (Kr-81m) and technetium-99m-labeled macroaggregated albumin (Tc-99m MAA) for prediction of postoperative lung function of NSCLC patients compared with SPECT and planar imaging. MATERIALS AND METHODS: Sixty consecutive patients considered candidates for lung resection underwent 16-slice CT, ventilation and perfusion scintigraphy with SPECT examinations, and preoperative and postoperative measurement of FEV(1)%. In each subject, SPECT and CT data were automatically fused by using commercially available software. Each postoperative FEV(1)% value was predicted from uptakes of Kr-81m and Tc-99m MAA within total and resected lungs. Then, reproducibility coefficients and the limits of agreement between actual and each predicted postoperative lung function were statistically assessed. RESULTS: Reproducibility coefficients of SPECT-CT (Kr-81m: 5.1%, Tc-99m MAA: 5.2%) were smaller than those of SPECT and planar image using Kr-81m (SPECT: 7.4%, planar image: 12.1%) and using Tc-99m MAA (SPECT: 7.2%, planar image: 11.8%). The limits of agreement for SPECT-CT (Kr-81m: 3.3 +/- 10.5%, Tc-99m MAA: 5.4 +/- 11.0%) were also smaller than that of SPECT and planar image and small enough for clinical purposes. CONCLUSIONS: Co-registered SPECT-CT using Kr-81m and Tc-99m MAA was able to more reproducibly and accurately predict postoperative lung function compared with SPECT and planar imaging.     

CT nonuniform attenuation and TEW scatter corrections in brain Tc-99m ECD SPECT

Perfusion brain single photon emission computed tomography (SPECT) is currently used to evaluate patients with cognitive impairments. Although widely available, it has been reported to be significantly less sensitive than F-18 FDG positron emission tomography. Optimization of SPECT parameters using nonuniform attenuation correction (NUAC) and scatter correction (SC) might improve the accuracy of the method. This study assessed the effect of x-ray CT-based NUAC and triple-energy window (TEW-SC) on brain SPECT compared with Chang-uniform (UAC). A total of 31 patients with memory complaints underwent Tc-99m ECD SPECT/CT. CT-NUAC+TEW-SC and Chang-UAC were applied and compared. The images were spatially normalized to a default SPECT template supplied with Statistical Parametric Mapping software (SPM2). A paired t test image was then reconstructed. Regional cerebral blood flow measurements were apparently reduced in the frontal white-matter and in the frontotemporal cortex when CT-NUAC+TEW-SC were used. These findings need to be considered when interpreting Tc-99m ECD SPECT after applying CT-AC+TEW-SC. Further prospective studies with clinical correlations are needed.     

Technical and analytical advances in pulmonary ventilation SPECT with xenon-133 gas and Tc-99m-Technegas

This paper describes the recent advances in technical and analytical methods in pulmonary ventilation SPECT studies, including a respiratory-gated image acquisition of Technetium-99m (99mTc)-labeled Technegas SPECT, a fusion image between Technegas SPECT and chest CT images created by a fully automatic image registration algorithm, and a three-dimensional (3D). display of xenon-133 (133Xe) gas SPECT data, and new analytical approaches by means of fractal analysis or the coefficient of variations of the pixel counts for Technegas SPECT data. The respiratory-gated image acquisition can partly eliminate problematic effects of the SPECT images obtained during non-breath-hold. The fusion image is available for routine clinical use, and provides complementary information on function and anatomy. The 3D displays of dynamic 133Xe SPECT data are helpful for accurate perception of the anatomic extent and locations of impaired ventilation, and the assessment of the severity of ventilation abnormalities. The new analytical approaches facilitate the objective assessment of the degrees of ventilation abnormalities.     

Conversion of brain SPECT images between different collimators and reconstruction processes for analysis using statistical parametric mapping

To make it possible to share a normal database in single photon emission computed tomography (SPECT) studies, we developed a new method for converting a SPECT image in one physical condition to that in another condition for data acquisition and reconstruction. A Hoffman 3-dimensional brain phantom experiment was conducted to determine systematic differences between collimators and reconstruction processes. SPECT images for the brain phantom were obtained using fan-beam collimators with scatter and attenuation corrections and using parallel-hole collimators without any correction. Dividing these two phantom images after anatomical standardization by Statistical Parametric Mapping 99 (SPM99) created a 3-dimensional conversion map. This conversion map was applied to convert an anatomically standardized SPECT image using parallel-hole collimators without any correction to that using fan-beam collimators with scatter and attenuation corrections in eleven subjects who underwent sequential SPECT measurements using different collimators after injection of 99mTc ethyl cysteinate dimer. The SPM99 demonstrated adequate validity of this conversion in comparative analyses of these sequential SPECT images with different collimators. This may be a promising approach for further sharing of a normal database in SPECT imaging between different cameras.     

Attenuation correction of myocardial SPECT images with X-ray CT: effects of registration errors between X-ray CT and SPECT

PURPOSE: Attenuation correction with an X-ray CT image is a new method to correct attenuation on SPECT imaging, but the effect of the registration errors between CT and SPECT images is unclear. In this study, we investigated the effects of the registration errors on myocardial SPECT, analyzing data from a phantom and a human volunteer. METHODS: Registerion (fusion) of the X-ray CT and SPECT images was done with standard packaged software in three dimensional fashion, by using linked transaxial, coronal and sagittal images. In the phantom study, an X-ray CT image was shifted 1 to 3 pixels on the x, y and z axes, and rotated 6 degrees clockwise. Attenuation correction maps generated from each misaligned X-ray CT image were used to reconstruct misaligned SPECT images of the phantom filled with 201Tl. In a human volunteer, X-ray CT was acquired in different conditions (during inspiration vs. expiration). CT values were transferred to an attenuation constant by using straight lines; an attenuation constant of 0/cm in the air (CT value = -1,000 HU) and that of 0.150/cm in water (CT value = 0 HU). For comparison, attenuation correction with transmission CT (TCT) data and an external gamma-ray source (99mTc) was also applied to reconstruct SPECT images. RESULTS: Simulated breast attenuation with a breast attachment, and inferior wall attenuation were properly corrected by means of the attenuation correction map generated from X-ray CT. As pixel shift increased, deviation of the SPECT images increased in misaligned images in the phantom study. In the human study, SPECT images were affected by the scan conditions of the X-ray CT. CONCLUSION: Attenuation correction of myocardial SPECT with an X-ray CT image is a simple and potentially beneficial method for clinical use, but accurate registration of the X-ray CT to SPECT image is essential for satisfactory attenuation correction.     

Attenuation correction using combination of a parallel hole collimator and an uncollimated non-uniform line array source

Attenuation correction is very important for quantitative SPECT imaging. We designed an uncollimated non-uniform line array source (non-uniform LAS) for attenuation correction based on transmission computed tomography (TCT) using Tc-99m and compared its performance with an uncollimated uniform line array source (uniform LAS) in a thorax phantom study. This non-uniform LAS was attached to one camera head of a dual-head gamma camera, and transmission data were acquired with another camera head with a low-energy, general purpose, parallel-hole collimator at 50 cm-distance apart from the source. The modified TEW using a subtraction factor of 1.0 was employed to correct scattered Tc-99m photons for transmission data. In the phantom experiment, eight TCT data were acquired with the scanning time changed from 2 minutes to 20 minutes for each LAS. The Tc-99m attenuation coefficient (mu) maps with the non-uniform LAS and uniform LAS improved the statistical count variation in the mediastinum filled with water as the scanning time got longer. The Tc-99m mu-map with the non-uniform LAS and 6 minutes of scanning time had equal quality at the center of the thorax phantom to that with the uniform LAS and 16 minutes of scanning time. In conclusion, for the TCT imaging with combination of the parallel hole collimator and uncollimated Tc-99m external source the non-uniform LAS can reduce the Tc-99m radioactivity or the TCT scanning time compared with the uniform LAS.     

Potential false positive Tc-99m sestamibi parathyroid study due to uptake in brown adipose tissue

We report on a 55-year-old woman with suspected primary hyperparathyroidism who underwent dual phase Tc-99m sestamibi parathyroid imaging. Symmetric, patchy activity in the neck and shoulders was localized to low attenuation areas on integrated SPECT/CT and attributed to uptake in brown adipose tissue (BAT). Focal uptake in the anterior thorax on SPECT images, which potentially may have been misinterpreted as ectopic parathyroid tissue, was demonstrated on SPECT/CT as uptake in BAT. Recognition of this pattern on parathyroid SPECT/CT scintigraphy may avoid false positive reports. Our case provides further evidence that in addition to F-18 FDG, I-123 MIBG, and Tc-99m tetrofosmin, Tc-99m sestamibi may also accumulate in BAT.     

Accurate scatter correction for transmission computed tomography using an uncollimated line array source

We investigated scatter correction in transmission computed tomography (TCT) imaging by the combination of an uncollimated transmission source and a parallel-hole collimator. We employed the triple energy window (TEW) as the scatter correction and found that the conventional TEW method, which is accurate in emission computed tomography (ECT) imaging, needs some modification in TCT imaging based on our phantom studies. In this study a Tc-99m uncollimated line array source (area: 55 cm x 40 cm) was attached to one camera head of a dual-head gamma camera as a transmission source, and TCT data were acquired with a low-energy, general purpose (LEGP), parallel-hole collimator equipped on the other camera head. The energy spectra for 140 keV-photons transmitted through various attenuating material thicknesses were measured and analyzed for scatter fraction. The results of the energy spectra showed that the photons transmitted had an energy distribution that constructs a scatter peak within the 140 keV-photopeak energy window. In TCT imaging with a cylindrical water phantom, the conventional TEW method with triangle estimates (subtraction factor, K = 0.5) was not sufficient for accurate scatter correction (micro = 0.131 cm(-1) for water), whereas the modified TEW method with K = 1.0 gave the accurate attenuation coefficient of 0.153 cm(-1) for water. For the TCT imaging with the combination of the uncollimated Tc-99m line array source and parallel hole collimator, the modified TEW method with K = 1.0 gives the accurate TCT data for quantitative SPECT imaging in comparison with the conventional TEW method with K = 0.5.