Hexa-methyl-propylene-amine-oxime (HMPAO) single photon emission computed tomography (SPECT) in epilepsy

Summary Twenty-eight normal volunteers and 74 seizure patients were investigated with hexa-methyl-propylene-amine-oxime (HMPAO) brain single photon emission computed tomography (SPECT). Fifty-four patients suffered from partial seizures and 20 patients had generalized seizures. Indices describing regional tracer distribution (RIs) were calculated in all investigated subjects. Regions whose RI exceeded the mean normal RI +/-3 SD were defined as abnormally perfused. In normals a significant interhemispheric asymmetry of HMPAO deposition was found, with higher RI values in the right frontal, parietal, temporal and occipital regions. In 59.3% of partial seizure patients abnormal RIs were found. Low RIs were detected predominantly in the frontal and temporal cortex, while elevated RIs were observed predominantly in the anterior basal ganglia. Only in 20% of the cases with generalized seizures, abnormal RIs were found. In one patient an ictal and 3 follow-up SPECT studies were obtained. Here SPECT results indicated transient rCBF changes between the ictal and seizure free state. EEG and SPECT foci were ipsilaterally located in 69.2% of the partial seizure cases. The results indicate that HMPAO brain SPECT is valuable for the detection of rCBF abnormalities in seizure patients and that patients with partial seizures have mostly several abnormally perfused areas in their brains.     

A comparison of attenuation correction methods for quantitative single photon emission computed tomography

Transverse section tomograms of experimental phantoms and patients have been obtained using a GE 400T camera and a filtered back-projection reconstruction technique. These tomograms have been compared with the corresponding sections reconstructed from the same tomographic projection data, but using iterative algorithms with correction for photon attenuation. The comparison assesses the importance of including a correction for attenuation as well as demonstrating how closely a simple geometric attenuation correction, applied to the filtered back-projection reconstruction method, approximates to a more accurate correction incorporated in the computation of line integrals during iterative reconstruction. A comparison is also made between the behaviour of reconstruction algorithms with simulated projection data and real data in terms of convergence properties, and some shortcomings arising from simulation are noted.     

Differential attenuation method for simultaneous estimation of activity and attenuation in multiemission single photon emission computed tomography

A penalized weighted least squares reconstruction algorithm is described that simultaneously estimates activity and attenuation distributions from emission sinogram data alone. This estimation technique is based on differential attenuation information and is applicable to any single photon emission computed tomography imaging isotope with emissions at two or more distinct energies, after accurate compensation for Compton scatter. A rotation-based forward projector is used to efficiently model photon attenuation at multiple emission energies, as well as distance-dependent spatial resolution. The algorithm was tested using simulated scatter-free 201T1 projection data from a single-slice numerical cardiac phantom with and without cold myocardial defects. Poisson noise was added to the projection data to mimic clinically realistic count densities. The activity estimates resulting from the proposed method had fewer artifacts and were substantially more accurate than images reconstructed with filtered backprojection without compensation for attenuation. Several techniques were employed to reduce the time required for the iterative routine to converge and to reduce the sensitivity of the solution to noise in the projection data. These included: (1) a preconditioning image variable transformation; (2) a coarse-to-fine grid initialization schedule; and (3) a convex hull image mask determined directly from the data. The combined effect of these techniques substantially reduced the compute time required for the reconstruction.     

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

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

The early years of single photon emission computed tomography (SPECT): an anthology of selected reminiscences

The origin of SPECT can be found in pioneering experiments on emission tomography performed approximately 50 years ago. This historical review consists of a compilation of first person recollections from nine trailblazing scientists who shaped the early years of SPECT instrumentation during the 1960s and 1970s.     

Quantitative pulmonary single photon emission computed tomography for radiotherapy applications.

Pulmonary imaging using single photon emission computed tomography (SPECT) is the focus of current radiotherapy research, including dose-response analysis and three-dimensional (3D) radiation treatment planning. Improvement in the quantitative capability of SPECT may help establish its potential role in this application as well as others requiring accurate knowledge of pulmonary blood flow. The purposes of this study were to quantitatively evaluate SPECT filtered backprojection (FBP) and ordered subset-expectation maximization (OS-EM) reconstruction implementations for measuring absolute activity concentration in lung phantom experiments, and to incorporate quantitative SPECT techniques in 3D-RTP for lung cancer. Quantitative FBP (nonuniform iterative Chang attenuation compensation, scatter correction, and 3D postreconstruction Metz filtering) and OS-EM implementations were compared with a "clinical" implementation of FBP (uniform multiplicative Chang attenuation compensation and post-reconstruction von Hann filtering), for their ability to improve quantification of inactive and active spherical defects in the lungs of an anthropomorphic torso phantom. Activity concentration estimates were found to depend on many factors, such as region of interest size, scatter subtraction constant (k), postreconstruction deconvolution filtering and, in the case of OS-EM, total number of iterations. In general, reconstruction implementations incorporating compensation for nonuniform attenuation and scatter provided reduced bias relative to the clinical implementation. Potential applications to lung radiotherapy, including dose-functional histograms and treatment planning are also discussed. SPECT has the potential to provide accurate estimates of lung activity distributions that, together with improved image quality, may be useful for the study and prediction of therapeutic response.     

Review of convergent beam tomography in single photon emission computed tomography.

Investigation of convergent-beam single photon emission computed tomography (SPECT) is actively being pursued to evaluate its clinical potentials. Fan-beam, cone-beam, pin-hole and astigmatic collimators are being used with rotating gamma cameras having large crystal areas, to increase the sensitivity for emission and transmission computed tomography of small organs such as the thyroid, brain or heart. With new multi-detector SPECT systems, convergent-beam geometry offers the ability to simultaneously obtain emission and transmission data necessary to quantify uptake of radiopharmaceutical distributions in the heart. The development of convergent-beam geometry in SPECT requires the integration of hardware and software. In considering hardware, the optimum detector system for cone-beam tomography is a system that satisfies the data sufficiency condition for which the scanning trajectory intersects any plane passing through the reconstructed region of interest. However, the major development of algorithms has been for the data insufficient case of single planar orbit acquisitions. The development of these algorithms have made possible the preliminary evaluation of this technology and the imaging of brain and heart are showing significant potential for the clinical application of cone-beam tomography. Presently, significant research activity is pursuing the development of algorithms for data acquisitions that satisfy the data sufficiency condition and that can be implemented easily and inexpensively on clinical SPECT systems.     

Positron emission tomography (PET) and single photon emission computed tomography (SPECT) imaging of macrophages in large vessel vasculitis: Current status and future prospects

Macrophages are key players in the pathogenesis of large-vessel vasculitis (LVV) and may serve as a target for diagnostic imaging of LVV. The radiotracer, ¹⁸F-FDG has proven to be useful in the diagnosis of giant cell arteritis (GCA), a form of LVV. Although uptake of ¹⁸F-FDG is high in activated macrophages, it is not a specific radiotracer as its uptake is high in any proliferating cell and other activated immune cells resulting in high non-specific background radioactivity especially in aging and atherosclerotic vessels which dramatically lowers the diagnostic accuracy. Evidence also exists that the sensitivity of ¹⁸F-FDG PET drops in patients upon glucocorticoid treatment. Therefore, there is a clinical need for more specific radiotracers in imaging GCA to improve diagnostic accuracy. Numerous clinically established and newly developed macrophage targeted radiotracers for oncological and inflammatory diseases can potentially be utilized for LVV imaging. These tracers are more target specific and therefore may provide lower background radioactivity, higher diagnostic accuracy and the ability to assess treatment effectiveness. However, current knowledge regarding macrophage subsets in LVV lesions is limited. Further understanding regarding macrophage subsets in vasculitis lesion is needed for better selection of tracers and new targets for tracer development. This review summarizes the development of macrophage targeted tracers in the last decade and the potential application of macrophage targeted tracers currently used in other inflammatory diseases in imaging LVV.     

Convolutional image reconstruction for quantitative single photon emission computed tomography

Two image reconstruction algorithms have been investigated. They are based on filtered backprojection, and are useful when the tissue attenuation is considered to be uniform in the object. The first method uses a weighted backprojection, the weighting factor being determined in such a way that the photon attenuation is compensated with low noise propagation. The parameters involved in the convolution kernel and the correction function were determined by a computer iteration program. The second method, which is a simplified version of the first, uses conventional backprojection, and takes a shorter computation time than the first method. The statistical noise of an image can be minimised by suitable positioning of the coordinate origin for the reconstruction. The theory of the two methods, their performance on statistical noise and some results of mathematical and experimental phantom studies are described.     

Brain single photon emission computed tomography findings in depressive pseudodementia patients

BACKGROUND: Recently, there have been studies suggesting that depressive pseudodementia would include early-stage dementing disorder. Through the comparison of the 99mTc-HMPAO single photon emission computed tomography (SPECT) image of depressive pseudodementia subjects, healthy comparison subjects, depressed subjects free of cognitive impairment, and dementia of Alzheimer's type (DAT) subjects, we aimed to see part of pathophysiology of the depressive pseudodementia of elderly patients. METHODS: Study subjects consisted of seven patients with depressive pseudodementia, seven healthy comparison subjects, seven patients with depression free of cognitive impairment, and eleven patients with DAT. Depression patients were diagnosed according to DSM-III-R. DAT patients were diagnosed by DSM III-R and NINCDS-ADRDA criteria of DAT. Other measures for assessment include Hamilton Rating Scale for Depression and Mini Mental State Exam. All underwent 99mTc-HMPAO SPECT scan. The images of each group were analyzed using statistical parametric mapping of Friston, which compares the images on voxel-by-voxel basis. RESULTS: The results were as follows (1) The DAT group showed significant decreases of cerebral blood flow (CBF) in the right frontal, right temporal region, and both parietal regions as compared with control group (P < 0.05). (2) The depression group showed a significant decrease of CBF in the left frontal region as compared with control group (P < 0.05). (3) The depressive pseudodementia group showed significant decreases of CBF in both parietal regions as compared with control group (P < 0.05). (4) The depressive pseudodementia group showed significant decreases of CBF in the right temporal region and both parietal regions as compared with depression group (P < 0.05). (5) The DAT group showed significant decreases of CBF in the right temporal region, both frontal regions, and both parietal regions as compared with depressive pseudodementia group (P < 0.05). LIMITATIONS: The small number of subjects may make it difficult to generalize from our results. Because decreased CBF in depressive pseudodementia is found while the subjects were depressed, we cannot tell whether it is a state marker or a trait marker. CONCLUSIONS: The depressive pseudodementia group showed decreased CBF in the temporo-parietal region, similar to that of the DAT group and different from that of the depression group.     

Rapid calculation of detectability in Bayesian single photon emission computed tomography

We consider the calculation of lesion detectability using a mathematical model observer, the channelized Hotelling observer (CHO), in a signal-known-exactly/background-known-exactly detection task for single photon emission computed tomography (SPECT). We focus on SPECT images reconstructed with Bayesian maximum a posteriori methods. While model observers are designed to replace time-consuming studies using human observers, the calculation of CHO detectability is usually accomplished using a large number of sample images, which is still time consuming. We develop theoretical expressions for a measure of detectability, the signal-to-noise-ratio (SNR) of a CHO observer, that can be very rapidly evaluated. Key to our expressions are approximations to the reconstructed image covariance. In these approximations, we use methods developed in the PET literature, but modify them to reflect the different nature of attenuation and distance-dependent blur in SPECT. We validate our expressions with Monte Carlo methods. We show that reasonably accurate estimates of the SNR can be obtained at a computational expense equivalent to approximately two projection operations, and that evaluating SNR for subsequent lesion locations requires negligible additional computation.     

Area weighted convolutional interpolation for data reprojection in single photon emission computed tomography

A data reprojection algorithm has been developed for use in single photon emission computed tomography on an array processor equipped computer system. The algorithm makes use of an accurate representation of pixel activity (uniform square pixel model of intensity distribution), and is rapidly performed due to the efficient handling of an array-based algorithm and the fast Fourier transform on parallel processing hardware. The algorithm consists of using a pixel driven nearest-neighbor projection operation to an array of subdivided projection bins. The subdivided project bin array is then convolved with the angle-dependent projection of the area of a uniform square pixel and compressed to original bin size. The new algorithm has thus been named the area weighted convolution (AWC) method of interpolation. When compared to nearest-neighbor and linear interpolation algorithms, the new AWC algorithm was found to be more accurate, having an accuracy approaching that of the line length algorithm. It also yielded an easier and more efficient implementation on parallel hardware than line length or linear interpolation, with faster execution times than either.     

Performance of the dynamic single photon emission computed tomography (dSPECT) method for decreasing or increasing activity changes

Radionuclide imaging is now widely used whenever functional information is required. We present a new approach to dynamic SPECT imaging (dSPECT method) that uses a single slow rotation of a conventional camera and allows us to reconstruct a series of 3D images corresponding to the radiotracer distribution in the body at various times. Using simulations of various camera configurations and acquisition protocols, we have shown that this method is able to reconstruct washout half-lives with an accuracy greater than 90% when used with triple-head SPECT cameras. Accuracy decreases when using fewer camera heads, but dual-head geometries still give an accuracy greater than 80% for short and 90% for long half-lives and about 50-75% for single-head systems. Dynamic phantom experiments have yielded similar results. Presence of attenuation and background activity does not affect the accuracy of the dSPECT reconstructions. In all situations investigated satisfactory dynamic images were produced. A preliminary normal volunteer study measuring renal function was performed. The reconstructed dynamic images may be presented as a three-dimensional movie showing movement of the tracer through the kidneys and the measurement of the regional renal function can be performed. The time-activity curves determined from this dSPECT data are very similar to those obtained from dynamic planar scans.     

Monte Carlo evaluation of Compton scatter subtraction in single photon emission computed tomography

In single photon emission computed tomography (SPECT), Compton scattering produces a background that degrades the image quality and contributes erroneously to quantitative measurements. A clinically implementable compensation algorithm has previously been reported that subtracts a Compton scatter image, acquired in an energy window set below the energy of the photopeak, from the primary image acquired in the photopeak window. We present an evaluation and justification of the assumptions made in the previous empirical development of the subtraction algorithm. A Monte Carlo model of the SPECT system in which the Compton scattered vents may be followed independently of the nonscattered events was used to evaluate this subtraction technique. Simulation shows that the assumptions made in the experimental application of this algorithm were valid. Specifically (1) the "scatter" energy window used in the experiment (91-125 keV for imaging Tc-99m) contains only scattered events, (2) the shape of the line spread function (LSF) for the events in the scatter window is a reasonable approximation to the shape of the scatter in the photopeak window, and (3) the ratio of the number of scattered events in the photopeak window to the number of events in the scatter window is 0.57, close to the value of 0.5 derived heuristically. Thus, Monte Carlo simulation validates the basic assumptions underlying the empirical implementation of the scatter subtraction algorithm.