Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images

Scintigraphic diagnosis, based on functional image interpretation, becomes more accurate and meaningful when supported by corresponding anatomical data. In order to produce anatomical images that are inherently registered with images of emission computerised tomography acquired with a gamma camera, an X-ray transmission system was mounted on the slip-ring gantry of a GEMS Millennium VG gamma camera. The X-ray imaging system is composed of an X-ray tube and a set of detectors located on opposite sides of the gantry rotor that moves around the patient along with the nuclear detectors. A cross-sectional anatomical transmission map is acquired as the system rotates around the patient in a manner similar to a third-generation computerised tomography (CT) system. Following transmission, single-photon emission tomography (SPET) or positron emission tomography (PET) coincidence detection images are acquired and the resultant emission images are thus inherently registered to the anatomical maps. Attenuation correction of the emission images is performed with the same anatomical maps to generate transmission maps. Phantom experiments of system performance and examples of first SPET and coincidence detection patient images are presented. Despite limitations of the system when compared with a state of the art CT scanner, the transmission anatomical maps allow for precise anatomical localisation and for attenuation correction of the emission images.     

Transmission scanning in emission tomography

Attenuation correction in single-photon (SPET) and positron emission (PET) tomography is now accepted as a vital component for the production of artefact-free, quantitative data. The most accurate attenuation correction methods are based on measured transmission scans acquired before, during, or after the emission scan. Alternative methods use segmented images, assumed attenuation coefficients or consistency criteria to compensate for photon attenuation in reconstructed images. This review examines the methods of acquiring transmission scans in both SPET and PET and the manner in which these data are used. While attenuation correction gives an exact correction in PET, as opposed to an approximate one in SPET, the magnitude of the correction factors required in PET is far greater than in SPET. Transmission scans also have a number of other potential applications in emission tomography apart from attenuation correction, such as scatter correction, inter-study spatial co-registration and alignment, and motion detection and correction. The ability to acquire high-quality transmission data in a practical clinical protocol is now an essential part of the practice of nuclear medicine. Received: 19 February 1998 / Accepted: 19 March 1998     

Application of transmission scan-based attenuation compensation to scatter-corrected thallium-201 myocardial single-photon emission tomographic images

A practical method for scatter and attenuation compensation was employed in thallium-201 myocardial single-photon emission tomography (SPET or ECT) with the triple-energy-window (TEW) technique and an iterative attenuation correction method by using a measured attenuation map. The map was reconstructed from technetium-99m transmission CT (TCT) data. A dual-headed SPET gamma camera system equipped with parallel-hole collimators was used for ECT/TCT data acquisition and a new type of external source named ”sheet line source” was designed for TCT data acquisition. This sheet line source was composed of a narrow long fluoroplastic tube embedded in a rectangular acrylic board. After injection of ^99mTc solution into the tube by an automatic injector, the board was attached in front of the collimator surface of one of the two detectors. After acquiring emission and transmission data separately or simultaneously, we eliminated scattered photons in the transmission and emission data with the TEW method, and reconstructed both images. Then, the effect of attenuation in the scatter-corrected ECT images was compensated with Chang’s iterative method by using measured attenuation maps. Our method was validated by several phantom studies and clinical cardiac studies. The method offered improved homogeneity in distribution of myocardial activity and accurate measurements of myocardial tracer uptake. We conclude that the above correction method is feasible because a new type of ^99mTc external source may not produce truncation in TCT images and is cost-effective and easy to prepare in clinical situations. Received 1 September and in revised form 25 October 1997     

Simultaneous acquisition of iodine-123 emission and technetium-99m transmission data for quantitative brain single-photon emission tomographic imaging

The aim of this study was to obtain quantitative iodine-123 brain single-photon emission tomographic (SPET) images with scatter and attenuation correction. We used a triple-headed SPET gamma camera system equipped with fan-beam collimators with a technetium-99m line transmission source placed at one of the focal lines of the fan-beam collimators. Four energy windows were employed for data acquisition: (a) 126–132 keV, (b) 132–143 keV, (c) 143–175 keV and (d) 175–186 keV. A simultaneous transmission-emission computed tomography scan (TCT-ECT) was carried out for a brain phantom containing ¹²³I solution. The triple energy window scatter correction was applied to the ¹²³I ECT data measured by means of the windows (b), (c) and (d) acquired by two detectors. Attenuation maps were reconstructed from ^99mTc TCT data measured by means of the windows (a), (b) and (c) acquired by one detector. Chang’s iterative attenuation correction method using the attenuation maps was applied to the ¹²³I ECT images. In the phantom study cross-calibrated SPET values obtained with the simultaneous mode were almost equal to those obtained with the sequential mode, and they were close to the true value, within an error range of 5.5%. In the human study corrected images showed a higher grey-to-white matter count ratio and relatively higher uptake in the cerebellum, basal ganglia and thalamus than uncorrected images. We conclude that this correction method provides improved quantification and quality of SPET images and that the method is clinically practical because it requires only a single scan with a ^99mTc external source. Received 6 June and in revised form 27 July 1998     

Motion detection and correction using multi-rotation 180° single-photon emission tomography for thallium myocardial imaging

Patient and organ motion is a potentially limiting factor in gamma camera single-photon emission tomography (SPET) imaging, as highlighted in stress thallium myocardial SPET, where the heart may exhibit a systematic axial motion (cardiac creep) following stress. Multi-rotation SPET has previously been described as a means of obtaining better raw data for motion detection and correction. This study describes the validation of a computerised motion detection algorithm applied to multi-rotation SPET, and reports measured motions in thallium myocardial stress SPET studies from a single-headed gamma camera. Forty-two patients underwent pharmacological stress (dipyridamole) with leg raising, with injection of 75 MBq thallium-201 and imaging after a 10-min delay to detect or evaluate coronary artery disease. Multi-rotation gamma camera SPET was performed with a single-headed gamma camera, with five sequential rapid (4.5 min) continuous SPET mode rotations over 180°. A one-dimensional cross-correlation alignment technique was applied to the projection images to perform motion detection and correction in the axial direction prior to combining the five data sets for tomographic reconstruction. Validation of the cross-correlation alignment analysis was carried out by performing imaging with measured whole-body axial motions in nine subjects, and by reproducibility measurements on multi-rotation data sets. The effect of the applied motion correction was evaluated by calculating mean differences between image pairs before and after shifting, and the general reliability of the automatic motion detection was checked to within one pixel by visual assessment of 160 image pairs. Validation measurements of the cross-correlation technique gave a mean absolute error of 1.5±0.4 mm (0.24±0.06pixels) with a maximum error of 3.7 mm (0.6 pixels). In 40 subjects undergoing pharmacological stress ²⁰¹Tl myocardial SPET imaging, the mean cardiac axial creep movement was calculated as 3.1±0.7 mm (0.49±0.11 pixels), with 13 out of 40 (32%) having a calculated motion of 1 pixel (6.3 mm) or more. The automatic image shift was visually judged to be within 1 pixel in all 160 image pair analyses, and the mean pixel value difference between image pairs was reduced following image shifting. It is concluded that multi-rotation 180° SPET imaging provides raw data which allow objective and accurate motion detection of cardiac motion in thallium stress myocardial imaging, whilst the one-dimensional cross-correlation technique demonstrates adequate accuracy and reliability to be applied as an automatic motion screening technique on these data. Received 14 March and in revised form 27 July 1998     

Simultaneous emission and transmission measurements as an adjunct to dynamic planar gamma camera studies

Anatomical imaging provides useful information which complements functional imaging performed using a gamma camera. We have previously used transmission measurements in single-photon emission tomography acquired simultaneously with the emission scan using either a plane flood source or a moving line source for attenuation and scatter correction. This approach is equally applicable in planar imaging and provides useful information to assist in detecting patient motion and in defining regions of interest in dynamic studies. We have adapted a moving transmission line source to acquire dynamic geometric mean measurements in the study of the mucociliary clearance of inhaled technetium-99m labelled colloids with a single-headed rotating gamma camera. The line source makes a return pass for each emission acquisition frame (alternating anterior/posterior views), each pass being initiated by a signal from the gamma camera. The result is a dynamic sequence of emission and transmission measurements obtained from a single acquisition. In this application transmission measurements are used to define the lung outline for clearance determination and to check for subject movement throughout the duration of the study.     

Improvement of brain single photon emission tomography (SPET) using transmission data acquisition in a four-head SPET scanner

Attenuation coefficient maps (-maps) are a useful way to compensate for non-uniform attenuation when performing single photon emission tomography (SPET). A new method was developed to record single photon transmission data and a-map for the brain was produced using a four-head SPET scanner. Transmission data were acquired by a gamma camera opposite to a flood radioactive source attached to one of four gamma cameras in the four-head SPET scanner. Attenuation correction was performed using the iterative expectation maximization algorithm and the-map. Phantom studies demonstrated that this method could reconstruct the distribution of radioactivity more accurately than conventional methods, even for a severely non-uniform-map, and could improve the quality of SPET images. Clinical application to technetium-99m hexamethylpropylene amine oxime (HMPAO) brain SPET also demonstrated the usefulness of this method. Thus, this method appears to be promising for improvement in the image quality and quantitative accuracy of brain SPET.This work was presented in part at the World Congress on Medical Physics and Biomedical Engineering, 7–12 July 1991, Kyoto, Japan     

The evaluation and calibration of fan-beam collimators

The aims of this study were (a) to determine the true focal length of a fan-beam collimator and (b) to calibrate image size (mm/pixel) for each collimator to permit inter-comparison of image data acquired on different gamma camera systems. A total of six fan-beam collimators on three dual-head gamma camera systems were evaluated using a set of four cobalt-57 point source markers. The markers were arranged in a line in the transverse plane with a known separation between them. Tomographic images were obtained at three radii of rotation. From reconstructed transaxial images the distance between markers was measured in pixels and used to determine pixel size in mm/pixel. The system value for the focal length of the collimator was modified by up to ±100 mm and transaxial images were again reconstructed. To standardize pixel size between systems, the apparent radius of rotation during a single-photon emission tomography (SPET) acquisition was modified by changes to the effective collimator thickness. SPET images of a 3D brain phantom were acquired on each system and reconstructed using both the original and the modified values of collimator focal length and thickness. Co-registration and subtraction of the reconstructed transaxial images was used to evaluate the effects of changes in collimator parameters. Pixel size in the reconstructed image was found to be a function of both the radius of rotation and the focal length. At the correct focal length, pixel size was essentially independent of the radius of rotation. For all six collimators, true focal length differed from the original focal length by up to 26 mm. These differences in focal length resulted in up to 6% variation in pixel size between systems. Pixel size between the three systems was standardized by altering the value for collimator thickness. Subtraction of the co-registered SPET images of the 3D brain phantom was significantly improved after optimization of collimator parameters, with a 35%–50% reduction in the standard deviation of residual counts in the subtraction images. In conclusion, we have described a simple method for measurement of the focal length of a fan-beam collimator. This is an important parameter on multidetector systems for optimum image quality and where accurate co-registration of SPET to SPET and SPET to MRI studies is required. Received 17 October and in revised form 12 December 1998     

Alternative positron emission tomography with non-conventional positron emitters: effects of their physical properties on image quality and potential clinical applications

The increasing amount of clinically relevant information obtained by positron emission tomography (PET), primarily with fluorine-18 labelled 2-deoxy-2-fluoro-d-glucose, has generated a demand for new routes for the widespread and cost-efficient use of positron-emitting radiopharmaceuticals. New dual-head single-photon emission tomography (SPET) cameras are being developed which offer coincidence detection with camera heads lacking a collimator or SPET imaging with specially designed collimators and additional photon shielding. Thus, not only satellite PET imaging units but also nuclear medicine units investing in these new SPET/PET systems need to examine all available alternatives for rational radionuclide supplies from host cyclotrons. This article examines 25 ”alternative” positron-emitting radionuclides, discusses the impact of their decay properties on image quality and reviews methods for their production as well as for their application in imaging techniques.     

Evaluation of SPET quantification of simultaneous emission and transmission imaging of the brain using a multidetector SPET system with the TEW scatter compensation method and fan-beam collimation

A gamma camera system which is able to acquire simultaneous single-photon emission tomographic (SPET) data and gamma ray transmission computed tomography (TCT) data for brain study using external rod sources and fan-beam collimators was developed and evaluated. Since the three external rod sources were located at the focal points of fan-beam collimators, which also happened to be the apexes of the equilateral triangle defined by the three detectors, simultaneous SPET and TCT scan could be performed using a 120° shared scan. Therefore, the proposed system required less than one third of the scanning time of a single-head system. Since the combination of rod sources and fan-beam collimators decreased the scatter component in transmission data without a slit collimator for each rod source, the radioactivity of the rod source was less than one-tenth of the previous investigations. For evaluation, we used two isotopes, thallium-201 for TCT and technetium-99m for SPET. The cross-contamination of transmission and emission was well compensated using the triple energy window (TEW) method. In a separate TCT scan, the measured attenuation coefficient of²⁰¹Tl for water was 0.19±0.01 cm^–1, while in a simultaneous scan, it was 0.20±0.01 cm^–1. The measured attenuation coefficient for water agreed well with the narrow-beam (theoretical) value of 0.187 cm^–1. In SPET images, scatter compensation was also performed using the TEW method and attenuation compensation was done using the measured attenuation map. The results showed the feasibility of simultaneous SPET and TCT scanning using the TEW method to obtain quantitative SPET images.     

Transmission imaging for registration of ictal and interictal single-photon emission tomography, magnetic resonance imaging and electroencephalography

A method developed for registration of ictal and interictal single-photon emission tomography (SPET), magnetic resonance imaging (MRI) and electroencephalography (EEG) is described. For SPET studies, technetium-99m ethyl cysteinate dimer (ECD) was injected intravenously while the patient was monitored on video-EEG to document the ictal or interictal state. Imaging was performed using a triple-head gamma camera equipped with a transmission imaging device using a gadolinium-153 source. The images (128×128 pixels, voxel size 3.7×3.7×3.6 mm³) were reconstructed using an iterative algorithm and postfiltered with a Wiener filter. The gold-plated silver electrodes on the patient’s scalp were utilized as markers for registration of the ictal and interictal SPET images, as these metallic markers were clearly seen on the transmission images. Fitting of the marker sets was based on a non-iterative least squares method. The interictal SPET image was subtracted from the ictal image after scaling. The T1-weighted MPRAGE MR images with voxel size of 1.0×1.0×1.0 mm³ were obtained with a 1.5-T scanner. For registration of MR and subtraction SPET images, the external marker set of the ictal SPET study was fitted to the surface of the head segmented from MR images. The SPET registration was tested with a phantom experiment. Registration of ictal and interictal SPET in five patient studies resulted in a 2-mm RMS residual of the marker sets. The estimated RMS error of registration in the final result combining locations of the electrodes, subtraction SPET and MR images was 3–5 mm. In conclusion, transmission imaging can be utilized for an accurate and easily implemented registration procedure for ictal and interictal SPET, MRI and EEG. Received 20 September and in revised form 16 October 1999     

Image fusion using an integrated, dual-head coincidence camera with X-ray tube-based attenuation maps.

The purpose of this study was to characterize a dual-head gamma camera capable of FDG imaging using coincidence detection and equipped with an integrated x-ray transmission system for attenuation correction, anatomic mapping, and image fusion. METHODS: Radiation dose (425 mrads skin dose) and tissue contrast (0.7% deviation from expected values) were assessed for the x-ray system. Registration of transmission and emission scans was validated using a hot sphere phantom and was verified in selected patient studies. RESULTS: Fusion of anatomic maps and FDG images allowed precise anatomic localization of lesions identified using dual-head coincidence imaging. CONCLUSION: The combined approach of x-ray attenuation, anatomic mapping, and image fusion with scintigraphic studies provides a new diagnostic tool for nuclear medicine and fertile ground for future research.     

Brain mapping of median nerve somatosensory evoked potentials with combined99mTc-ECD single-photon emission tomography and magnetic resonance imaging

Single-photon emission tomography (SPET) was performed during electrical median nerve stimulation and used to detect focal neuronal activation in the somatosensory pathways. Intravenously administered technetium-99m ethyl cysteinate dimer (ECD) was used as a blood flow tracer to obtain baseline and activated images in each of three subjects. After image registration, baseline images were compared voxel by voxel with the activation images. In addition, the mean summation of the activated-state images of the subjects was compared with the mean summation of the baseline-state images of ten normal subjects. Discrete brain regions occupying 0.9%–1.6% of total brain volume showed an increase in signal from 33.6% to 35.0%. For further anatomical localization of regional increases in signal, the MRI scan of each subject was registered and superimposed on the activated-state SPET image. This method may be used to localize lesions in various disorders of the central nervous system.     

Gated SPET myocardial perfusion acquisition within 5 minutes using focussing collimators and a three-head gamma camera

Short acquisition protocols for gated single-photon emission tomography (SPET) myocardial perfusion imaging are desirable for sequential imaging to evaluate the myocardial response during pharmacological intervention. In this study a less than 5 min gated SPET acquisition protocol is proposed. Perfusion characteristics (defect severity) and left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (EDV, ESV), wall motion (WM) and wall thickening (WT) were calculated, checked for reproducibility and compared with data obtained using a standard gated SPET acquisition protocol. Gated SPET images were recorded in 20 patients starting 60 min after the administration of 925 MBq technetium-99m tetrofosmin at rest. The 5 min gated SPET studies were acquired with a three-head camera equipped with Cardiofocal collimators. This protocol was repeated twice. In addition gated SPET studies were acquired according to a standard protocol using parallel-hole collimators. The severity of perfusion defects was quantified on polar maps using the non-gated image data and a normal database. LVEF, EDV, ESV, WM and WT were calculated from the gated images. The agreement between 5-min and standard gated SPET acquisitions was excellent for all investigated parameters. The reproducibility of repeated 5-min acquisitions for the quantification of perfusion defect severity was excellent (r=0.97). The agreement for segmental WT scores between repeated 5-min gated SPET acquisitions was good: κ=0.71; major differences in segmental classification were observed in 2.5%. For WM a good agreement was found for segments with a tracer uptake ≥30% of the maximum: κ=0.65, major differences =7.7%. Excellent reproducibility was found for LVEF, EDV and ESV measurements: r=0.97, 0.99 and 0.99, respectively. It is concluded that fast gated SPET perfusion studies acquired in less than 5 min yield accurate and reproducible measurements of myocardial perfusion and function (global and regional). In addition the results obtained with the 5-min gated SPET protocol correlate well with those obtained using a standard acquisition protocol. Received 1 February and in revised form 11 March 1998     

Transmission scanning system for a gamma camera coincidence scanner.

The goal of this research was to develop and evaluate a practical transmission scanning system for attenuation correction on a 2-head gamma camera coincidence scanner. METHODS: The transmission system operates in singles mode and uses point sources of 137Cs that emit 662-keV gamma-radiation. Each point source is inserted between existing septa that are normally used to provide an approximately 2-dimensional emission acquisition geometry. The sources are placed along a line parallel to the axis of rotation near the edge of 1 camera. Data are acquired with the opposing camera. The septa provide axial collimation for the sources so that the transmission system operates in a 2-dimensional offset fanbeam geometry. Camera energy and spatial resolution were measured at 511 and 662 keV. Sensitivity was measured at 662 keV. The effects on axial resolution of adding supplemental collimation to the septa were shown. The system was calibrated and tested using a resolution (rod) phantom and a uniformity phantom. Torso phantom data were acquired. Patient transmission and emission scans were obtained. Postinjection transmission data were used to correct patient emission data. RESULTS: The camera resolution at postinjection counting rates was 11.7% full width at half maximum (FWHM) for 662-keV gamma-rays. Intrinsic spatial resolution was 2.7 mm (FWHM) at 662 keV. The sensitivity of the system was 280 Hz/MBq using five 74-MBq sources of 137Cs in the transmission geometry, with supplemental collimation added to the septa to improve axial resolution. The transaxial resolution of the system was such that the smallest rods (6-mm diameter and 12-mm spacing) were well resolved in a reconstructed resolution-phantom image. The corrected patient emission scans were free of attenuation-induced artifacts. CONCLUSION: An easily implemented transmission system for a 2-head gamma camera coincidence scanner that can be used for postinjection transmission scanning has been developed.     

The role of hybrid cameras in oncology

The rapid advances in imaging technologies are a challenge for nuclear medicine physicians, radiologists, and clinicians who must integrate these technologies for optimal patient care and outcome at minimal cost. Multiple indications for functional imaging using F-18-fluorodeoxyglucose (FDG) are now well accepted in the field of oncology, including differentiation of benign from malignant lesions, staging malignant lesions, detection of malignant recurrence, and monitoring therapy. The use of FDG imaging was first shown using dedicated positron emission tomography (PET) with multiple full rings of bismuth germanate detectors. Most manufacturers now have available hybrid gamma cameras capable of imaging conventional single-photon emitters, as well as positron emitters such as FDG. This new technology was developed to make FDG imaging more widely accessible, first using single photon emission computed tomography (SPECT) with high-energy collimators, and then using dualhead coincidence (DHC) detection with multihead gamma cameras that improved spatial resolution. Most hybrid gamma cameras are now equipped with thicker NaI(TI) crystals to improve sensitivity. Technical developments are still evolving with correction for attenuation and new iterative reconstruction algorithms to improve the quality of the images. Users need to be familiar with the rapid developments of the technology as well as its limitations. Currently, one model of hybrid gamma camera is equipped with an integrated x-ray transmission system for attenuation correction, anatomic mapping, and image fusion. This powerful tool has promising clinical applications including intensity-modulated radiation therapy.     

The CdTe detector module and its imaging performance

In recent years investigations into the application of semiconductor detector technology in gamma cameras have become active world-wide. The reason for this burst of activity is the expectation that the semiconductor-based gamma camera would outperform the conventional Anger-type gamma camera with a large scintillator and photomultipliers. Nevertheless, to date, it cannot be said that this expectation has been met. METHODS: While most of the studies have used CZT (Cadmium Zinc Telluride) as the semiconductor material, we designed and fabricated an experimental detector module of CdTe (Cadmium Telluride). The module consists of 512 elements and its pixel pitch is 1.6 mm. We have evaluated its energy resolution, planar image performance, single photon emission computed tomography (SPECT) image performance and time resolution for coincidence detection. RESULTS: The average energy resolution was 5.5% FWHM at 140 keV. The intrinsic spatial resolution was 1.6 mm. The quality of the phantom images, both planar and SPECT, was visually superior to that of the Anger-type gamma camera. The quantitative assessment of SPECT images showed accuracy far better than that of the Anger-type camera. The coincidence time resolution was 8.6 ns. All measurements were done at room temperature, and the polarization effect that had been the biggest concern for CdTe was not significant. CONCLUSION: The results indicated that the semiconductor-based gamma camera is superior in performance to the Anger-type and has the possibility of being used as a positron emission computed tomography (PET) scanner.     

Regional ventilatory evaluation using dynamic SPET imaging of xenon-133 washout in obstructive lung disease: an initial study

Regional ventilatory abnormalities in obstructive lung disease were evaluated by dynamic single-photon emission tomography (SPET) of pulmonary washout of xenon-133 (¹³³Xe) gas. The subjects included seven healthy volunteers. 17 patients with obstructive lung disease, and seven patients with restrictive lung disease. Following 6 min of inhalation of¹³³Xe gas (60–72 MBq/1), equilibrium and subsequent washout SPET images during spontaneous breathing were sequentially acquired every 30 s for 6–7 min, using a triple-head SPET system with the return mode of continuous repetitive rotating acquisition. A gravity-induced gradient of ventilation was demonstrated in the volunteers' lungs. Compared with the normal subjects, all the patients with obstructive disease showed abnormal¹³³Xe retention on the washout SPET images, with or without abnormalities on chest X-ray computed tomography, whereas the patients with restrictive disease did not show any significant delays in washout. This modality may assist in the evaluation of the three-dimensional dynamic process of ventilatory abnormalities in obstructive lung disease.     

The benefit of functional-anatomical imaging with [18F]fluorodeoxyglucose utilizing a dual-head coincidence gamma camera with an integrated X-ray transmission system in non-small cell lung cancer

AIM: To evaluate functional-anatomical imaging with 2-[F]fluoro-2-deoxy-D-glucose (F-FDG) utilizing a dual-head coincidence gamma camera with an integrated X-ray transmission system for attenuation correction, anatomical mapping, and image fusion compared to conventional diagnostics by computed tomography (CT) in non-small cell lung cancer (NSCLC). METHODS: Thirty-five patients with NSCLC underwent FDG imaging of the thoracic area using a dual-head coincidence gamma camera (DHC) with an integrated X-ray transmission system. State-of-the-art CT scans had been performed before. Whole-body dedicated FDG positron emission tomography (PET) was performed immediately prior to DHC. Staging by CT and DHC, and DHC with integrated image fusion (FDHC) were re-evaluated with regard to detectable lesions, correct anatomical diagnoses, and clinical impact. Results of DHC and PET were compared for analysis of limitations of DHC. RESULTS: One hundred and thirteen tumour lesions were identified by CT. DHC detected 128 lesions overall: 102 true positive CT lesions were confirmed, 25 additional lesions were detected which affected staging in eight patients, and one false positive lung lesion did not show up in DHC. Nine CT lesions were missed by DHC (lymph node and lung). PET detected 150 areas of focally enhanced uptake, delivering two false positive results (nuchal muscles, pneumonia). Final evaluation confirmed 148 malignant lesions. Compared to CT, the results of DHC changed staging or treatment in 8/35 patients (23%). Lesion detection by DHC was limited by tumour size and intensity of FDG uptake. Image fusion provided relevant clinical information in 9/35 patients (26%). CONCLUSION: Functional imaging in NSCLC with this dual-head gamma camera is superior to morphological imaging by CT, although inferior to dedicated PET imaging. Combined functional-anatomical imaging has the potential to improve staging and localization procedures before surgery or radiotherapy.     

Quantitative analysis of inhomogeneity in ventilation SPET

The aim of this study was to evaluate a method for quantification of inhomogeneity in ventilation single-photon emission tomography (SPET). Nine emphysematous patients, nine life-long non-smokers and nine smokers were included in the study. The SPET investigation was performed after 50 MBq ^99mTc-Technegas had been inhaled by each subject in the supine position. A single-head gamma camera, equipped with a general-purpose parallel-hole collimator using 64 projections (20 s each) over 360°, was used. Data were acquired in 128쏐 matrices. Attenuation correction was applied based upon computed tomography (CT) density maps. Lung regions of interest were delineated manually on CT images and then positioned on SPET images. Several attenuation-corrected transaxial SPET slices (thickness 1 cm, spacing 3.5 cm) were reconstructed. Each SPET slice was divided into several 2Ƕǵ cm³ elements. Inhomogeneity was assessed by the coefficient of variation (CV) of the pixel counts within these elements (micro-level) and the CV of the total counts of the elements (macro-level). Micro-level CVs in non-smokers varied between 1% and 41%, whereas they were dispersed over a wide range (1%-600%) in emphysematous patients. In seven smokers, the frequency distribution of micro-level CVs was within the normal range, whereas in the other two smokers the values were between the normal range and the range in emphysematous patients. The pooled mean values of micro-level CVs and macro-level CVs in each subject clearly separated the patients from the others. Parametric images of micro-level CV indicated the localisation and severity of ventilation inhomogeneity. We conclude that the present method enables quantification and localisation of regional inhomogeneity in ventilation SPET images.