Overview of SPECT/CT Applications - NuclearMD · “Single photon emission computed tomography/CT (SPECT/CT) is a dual modality technique which increases the sensitivity and specificity

Overview of SPECT/CT Applications

way to “new & clear” medicine

Peeyush Bhargava M.D, M.S

Attending in Nuclear Medicine, MEDVAMCAttending 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 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”

Integrated SPECT/CT Systems

imaging session”

“enables a direct correlation of anatomic information and

functional information resulting in better localization and

definition of scintigraphic findings”

SPECT/CT – pubmed search

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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.

SPECT/CT - References


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.

Current SPECT/CT Systems

Vendor GE SIEME�S PHILIPS

Camera

Models

Infinia

Hawkeye 4

Symbia T

Symbia T2

Symbia T6

Symbia T16

BrightView

XCT

Discovery

NM/CT 670

Precedence

SPECT/CTSymbia T16NM/CT 670 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 Reconstruction2. CT Multiplanar Reconstruction

3. Image

Coregistration

Automated Software


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”

SPECT/CT in Bone Scintigraphy

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SPECT-CT

and Bone

129 18

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.

Case # 1 – Whole Body Bone Scan






Case # 4 – Three Phase Bone Scan

Case # 4 – Three Phase Bone Scan

SPECT/CT in Imaging Infection

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SPECT-CT

and Infection

39 8

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.

and Infection

Case # 5 – 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 # 12 – Octreotide Scan





Case # 14 – MIBG Scan

Case # 14 – MIBG Scan

SPECT/CT in Thyroid Scintigraphy

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SPECT-CT

and Thyroid

64 6

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.

Case # 15 – I-131 Whole Body Scan



Case # 16 – I-123 Thyroid Scan

SPECT/CT in Prostascint Imaging

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SPECT-CT

and Prostascint

16 1

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.

Case # 17 – Prostascint Scan




SPECT/CT in Lymphoscintigraphy

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SPECT-CT and

Sentinel Node

65 7

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

Case # 19 – Lymphoscintigraphy

Case # 20 – Lymphoscintigraphy

Case # 21 – Sulfur Colloid Scan

Case # 21 – Sulfur Colloid 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 Pulmonary Embolism

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SPECT-CT and

Lung

77 11

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.

Lung

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.


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.


SPECT/CT: Conclusions and Issues

Improved Sensitivity and Specificity

Excellent anatomical localization

Morphological characterization

* More confident reporting

* Less indeterminate findings

* Biopsy assistance

* Dosimetry

* CT quality

* Reimbursement

* Radiation exposure

* Study time

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Overview of SPECT/CT Applications - NuclearMD · “Single photon emission computed tomography/CT (SPECT/CT) is a dual modality technique which increases the sensitivity and specificity