Automatic segmentation of dynamic neuroreceptor single-photon emission tomography images using fuzzy clustering.

The segmentation of medical images is one of the most important steps in the analysis and quantification of imaging data. However, partial volume artefacts make accurate tissue boundary definition difficult, particularly for images with lower resolution commonly used in nuclear medicine. In single-photon emission tomography (SPET) neuroreceptor studies, areas of specific binding are usually delineated by manually drawing regions of interest (ROIs), a time-consuming and subjective process. This paper applies the technique of fuzzy c-means clustering (FCM) to automatically segment dynamic neuroreceptor SPET images. Fuzzy clustering was tested using a realistic, computer-generated, dynamic SPET phantom derived from segmenting an MR image of an anthropomorphic brain phantom. Also, the utility of applying FCM to real clinical data was assessed by comparison against conventional ROI analysis of iodine-123 iodobenzamide (IBZM) binding to dopamine D2/D3 receptors in the brains of humans. In addition, a further test of the methodology was assessed by applying FCM segmentation to [123I]IDAM images (5-iodo-2-[[2-2-[(dimethylamino)methyl]phenyl]thio] benzyl alcohol) of serotonin transporters in non-human primates. In the simulated dynamic SPET phantom, over a wide range of counts and ratios of specific binding to background, FCM correlated very strongly with the true counts (correlation coefficient r2>0.99, P<0.0001). Similarly, FCM gave segmentation of the [123I]IBZM data comparable with manual ROI analysis, with the binding ratios derived from both methods significantly correlated (r2=0.83, P<0.0001). Fuzzy clustering is a powerful tool for the automatic, unsupervised segmentation of dynamic neuroreceptor SPET images. Where other automated techniques fail completely, and manual ROI definition would be highly subjective, FCM is capable of segmenting noisy images in a robust and repeatable manner.     

Imaging of the dopaminergic neurotransmission system using single-photon emission tomography and positron emission tomography in patients with parkinsonism

Parkinsonism is a feature of a number of neurodegenerative diseases, including Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. The results of post-mortem studies point to dysfunction of the dopaminergic neurotransmitter system in patients with parkinsonism. Nowadays, by using single-photon emission tomography (SPET) and positron emission tomography (PET) it is possible to visualise both the nigrostriatal dopaminergic neurons and the striatal dopamine D₂ receptors in vivo. Consequently, SPET and PET imaging of elements of the dopaminergic system can play an important role in the diagnosis of several parkinsonian syndromes. This review concentrates on findings of SPET and PET studies of the dopaminergic neurotransmitter system in various parkinsonian syndromes.     

Quality of brain perfusion single-photon emission tomography images: multicentre evaluation using an anatomically accurate three-dimensional phantom

The aim of the study was to evaluate the quality of routine brain perfusion single-photon emission tomography (SPET) images in Finnish nuclear medicine laboratories. Twelve laboratories participated in the study. A three-dimensional high resolution brain phantom (Data Spectrum’s 3D Hoffman Brain Phantom) was filled with a well-mixed solution of technetium-99m (110 MBq), water and detergent. Acquisition, reconstruction and printing were performed according to the clinical routine in each centre. Three nuclear medicine specialists blindly evaluated all image sets. The results were ranked from 1 to 5 (poor quality–high quality). Also a SPET performance phantom (Nuclear Associates’ PET/SPECT Performance Phantom PS 101) was filled with the same radioactivity concentration as the brain phantom. The parameters for the acquisition, the reconstruction and the printing were exactly the same as with the brain phantom. The number of detected ”hot” (from 0 to 8) and ”cold” lesions (from 0 to 7) was visually evaluated from hard copies. Resolution and contrast were quantified from digital images. Average score for brain phantom images was 2.7±0.8 (range 1.5–4.5). The average diameter of the ”hot” cylinders detected was 16 mm (range 9.2–20.0 mm) and that of the ”cold” cylinders detected, 11 mm (5.9–14.3 mm) according to visual evaluation. Quantification of digital images showed that the hard copy was one reason for low-quality images. The quality of the hard copies was good only in four laboratories and was amazingly low in the others when comparing it with the actual structure of the brain phantom. The described quantification method is suitable for optimizing resolution and contrast detectability of hard copies. This study revealed the urgent need for external quality assurance of clinical brain perfusion SPET images. Received 2 February and in revised form 31 May 1998     

Clinical deficits in Huntington disease correlate with reduced striatal uptake on iodine-123 epidepride single-photon emission tomography

Huntington disease (HD) is characterized by severe abnormalities in neurotransmitter concentrations and neuroreceptor density. Quantitative changes in dopamine D₂ receptors occur in the early stages of HD and may be detectable with functional neuroimaging techniques. The aim of this study was to determine whether dopamine D₂ receptor imaging with single-photon emission tomography (SPET) identifies preclinical abnormalities in HD.The study population comprised 32 subjects from families affected by HD: 11 were genetically normal while 21 were genetically positive for HD (seven asymptomatic, six early, three moderate and five advanced findings). Disease severity was determined using a standardized quantitative neurological examination (QNE) and the mini-mental status examination (MMSE). Subjects underwent brain SPET imaging 120 min following intravenous injection of iodine-123 epidepride. Ratios of target (striatal) to nontarget (occipital or whole-brain) uptake were calculated from the reconstructed image data. Striatum to occiput and striatum to whole-brain count ratios correlated negatively with disease stage (P=0.002 and P=0.0002) and QNE (P<0.002 and P=0.0002), and positively with the MMSE (P=0.001 and P<0.001). Uptake was significantly reduced in the moderate-advanced subjects but was still normal for the asymptomatic and early symptomatic stages. It is concluded that reductions in striatal dopamine D₂ receptor density can be detected with ¹²³I epidepride at moderate or advanced stages of HD. In contrast to other reports, we could not identify abnormalities in clinically unaffected or early stages of HD. Received 1 May and in revised form 29 June 1999     

模糊聚类技术分割颅脑肿瘤MR图像的应用研究

目的：分析自编的模糊C均值（fuzzy cmeans,FCM）算法图像处理程序对颅脑肿瘤MRI图像的分割效果。方法：采集50幅不同脑肿瘤MRI平扫系列图像,用FCM程序对病灶自动分割,同时请影像学专家对相应病灶面积进行手工绘制,用重合率和误分割率两个指标进行比较分析两者的分割效果。结果：FCM程序分割病灶的重合率为91.2%,误分割率为10.8%。二者面积的差值无显著性差异（P〉0.05）。结论：FCM程序可以无监督地自动分割脑肿瘤MRI图像,有较强的临床应用价值。     

Evaluation of optimally designed planar-concave collimators in single-photon emission tomography

The imaging properties of optimally designed planar-concave (PC) collimators were evaluated by means of Monte Carlo simulations. The evaluation was done with respect to total system spatial resolution and the overall image noise distribution in single-photon emission tomography. The results showed that the non-isotropy with PC collimators, assessed by the ratio of the full-width at half-maximum in the radial and tangential directions, was reduced by about 60% as compared with a conventional parallel-hole collimator for sources located 200 mm away from the centre of rotation. Furthermore, the image noise distribution along the object radius became more uniform when the curved collimator was used. The maximum increase in noise due to use of the curved collimator was about 45% close to the edge of the phantom, where the hole length was about 3 times longer. We also showed with Monte Carlo simulations that the spatial resolution of the lateral cortex when using the curved collimator was significantly improved due to improved radial resolution. Received 1 May and in revised form 4 August 1997     

Imaging of dopamine D2 and somatostatin receptors in vivo using single-photon emission tomography in a patient with a TSH/PRL-producing pituitary macroadenoma

A 28-year-old man with a thyroid stimulating hormone/prolactin (TSH/PRL)-secreting pituitary macroadenoma is discussed in relation to dopamine D₂ and somatostatin receptor single-photon emission tomography (SPET). The patient presented with decreased vision in the left eye as a result of a temporal visual field defect and with mild hyperthyroidism. Medical therapy was tried. A test dose of both octreotide and bromocriptine resulted in an acute reduction in serum levels of TSH, -subunits and PRL, whereas there was no response to TRIAC. Somatostatin and dopamine D₂ receptors were present on the tumour as visualised by SPET with the ligands indium-111 diethylene triamine penta-acetic acid (DTPA)-octreotide (¹¹¹In-SMS) and iodine-123 iodobenzamide (¹²³I-IBZM), respectively. Therefore, treatment with octreotide 150 g t.i.d. subcutaneously and bromocriptine 10 mg b.i.d. orally was given for > 12 and > 6 weeks, respectively. Following this treatment the visual defects disappeared, although tumour size, as measured by CT scanning, and serum TSH levels did not decrease. SPET with ¹¹¹In-SMS and ¹²³I-IBZM after therapy revealed no change or a possible increase in somatostatin receptor binding potential and a possible decrease in dopamine D₂ receptor binding potential. The lack of long-term effects of the medical treatment is discussed. It is concluded that a high somatostatin and dopamine D₂ receptor binding potential in vivo in a TSH/PRL-producing adenoma does not necessarily predict a successful outcome of medical treatment. Correspondence to: N.P.L.G. Verhoeff     

Resting state rCBF mapping with single-photon emission tomography and positron emission tomography: magnitude and origin of differences

Single-photon emission tomography (SPET), using technetium-99m hexamethylpropylene amine oxime, and positron emission tomography (PET), using oxygen-15 butanol were compared in six healthy male volunteers with regard to the mapping of resting state regional cerebral blood flow (rCBF). A computerized brain atlas was utilized for 3D regional analyses and comparison of 64 selected and normalized volumes of interest (VOIs). The normalized mean rCBF values in SPET, as compared to PET, were higher in most of the Brodmann areas in the frontal and parietal lobes (4.8% and 8.7% respectively). The average differences were small in the temporal (2.3%) and occipital (1.1%) lobes. PET values were clearly higher in small VOIs like the thalamus (12.3%), hippocampus (12.3%) and basal ganglia (9.9%). A resolution phantom study showed that the in-plane SPET/PET system resolution was 11.0/7.5 mm. In conclusion, SPET and PET data demonstrated a fairly good agreement despite the superior spatial resolution of PET. The differences between SPET and PET rCBF are mainly due to physiological and physical factors, the data processing, normalization and co-registration methods. In order to further improve mapping of rCBF with SPET it is imperative not only to improve the spatial resolution but also to apply accurate correction techniques for scatter, attenuation and non-linear extraction. Received 3 August and in revised form 1 October 1997     

Technetium-99m methoxyisobutylisonitrile single-photon emission tomography in hepatocellular carcinoma

Nine lesions in eight patients with hepatocellular carcinoma (HCC) were studied using single-photon emission tomography (SPET) and technetium-99m methoxyisobutylisonitrile (^99mTc-MIBI) to evaluate the pattern of uptake of ^99mTc-MIBI in the lesions and the relation between the uptake pattern and the histopathology of HCC. All the lesions were diagnosed as HCC by percutaneous needle biopsy. Four of the nine lesions showed positive uptake of ^99mTc-MIBI, while the other five showed negative uptake. All of the lesions which showed positive uptake were of the compact type. Of the five lesions that showed negative uptake, four were of the trabecular type while one was of the compact type. These results suggest that the patterns of ^99mTc-MIBI accumulation in HCC are divided into positive and negative types and that these uptake patterns are associated with the tissue structure of HCC. Received 10 August and in revised form 15 August 1997     

Simplified reference region model for the kinetic analysis of [99mTc]TRODAT-1 binding to dopamine transporters in nonhuman primates using single-photon emission tomography

Accurate quantification of neuroreceptors requires full kinetic modeling of the dynamic single-photon emission tomography (SPET) or positron emission tomography (PET) images, with highly invasive arterial blood sampling. This study investigated the application of a reference region kinetic model to the dynamics of [^99mTc]TRODAT-1 in nonhuman primates, obviating the need for blood sampling. A series of dynamic SPET scans were performed on two baboons following the injection of approximately 700 MBq of [^99mTc]TRODAT-1. Rapid arterial blood samples were taken automatically during scanning. Reconstructed SPET images were co-registered with magnetic resonance imaging (MRI) scans of the baboons, and regions of interest (ROIs) placed on the striatum, cerebellum and cerebral hemispheres. The ROI data were combined with metabolite-corrected blood data, and fitted to a three-compartment kinetic model using nonlinear least squares techniques. The same data were also used in a simplified reference region model, in which the input function was derived from the nondisplaceable tissue compartment. In addition, semiquantitative blinded analysis was performed by three raters to determine the point of transient equilibrium in the specific binding curves. All methods generated values for the ratio of the kinetic rate constants k ₃ /k ₄, which gives an estimate of the binding potential, BP. These were compared with the full kinetic model. The mean values of k ₃ /k ₄ for the three different analysis techniques for each baboon were: 1.17±0.21 and 1.12±0.13 (full kinetic model), 0.93±0.13 and 0.90±0.07 (reference region model), and 0.97±0.18 and 0.92±0.08 (equilibrium method). The reference region method gave significantly lower results than the full kinetic model (P = 0.01), but it also produced a much smaller spread and better quality fits to the kinetic data. The reference region model results for k ₃ /k ₄ correlated very strongly with the full kinetic analysis (r ² = 0.992, P<0.001), and with the equilibrium model (r ² = 0.88, P = 0.002). The subjectivity inherent in the equilibrium method produces inferior results compared with both kinetic analyses. It is suggested that the self-consistency of the reference region model, which requires no arterial blood sampling, provides a more precise and reliable estimate of the binding of [^99mTc]TRODAT-1 to dopamine transporters than full kinetic modeling. The reference region method is also better suited to a routine clinical environment, and would be able to distinguish smaller differences in dopaminergic function between patient groups. Received 26 October 1998 and in revised form 11 January 1999     

Prognostic value of single-photon emission tomography in acute ischaemic stroke

Single-photon emission tomography (SPET) is widely used in the investigation of acute stroke. We investigated the relationship between SPET data and functional outcome in a large group of acute stroke patients. One hundred and eight patients underwent cerebral computed tomography (CT) and technetium-99m hexamethylpropylene amine oxime SPET after acute ischaemic stroke. We categorised the clinical presentation according to the Oxford classification of acute stroke. Outcome was measured 1 year after stroke using mortality and the Barthel Index for survivors. SPET scans were interpreted without reference to the clinical data using a semi-automatic technique. Three experienced observers determined the presence of luxury perfusion using suitably scaled SPET images in conjunction with the CT scan. Both SPET volume and severity of deficit were significantly negatively correlated with Barthel Index at 1 year (r _s=–0.310,P<0.0001, andr _s=–0.316,P<0.0001 respectively). In patients scanned with SPET within 16 h of stroke onset, the correlations were more strongly negative (r _s=–0.606,P<0.0001, andr _s=–0.492,P<0.005 respectively). Luxury perfusion was not associated ( ²=0.073,df=1,P=0.79) with good functional outcome (Barthel score 60). Stepwise logistic regression identified Oxford classification, total deficit volume and patient's age as significant predictors of functional outcome. Overall predictive accuracy was 72%. Predictive accuracy was better in patients who received SPET within 16 h of stroke onset. SPET provides useful information about the functional outcome of acute stroke at 1 year. However, the accuracy of prediction decreases the longer SPET is delayed. Prognostication using SPET in combination with clinical assessment and other investigations may also be considered.     

Towards an optimal reference region in single-photon emission tomography difference images in epilepsy

There is marked variability in the cerebral blood flow (CBF) between the ictal and interictal state in epilepsy, and it would therefore be desirable to increase the reliability of ictal/interictal single-photon emission tomography (SPET) difference images. We aimed to improve the step of quantitative normalization of images by finding the best possible reference region. In 16 patients (11 with lateralization of the epileptogenic focus, five with bilateral foci) both ictal and inter-ictal SPET scans were performed after injection of technetium-99m labelled tracer. Then, each region among a selected set (brain+cerebellum, brain, cerebellum, hemispheres, and for patients with an expected lateralization, cortical lobe containing the focus and symmetrical contralateral lobe) was investigated by comparison of the regional ictal/inter-ictal variance in counts. Among patients with a suspected lateralized focus, the distribution of CBF in the contralateral cortical lobe appeared to vary less between ictal and inter-ictal states than in other investigated areas. As a consequence, this latter region constitutes the best choice as a reference region. For patients with bilateral foci, the cerebellum appears to be a good compromise even though it presents with significant CBF changes. Received 9 April and in revised form 20 September 1999     

Quality of myocardial perfusion single-photon emission tomography imaging: multicentre evaluation with a cardiac phantom

The aim of the study was to evaluate quality of myocardial perfusion single-photon emission tomography (SPET) imaging in Finnish hospitals. Nineteen nuclear medicine departments participated in the study. A myocardial phantom simulating clinical stress and rest conditions was filled with routinely used isotope solution (technetium-99m or thallium-201). The cardiac insert included three reversible defects (simulating ischaemia): 30×30×14 mm³ septal (90% recovery at rest), 30×20×14 mm³ posterobasal (full recovery) and 20×20×14 mm³ lateral (full recovery). There were two fixed defects (simulating infarct): 30×20×14 mm³ postero-apical and 10×10×6 mm³ apical. The phantom was imaged and interpreted as a myocardial perfusion patient. Reconstruction, printout and reporting were performed according to the clinical routine of each centre. Three nuclear medicine specialists anonymously evaluated the quality of the image sets. The visual scores of the experts were ranked from 1 to 5. Additionally, points from 0 to 8 were given to research reports according to how well perfusion defects were detected. Quantitative points were calculated by comparing background-subtracted and -normalized counts from 12 regions of interest between stress and rest images. Results for technetium studies (12 departments) were better than those for thallium (7 departments). The average visual scores of the experts were 3.7±0.9 for all image sets, 3.2±0.5 for thallium users and 3.9±0.6 for technetium users (P=0.003). Five laboratories received a low score which, according to the specialists, is barely sufficient for limited clinical use. Average points for the reports were 5.6±2.1, 4.9±1.5 and 6.5±1.7 (P=0.051), and for the quantitation 8.2±1.0, 7.9±0.4 and 8.4±1.1 (P=0.185), respectively. Seven out of 22 interpreters did not detect the lateral 20×20×14 mm³ defect; five of them used thallium. This study demonstrated the heterogeneity of myocardial perfusion SPET in Finland. The participating laboratories used a wide scale of methods and, sometimes, inappropriate imaging protocols. The need for quality assurance in nuclear cardiology, correct use of SPET instrumentation and objective comparison of clinical studies is evident. The method described is suitable for external quality assurance and quality improvement of myocardial SPET imaging, and is recommended for regular use in nuclear medicine. Reiceived 15 March and in revised form 9 May 1999     

Rapid renal single-photon emission tomography by continuous infusion of iridium-191m

Continuous infusion of iridium-191m (t_1/2 = 5 s), produced with an ¹⁹¹Os/^191mIr generator, was used to obtain rapid high-resolution single-photon emission tomography (SPET) of renal blood flow in the rabbit. SPET scans of the abdomen were obtained with a triple-detector SPET system (MS3, Siemens Gammasonics). The generator was eluted at a flow rate of 3 ml/min, which delivered a steady-state dose of 170 MBq (4.5 mCi) of ^191mIr. The total ¹⁹¹Os breakthrough was 850 kBq (23 μCi). A 5-min SPET acquisition recorded a total of 2.8 million counts, resulting in images of high technical quality. Volume-rendered images clearly showed the abdominal aorta, splenic artery, spleen, renal arteries, kidneys and splanchnic vasculature. Tomographic slices through the kidneys revealed tracer primarily within the renal cortices without visualization of the collecting system. The estimated effective dose equivalent for a 5 min infusion of ^191mIr at a steady-state dose of 170 MBq is 0.74 mSv compared with 2.7 mSv from a 170 MBq dose of ^99mTc-DMSA. This study demonstrates the feasibility of high-resolution SPET of regional renal perfusion in the rabbit by continuous intravenous infusion of ^191mIr. The renal distribution of continuously infused ^191mIr is largely within the cortices, with minimal or no detectable activity in the region of the renal pelvicalyceal system. Using this technique, cortical renal SPET can be completed much more rapidly (<5 min) than with conventional renal cortical imaging agents, which suggests that this technique could be applied to the observation of rapid changes in renal perfusion such as those resulting from pharmacologic intervention, obviating the need for the patient to return for additional visits. Additional studies are required to (a) validate the methodology in larger animals prior to considering the potential for use in human beings, (b) optimize the generator design for continuous infusion, and (c) evaluate the changes in the distribution of ^191mIr that occur in animal models of altered renal perfusion. Received 1 October and in revised form 6 January 1999     

Delayed cerebral radionecrosis with a high uptake of 11C-methionine on positron emission tomography and 201Tl-chloride on single-photon emission computed tomography

A 47-year-old woman, who 2.5 years previously had undergone resection of a malignant astrocytoma of the left temporal lobe followed by radiotherapy, was found to have a mass in the left frontal lobe. This showed high uptake of thallium-201 (²⁰¹Tl) on single-photon emission computed tomography and ¹¹C-methionine on positron-emission tomography, suggesting recurrent tumour. Histological examination of the resected lesion, however, revealed it to be radionecrosis. This case thus illustrates a diagnostic pitfall in the use of these investigations for distinguishing radionecrosis from recurrent malignant glioma. Received: 19 September 1997 Accepted: 16 October 1997     

Validation of automated brain contour determination in normal and abnormal cerebral single-photon emission tomography

A contour detection algorithm for cerebral studies, using the method of Tomitani, has been implemented on a single-photon emission tomographic (SPET) system. It is based on the detetion by threshold of the brain edge in the sinogram and does not depend on the reconstruction algorithm. Thirteen normal subjects underwent an examination on both computed tomography (CT) and SPET using a head holder to ensure the reproducibility of the positioning. The CT scan contour of the brain was drawn manually according to the brain parenchyma limits. The SPET brain contour was obtained by use of the Tomitani algorithm after the threshold had been determined on an active cylindrical phantom. Using a threshold of 37% of the maximum uptake, the length of the contour as well as the area obtained with SPET and CT were not found to be statistically different. The method of Tomitani, which is simpler and faster then previous methods, provides contours which superimpose very well with CT scan images. Application to patients with unilateral pathological defects is possible by requiring that the contour is symmetrical.     

External reference markers for the correction of head rotation in brain single-photon emission tomography

Accurate reorientation of brain single-photon emission tomography (SPET) is required for quantitative procedures and for correlation with other imaging modalities. Traditionally, brain SPET has utilized reoriented slices parallel to the orbitomeatal line (OML). Reorientation using internal landmarks would be more convenient but has not been systematically compared with the use of external landmarks. We compared the interobserver reproducibility for defining the sagittal and coronal angular deviations using internal landmarks, a visual method based upon external reference markers, and an automated method based upon external reference markers. Internal landmarks were inaccurate for defining the OML whether this was based upon the frontal-occipital or frontal-cerebellar plane. External reference markers resulted in significantly lower interobserver differences for both sagittal and coronal reorientation. An operator-independent implementation proved to be feasible and provided an objective measure of marker coplanarity. In summary, external reference markers should be used when reproducible reorientation and ROI placement are required.     

A simplified intravenous glucose loading protocol for fluorine-18 fluorodeoxyglucose cardiac single-photon emission tomography

The myocardial uptake of fluorine-18 fluorodeoxyglucose (FDG) has emerged as the most sensitive and specific technique for the assessment of myocardial viability. With the development of FDG single-photon emission tomography (SPET) and dual head coincidence imaging, a hindrance to the widespread clinical use of FDG cardiac imaging is the complexity of the preinjection glucose loading necessary for obtaining interpretable myocardial FDG scans. In a population of 209 patients undergoing dual-isotope single acquisition (DISA) FDG/sestamibi (MIBI) SPET, we describe the improvements in both image quality and time efficiency using a new short, simple glucose/insulin/potassium (GIK) infusion protocol prior to FDG injection as compared to a conventional oral glucose loading protocol. DISA FDG/MIBI SPET scans were performed in 111 nondiabetic patients after oral loading with 50 g of glucose (group 1). Ninety-eight consecutive nondiabetic patients were subsequently scanned following preparation with a fixed-concentration GIK infusion administered at a standardized rate (group 2). A three-point grading scale was used to assess image quality. The time to FDG injection following glucose administration was significantly shorter for the group 2 patients (39.9±15.6 min; range 20–105 min) than for the group 1 patients (99.5±30.3 min; range 56–270 min) (P<0.0001), representing a 1-h decrease in patient preparation time. More of the group 1 patients (n=30; 27%) required supplemental intravenous boluses of regular insulin than did the group 2 patients (n=13; 13%) (P<0.02). There were more excellent and good quality graded images using the GIK method (group 2) than the more traditional oral loading protocol (group 1) (P<0.02). Nine of 111 scans (8%) in group 1 were uninterpretable, whereas only one of 98 scans (1%) in group 2 was uninterpretable. Standardized infusion of a fixed concentration of GIK prior to FDG administration and continued during myocardial FDG uptake is an effective yet simple method of obtaining consistently good to excellent quality FDG SPET cardiac scans. It is preferable to conventional oral glucose loading due to decreased patient preparation time and improved image quality. The technique is safe and should improve both the clinical use and the cost-effectiveness of FDG SPET imaging for the identification of injured but viable myocardium. Received 2 February and in revised form 12 June 1997     

Bone single-photon emission tomography in recent meniscal tears: an assessment of diagnostic criteria

Bone single-photon emission tomography (SPET) was performed in 40 patients within 6 months of acute knee injury where internal derangement of the knee was suspected, and the results related to the arthroscopy findings. Scan features with high sensitivity, specificity, and predictive accuracy for a meniscal tear could not be obtained on planar imaging. However, a half-crescent or more of increased tibial plateau activity on transaxial SPET gave a sensitivity of 89%, a specificity of 76%, a positive predictive accuracy of 77% and a negative predictive value of 89%. For longitudinal (bucket handle) tears alone the optimum scan pattern was a full crescent of increased tibial plateau activity with adjacent femoral activity and increased blood pool activity which gave corresponding values of 78%, 94%, 78% and 93%. It is concluded that the inclusion of tibial plateau activity of less than a full crescent and the presence of femoral condyle and blood pool activity in the diagnostic criteria improves the ability of bone SPET to detect meniscal tears. The value of bone SPET in the diagnosis of meniscal tears suggests that it could have a significant role to play in the management of knee injuries. Correspondence to: P.J. Ryan