Post on 01-Apr-2015
Overview of SPECT/CT Applicationsway to “new & clear” medicine
Peeyush Bhargava M.D, M.S
Attending in Nuclear Medicine, MEDVAMC
Associate Professor of Radiology, BCM
www.nuclearmd.com
SPECT & CT - Definitions
• SPECT (Single Photon Emission Computed Tomography) – “tomographic scintigraphy where computer generated three
dimensional images of radioactive tracer distribution are produced by detection of single photons from acquired
multiple planar images”
• CT (Computed Tomography) – “tomographic imaging performed with an external x-ray source to derive three
dimensional anatomic image data”
SPECT/CT - Definitions
“that can perform both functions on one gantry and provide fused functional and anatomic data in a single
imaging session”
“enables a direct correlation of anatomic information and functional information resulting in better localization and
definition of scintigraphic findings”
Integrated SPECT/CT Systems
SPECT/CT – pubmed searchSearch Keyword
AllArticles
ReviewArticles
1. SPECT-CT 700 86
2. SPECT/CT 2 1
3 PET-CT 4903 741
4. PET/CT 3744 530
Hybrid SPECT/CT: the end of "unclear" medicine.Patel CN, Chowdhury FU, Scarsbrook AF.Postgrad Med J. 2009 Nov;85(1009):606-13.
“Single photon emission computed tomography/CT (SPECT/CT) is a dual modality technique which increases the sensitivity and specificity of existing radionuclide imaging and helps characterize equivocal lesions detected by other imaging methods.”
SPECT/CT.Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, Scheidhauer K, Wester HJ, Rummeny EJ, Schwaiger M, Drzezga A. J Nucl Med. 2008 Aug;49(8):1305-19.
SPECT/CT imaging: clinical utility of an emerging technology.Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. Radiographics. 2008 Jul-Aug;28(4):1097-113.
A review on the clinical uses of SPECT/CT. Mariani G, Bruselli L, Kuwert T, Kim EE, Flotats A, Israel O, Dondi M, Watanabe N. Eur J Nucl Med Mol Imaging. 2010 Oct;37(10):1959-85.
SPECT/CT - References
Current SPECT/CT Systems
Vendor GE SIEMENS PHILIPS
CameraModels
Infinia Hawkeye 4
Symbia TSymbia T2Symbia T6Symbia T16
BrightView XCT
Discovery NM/CT 670
Precedence SPECT/CT
Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images.Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, Chisin R.Eur J Nucl Med. 2000 Jun;27(6):619-27.
“In order to produce anatomical images that are inherently registered with images of emission computerized 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.”
SPECT/CT Image Processing
Modality Image Reconstruction
1. SPECT Iterative Reconstruction using CT Attenuation Map
2. CT Multiplanar Reconstruction
3. Image Coregistration
Automated Software
SPECT/CT imaging: clinical utility of an emerging technology. Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. Radiographics. 2008 Jul-Aug;28(4):1097-113.
“The attenuation map is then used by an iterative reconstruction algorithm to perform attenuation correction of the emission data”
Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary. Gnanasegaran G, Barwick T, Adamson K, Mohan H, Sharp D, Fogelman I. Semin Nucl Med. 2009 Nov;39(6):431-42.
Bone SPECT-CT with 99mTc-labelled bisphosphonates. Rasilla JM, Arboniés JC, Gutiérrez LL. Rev Esp Med Nucl. 2009 Nov-Dec;28(6):307-8.
SPECT/CT in Bone Scintigraphy
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ReviewArticles
SPECT-CT and Bone
129 18
Case # 1 – Whole Body Bone Scan
Case # 1 – Whole Body Bone Scan
Case # 2 – Whole Body Bone Scan
Case # 2 – Whole Body Bone Scan
Case # 3 – Whole Body Bone Scan
Case # 3 – Whole Body Bone Scan
Case # 4 – Three Phase Bone Scan
Case # 4 – Three Phase Bone Scan
Diabetic foot infection: usefulness of SPECT/CT for 99mTc-HMPAO-labeled leukocyte imaging.Filippi L, Uccioli L, Giurato L, Schillaci O.J Nucl Med. 2009 Jul;50(7):1042-6.
SPECT/CT in Imaging Infection
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SPECT-CT and Infection
39 8
Case # 5 – Leukocyte Scintigraphy
Case # 5 – Leukocyte Scintigraphy
Case # 6 – Leukocyte Scintigraphy
Case # 6 – Leukocyte Scintigraphy
Case # 7 – Leukocyte Scintigraphy
Case # 7 – Leukocyte Scintigraphy
Case # 8 – Leukocyte Scintigraphy
Case # 8 – Leukocyte Scintigraphy
SPECT/CT in Endocrine Scintigraphy
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SPECT-CT and Endocrine
33 10
Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy.Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, Dackiw AP, Tufano RP, Zeiger MA, Ziessman HA.J Nucl Med. 2007 Jul;48(7):1084-9.
“These findings strongly suggest that dual-phase imaging, with early
SPECT/CT whenever possible, should be part of the routine preoperative
evaluation of patients with primary hyperparathyroidism in this new age of minimally invasive parathyroidectomy.”
Case # 9 – Parathyroid Scan
Case # 9 – Parathyroid Scan
Case # 10 – Parathyroid Scan
Case # 10 – Parathyroid Scan
Case # 11 – Parathyroid Scan
Case # 11 – Parathyroid Scan
Case # 12 – Octreotide Scan
Case # 12 – Octreotide Scan
Case # 12 – Octreotide Scan
Case # 13 – Octreotide Scan
Case # 13 – Octreotide Scan
Case # 14 – MIBG Scan
Case # 14 – MIBG Scan
Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma.Wong KK, Zarzhevsky N, Cahill JM, Frey KA, Avram AM.Br J Radiol. 2009 Oct;82(982):860-76.
Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma.Chen L, Luo Q, Shen Y, Yu Y, Yuan Z, Lu H, Zhu R.J Nucl Med. 2008 Dec;49(12):1952-7.
SPECT/CT in Thyroid Scintigraphy
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SPECT-CT and Thyroid
64 6
Case # 15 – I-131 Whole Body Scan
Case # 15 – I-131 Whole Body Scan
Case # 15 – I-131 Whole Body Scan
Case # 16 – I-123 Thyroid Scan
Synergistic value of single-photon emission computed tomography/computed tomography fusion to radioimmunoscintigraphic imaging of prostate cancer.Sodee DB, Sodee AE, Bakale G.Semin Nucl Med. 2007 Jan;37(1):17-28.
SPECT/CT in Prostascint Imaging
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SPECT-CT and Prostascint
16 1
Case # 17 – Prostascint Scan
Case # 17 – Prostascint Scan
Case # 18 – Prostascint Scan
Case # 18 – Prostascint Scan
SPECT/CT for preoperative sentinel node localization.Vermeeren L, van der Ploeg IM, Olmos RA, Meinhardt W, Klop WM, Kroon BB, Nieweg OE.J Surg Oncol. 2010 Feb 1;101(2):184-90.
Evaluation and localization of lymphatic drainage and sentinel lymph nodes in patients with head and neck melanomas by hybrid SPECT/CT lymphoscintigraphic imaging.Mar MV, Miller SA, Kim EE, Macapinlac HA.J Nucl Med Technol. 2007 Mar;35(1):10-6
SPECT/CT in Lymphoscintigraphy
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SPECT-CT and Sentinel Node
65 7
Case # 19 – Lymphoscintigraphy
Case # 20 – Lymphoscintigraphy
Case # 21 – Sulfur Colloid Scan
Case # 21 – Sulfur Colloid Scan
Case # 22 – Hemangioma Scan
Case # 22 – Hemangioma Scan
Case # 22 – Hemangioma Scan
Case # 23 – Hepatobiliary Scan
SPECT/CT in Nuclear Cardiology
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SPECT-CT and Cardiac
72 19
Hybrid SPECT-CT: integration of CT coronary artery calcium scoring and angiography with myocardial perfusion.Mahmarian JJ.Curr Cardiol Rep. 2007 Apr;9(2):129-35.
“Hybrid imaging with SPECT and CT angiography may prove important from a diagnostic and therapeutic view point in several clinical scenarios, and it is likely that over the next decade fusion imaging may more precisely tailor therapy, reduce healthcare costs, and improve patient outcome.”
Case # 24 – Myocardial Perfusion Imaging
SPECT/CT in V/Q scanning.Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA, Willowson KP, Bailey DL.Semin Nucl Med. 2010 Nov;40(6):455-66.
SPECT/CT in Pulmonary Embolism
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SPECT-CT and Lung
77 11
Case # 25 – Lung Scan
Acute pulmonary embolism detected by perfusion SPECT/CT masquerading as an intermediate probability planar V/Q scan.Lu Y, Fox JJ.Clin Nucl Med. 2010 Dec;35(12):941-3.
Case # 25 – Lung Scan
Acute pulmonary embolism detected by perfusion SPECT/CT masquerading as an intermediate probability planar V/Q scan.Lu Y, Fox JJ.Clin Nucl Med. 2010 Dec;35(12):941-3.
Case # 26 – Lung Scan
SPECT/CT: Conclusions and Issues
* More confident reporting
* Less indeterminate findings
* Biopsy assistance
* Dosimetry
* CT quality
* Reimbursement
* Radiation exposure
* Study time
Improved Sensitivity and Specificity
Excellent anatomical localization
Morphological characterization