A Bayesian iterative transmission gradient reconstruction algorithm for cardiac SPECT attenuation correction

Background  High-quality attenuation maps are critical for attenuation correction of myocardial perfusion single photon emission computed tomography studies. The filtered backprojection (FBP) approach can introduce errors, especially with low-count transmission data. We present a new method for attenuation map reconstruction and examine its performance in phantom and patient data. Methods and Results  The Bayesian iterative transmission gradient algorithm incorporates a spatially varying gamma prior function that preferentially weights estimated attenuation coefficients toward the soft-tissue value while allowing data-driven solutions for lung and bone regions. The performance with attenuation-corrected technetium 99m sestamibi clinical images was evaluated in phantom studies and in 50 low-likelihood patients grouped by body mass index (BMI). The algorithm converged in 15 iterations in the phantom studies. For the clinical studies, soft-tissue estimates had significantly greater uniformity of mediastinal coefficients (mean SD, 0.005 cm⁻¹ vs 0.011 cm⁻¹; P<.0001). The accuracy and uniformity of the Bayesian iterative transmission gradient algorithm were independent of BMI, whereas both declined at higher BMI values with FBP. Attenuation-corrected perfusion images showed improvement in myocardial wall variability (4.8% to 4.1%, P=.02) for all BMI groups with the new method compared with FBP. Conclusion  This new method for attenuation map reconstruction provides rapidly converging and accurate attenuation maps over a wide spectrum of patient BMI values and significantly improves attenuation-corrected perfusion images.     

A study on attenuation correction using Tc-99m external TCT source in Tc-99m GSA liver SPECT

PURPOSE: In attenuation correction of ECT images by transmission CT (TCT) with an external 99mTc gamma-ray source, simultaneous TCT/ECT data acquisition is difficult, when the same radionuclide such as 99mTc-tetrofosmin or 99mTc-GSA is used as the tracer. In this case, TCT is usually acquired before administration of the tracer, and ECT is acquired separately after the tracer injection. However, misregistration may occur between the TCT and ECT images, and the repetition of examinations add to the mental and physical stress of the patients. In this study, to eliminate this problem, we evaluated whether attenuation correction of ECT images can be achieved by acquiring TCT and ECT simultaneously, then acquiring ECT alone, and preparing an attenuation map by subtracting the latter from the former using 99mTc-GSA liver ECT. METHOD: The ECT system used was a three-head gamma camera equipped with one cardiac fan beam collimator and two parallel beam collimators. External gamma-ray source for TCT of 99mTc was 740 MBq, and ECT of 99mTc-GSA was 185 MBq. First, pure TCT data were acquired for the original TCT-map, then, ECT/TCT data were acquired for the subtracted TCT-map, and finally, pure ECT data were acquired. The subtracted attenuation map was produced by subtracting the pure ECT image from the TCT/ECT image, and attenuation correction of the ECT image was done using both this subtracted TCT map and attenuation map from pure TCT. These two attenuation corrected images and non-corrected images were compared. Hot rods phantom, a liver phantom with a defect, and 10 patients were evaluated. RESULTS: Attenuation corrected ECT values using the subtraction attenuation map showed an error of about 5% underestimation compared with ECT values of the images corrected by original attenuation map at the defect in the liver phantom. A good correlation of y = 22.65 + 1.06x, r = 0.958 was observed also in clinical evaluation. CONCLUSION: By means of the method proposed in this study, it is possible to perform simultaneous TCT/ECT data acquisition for attenuation correction using Tc-99m external source in Tc-99m GSA liver SPECT. Moreover, it is thought that this method decreases the mental and physical stress of the patients.     

A count-based algorithm for attenuation-corrected volume determination using data from an external flood source

We discuss the basic features of a count-based algorithm for attenuation-corrected volume determination, for use with planar gamma camera images. The attenuation correction is arrived at by combining the results of two 180 degrees opposed images with a transmission image obtained with an external flood source. A sample of the imaged radioactive volume is used to convert the attenuation-corrected count to an absolute volume. The algorithm is best suited to the measurement of small to medium-sized volumes of uniform activity, such as are encountered in cardiac blood-pool imaging.     

Risk stratification using line source attenuation correction with rest/stress Tc-99m sestamibi SPECT myocardial perfusion imaging

Background

Although line source attenuation correction (AC) in SPECT MPI studies improves diagnostic accuracy, its prognostic value is less understood.

Methods

Consecutive patients (n = 6,513) who underwent rest/stress AC ECG-gated SPECT MPI were followed for cardiac death or non-fatal myocardial infarction (MI). A 17-segment model and AC summed stress score (SSS) were used to classify images.

Results

Of the 6,513 patients, cardiac death or non-fatal MI occurred in 267 (4.1%), over 2.0 ± 1.4 years. The AC-SSS in patients with a cardiac event (5.6 ± 7.8) was significantly higher than in those without (1.9 ± 4.6, P < .001). The annualized cardiac event rate in patients with an AC-SSS 1-3 (3.6%) was significantly higher than in those with an AC-SSS = 0 (1.1%, P < .001) but similar to that in those with an AC-SSS 4-8 (2.9%, P = .4). Accordingly, patients were classified to AC-SSS = 0, 1-8, and >8 with annualized cardiac event rates of 1.1%, 3.2%, and 8.5%, respectively (P < .0001). In multivariate analysis, an AC-SSS 1-8 and >8 emerged as independent predictors of cardiac events (P < .02 and P < .0001, respectively).

Conclusion

Rest/stress ECG-gated SPECT MPI with line source AC provides highly effective and incremental risk stratification for future cardiac events.     

Usefulness of attenuation correction with transmission source in myocardial SPECT

Attenuation correction in SPECT has been used for uniformly absorptive objects like the head. On the other hand, it has seldom been applied to nonuniform absorptive objects like the heart and surrounding lungs because of the difficulty and inaccuracy of data processing. However, since attenuation correction using a transmission source recently became practical, we were able to apply this method to a nonuniform absorptive object. Therefore, we evaluated the usefulness of this attenuation correction system with a transmission source in myocardial SPECT. The dose linearity, defect/normal ratio using a myocardial phantom, and myocardial count distribution in clinical cases was examined with and without the attenuation correction system. We found that all data processed with attenuation correction were better than those without attenuation correction. For example, in myocardial count distribution, while there was a difference between men and women without attenuation correction, which was considered to be caused by differences in body shape, after processing with attenuation correction, myocardial count distribution was almost the same in all cases. In conclusion, these results suggested that attenuation correction with a transmission source was useful in myocardial SPECT.     

Compensation for three-dimensional detector response, attenuation and scatter in SPECT grey matter imaging using an iterative reconstruction algorithm which incorporates a high-resolution anatomical image.

The use of SPECT to diagnose physiological alterations in disease states depends on the potential of SPECT to provide a quantitatively accurate reconstructed image. However, the reconstructed values depend upon the shape and size of the brain region as strongly as they depend upon true radioactivity concentration. We report here the results of applying an iterative reconstruction algorithm (IRA) to compensate for shape- and size-dependence, as well as for attenuation and scatter. The IRA is designed only for the reconstruction of images for which the true radioactivity in the white matter within the actual brain is negligible compared with the true radioactivity in the grey matter within the actual brain. The IRA incorporates an accurate three-dimensional model of detector response and utilizes an MRI image which defines the anatomical features of the brain being imaged by segmenting the grey, white and ventricular regions. It is the assumption of radioactivity localization exclusively in the grey matter which permits the efficient incorporation of the MRI image. The IRA was validated by simulation studies that utilized a slice through the basal ganglia in the realistic Hoffman three-dimensional mathematical brain model. FBP images deviate significantly from true radioactivity distribution, whereas IRA images are nearly identical to true radioactivity distribution, except for random fluctuations due to the presence of statistical noise. These results indicate that the application of the IRA will permit SPECT to distinguish deficits due to true physiological changes from apparent deficits due to imaging/reconstruction artifacts.     

衰减校正技术在SPECT心肌灌注显像中的应用分析

心肌灌注显像（MPI）的伪影对其图像质量以及图像的判别产生较大影响,造成假阳性率较高。目前针对软组织衰减所造成的伪影主要有以下2类校正技术,非X射线校正法（如变换体位采集、门控采集和固体153Gd线源穿透式采集）和CT衰减校正法。明确2种方法的应用范围及其优缺点,使临床医师在阅片中对伪影有正确的分析判断,从而提高诊断的准确率。     

Segmented attenuation correction for myocardial SPECT

PURPOSE: One of the main factors contributing to the accuracy of attenuation correction for SPECT imaging using transmission computed tomography (TCT) with an external gamma-ray source is the radionuclide count. To reduce deterioration of TCT images due to inadequate radionuclide counts, a correction method, segmented attenuation correction (SAC), in which TCT data are transformed into several components (segments) such as water, lungs and spine, providing a satisfactory attenuation correction map with less counts, has been developed. The purpose of this study was to examine the usefulness of SAC for myocardial SPECT with attenuation correction. METHODS: A myocardial phantom filled with Tc-99m was scanned with a triple headed SPECT system, equipped with one cardiac fan beam collimator for TCT and two parallel hole collimators for ECT. As an external gamma-ray source for TCT, 740 MBq of Tc-99m was also used. Since Tc-99m was also used for ECT, the TCT and ECT data were acquired separately. To make radionuclide counts, the TCT data were acquired in the sequential repetition mode, in which a 3-min-rotation was repeated 7 times followed by a 10-min-rotation 4 times (a total of 61 minutes). The TCT data were reconstructed by adding some of these rotations to make TCT maps with various radionuclide counts. Three types of SAC were used: (a) 1-segment SAC in which the body structure was regarded as water, (b) 2-segment SAC, in which the body structure was regarded as water and lungs, and (c) 3-segment SAC, in which the body structure was regarded as water, lungs and spine. We compared corrected images obtained with non-segmentation methods, and with 1- to 3-segment SACs. We also investigated the influence of radionuclide counts of TCT (3, 6, 9, 12, 15, 18, 21, 31, 41, 51, 61 min acquisition) on the accuracy of the attenuation correction. RESULTS: Either 1-segment or 2-segment SAC was sufficient to correct the attenuation. When non-segmentation TCT attenuation methods were used, rotations of at least 31 minutes were required to obtain sufficiently large counts for TCT. When the 3-segment SAC was used, the minimal acquisition time for a satisfactory TCT map was 7 min. CONCLUSION: The 3-segment SAC was effective for attenuation correction, requiring fewer counts (about 1/5 of the value for non-segmentation TCT), or less radiation for TCT.     

衰减校正在18F-FDG SPECT显像中的价值

目的评价衰减校正(AC)在18F-脱氧葡萄糖(FDG) SPECT显像中的临床价值.方法对病理检查证实的36例恶性肿瘤和4例良性肿物患者进行18F-FDG SPECT显像,进行迭代法重建AC和非衰减校正(NAC),并计算两者的肿瘤与本底比值(T/B).28例正常人进行了胸部18F-FDG SPECT显像.将左室心肌分为9个节段,用5分法(0正常;1分轻度减少;2分中度减少;3分明显减少;4分缺损)对AC与NAC图像的各心肌节段进行评分.结果 36例恶性肿瘤患者中34例AC与NAC均诊断为恶性,两者均检出55个病灶,2例(6%)AC与NAC均为假阴性,4例良性病变AC与NAC均为阴性.肺部肿瘤T/B在AC后增加(P<0.01),肺外肿瘤T/B AC后降低(P<0.05),不同部位肿瘤T/B在AC与NAC间呈显著正相关(P<0.01).AC对病变的解剖位置、周围组织受累情况及深部病变显示更加清晰.全部28例心肌显像者的左室前、后间壁,下、后壁在NAC影像均出现明显放射性衰减伪影,AC后显著改善(P<0.01);17例(60.7%)心尖、6例(21.4%)前壁心尖段放射性分布在AC后有轻度减低(P<0.01);AC后平均左室总分由NAC时的10.82±2.14下降为3.64±2.23(P<0.01).结论 AC虽未能增加肿瘤检出率,但可更清晰地显示肿瘤的位置、范围以及深部病灶,并可显著改善心肌衰减伪影,具有一定的临床价值.     

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.     

Scatter and attenuation correction for brain SPECT using attenuation distributions inferred from a head atlas.

Sequential transmission scanning (TS)/SPECT is impractical for neurologically impaired patients who are unable to keep their heads motionless for the extended duration of the combined scans. To provide an alternative to TS, we have developed a method of inferring-attenuation distributions (IADs), from SPECT data, using a head atlas and a registration program. The validity of replacing TS with IAD was tested in 10 patients with mild dementia. METHODS: TS was conducted with each patient using a collimated 99mTc line source and fanbeam collimator; this was followed by hexamethyl propyleneamine oxime-SPECT. IAD was derived by deformably registering the brain component of a digital head atlas to a preliminary SPECT reconstruction and then applying the resulting spatial transformation to the full head atlas. SPECT data were reconstructed with scatter and attenuation correction. Relative regional cerebral blood flow was quantified in 12 threshold-guided anatomic regions of interest, with cerebellar normalization. SPECT reconstructions using IAD were compared with those using TS (which is the "gold standard") in terms of these regions of interest. RESULTS: When we compared all regions of interest across the population, the correlation between IAD-guided and TS-guided SPECT scans was 0.92 (P < 0.0001), whereas the mean absolute difference between the scans was 7.5%. On average, IAD resulted in slight underestimation of relative regional cerebral blood flow; however, this underestimation was statistically significant for only the left frontal and left central sulcus regions (P = 0.001 and 0.002, respectively). Error analysis indicated that approximately 10.0% of the total error was caused by IAD scatter correction, 36.6% was caused by IAD attenuation correction, 27.0% was caused by discrepancies in region-of-interest demarcation from quantitative errors in IAD-guided reconstructions, and 26.5% was caused by patient motion throughout the imaging procedure. CONCLUSION: SPECT reconstructions guided by IAD are sufficiently accurate to identify regional cerebral blood flow deficits of 10%, which are typical in moderate and advanced dementia.     

SPECT/CT physical principles and attenuation correction

Using nuclear medicine techniques, physiologic activity and processes can be identified in a way that is unique from other modalities. Oftentimes it is helpful to know the exact location of the physiologic uptake that is visualized on a scan. Knowing the exact location can sometimes help to distinguish normal from abnormal physiologic uptake. When an abnormality has been identified, knowing the exact location can then be helpful in treatment planning. The ability to provide precise localization of physiologic data from nuclear medicine studies is now possible with hybrid SPECT/CT systems. Additionally, these systems provide an accurate attenuation correction of the nuclear medicine image data. After reading this article, the technologist will be able to list and describe the inherent problems associated with SPECT image acquisition and reconstruction, briefly explain how data acquired from the CT scanner are used to provide attenuation correction data for SPECT and anatomic information for diagnostic purposes, list and briefly describe the different types of clinical SPECT/CT systems, and discuss the importance of accurate CT and SPECT image registration.     

Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging

BACKGROUND: Attenuation artifact remains a substantial limitation to confident interpretation of images and reduces laboratory efficiency by requiring comparison of stress and rest image sets. Attenuation-corrected stress-only imaging has the potential to ameliorate these limitations. METHODS AND RESULTS: Ten experienced nuclear cardiologists independently interpreted 90 stress-only electrocardiography (ECG)-gated technetium 99m sestamibi images in a sequential fashion: myocardial perfusion imaging (MPI) alone, MPI plus ECG-gated data, and attenuation-corrected MPI with ECG-gated data. Images were interpreted for diagnostic certainty (normal, probably normal, equivocal, probably abnormal, abnormal, and perceived need for rest imaging). With stress MPI data alone, only 37% of studies were interpreted as definitely normal or abnormal, with a very high perceived need for rest imaging (77%). The addition of gated data did not alter the interpretations. However, attenuation-corrected data significantly increased the number of studies characterized as definitely normal or abnormal (84%, P <.005) and significantly reduced the perceived need for rest imaging (43%, P <.005). These results were confirmed by use of a nonsequential consensus interpretation of three readers. CONCLUSION: Attenuation correction applied to studies with stress-only Tc-99m ECG-gated single photon emission computed tomography images significantly increases the ability to interpret studies as definitely normal or abnormal and reduces the need for rest imaging. These findings may improve laboratory efficiency and diagnostic accuracy.     

Introducing simultaneous spatial resolution and attenuation correction after scatter removal in SPECT imaging.

A new approach to simultaneous spatial resolution and attenuation correction in SPECT imaging is presented. Before these corrections, scatter is removed on the projections. This removal is performed by spectral constrained factor analysis. The innovation reported here is the use of the different impulse responses of the system, according to the source-detector distance, and their integration in a generalized version of the Chang attenuation correction method. This novel algorithm is evaluated on computed and physical phantoms. In the computer-simulated phantom, the count rates after full-processing are very close to the initial values. In the physical phantom, the contrast is increased by 1.8 after full processing. The activity profiles drawn both on raw projections and reconstructed slices demonstrate the effectiveness of the algorithm for the restoration of spatial resolution. Furthermore, the method improves the quality of the images greatly. A clinical study is also presented. When the whole procedure is applied, the resulting slice matches the corresponding computed tomographic scan very well, which is not the case with the usual back-projected images. The process is fully automatic and the computing time performance allows its daily use for single photon emission tomographic examinations.     

SPECT／CT图像配准不良对心肌灌注显像CT衰减校正的影响

目的探讨CT与SPECT图像配准不良对MPICT衰减校正（CTAC）的影响。方法99Tcm-MIBIMPI受检者19名,均为行健康体格检查者,其中男11名,女8名,年龄（65．3±9．6）岁。对MPI图像进行CTAC。利用仪器自带的软件对CT图像进行模拟位移：相对心脏位置进行上、下、左、右、前、后6个方向的移动,移动幅度分别为0．5、1．0、1．5、2．0、2．5、3．0、3．5、4．0和4．5em。重建不同位移状态的CTAC心肌断层图像,利用靶心图获得左心室各壁段的放射性计数百分比,比较位移前后左心室各壁段放射性计数的差异和图像差异。采用SPSS13．0软件对数据进行配对t检验。结果当CT图像的移动距离为0．5cm时,所有位移方向的CTAC图像均未见明显可识别的图像伪影。当CT图像的移动距离≥1．0CITI时,左心室各壁段出现不同程度的图像伪影以及放射性计数的改变;CT图像向上、下、左、右、前、后方向位移时,分别对心尖部,前壁和心尖部,间壁,前壁、心尖部和侧壁,侧壁和下后壁,前壁、心尖部和间壁放射性计数的影响最为显著。向下位移时左心室各壁段放射性计数的改变大于向上位移[（-9．68±8．06）％和（-2．04±1．83）％;f=6．573,P〈0．01],向右位移的改变大于向左位移[（-9．02±8．47）％和（-4．38±3．67）％;t=1．987,P〈0．05]。在左心室各壁段中,前壁、心尖部和侧壁的伪影程度明显较下后壁和间壁显著。结论CT与SPECT图像配准不良可使MPICTAC图像出现不同程度的伪影,其伪影出现的部位和严重程度与配准不良的方向和幅度密切相关。     

A technique for using CT images in attenuation correction and quantification in SPECT

A technique is described for using computed tomography (CT) images for attenuation correction and quantification in SPECT. The CT images are aligned with the corresponding SPECT slices and the Hounsfield units are converted to linear attenuation coefficient values for the SPECT radionuclide. The attenuation coefficient map thus produced is used to provide the attenuation correction required in the SPECT reconstruction. The technique has been evaluated in both a non-anatomical and an anatomical phantom giving a mean accuracy in quantifying activity of various features in the phantoms of 2.6% (range 0.3%-4.0%). The value of performing scatter correction prior to attenuation correction in obtaining accurate quantification is demonstrated. The practicalities of applying the technique in patient studies are discussed.