A comparative study of attenuation correction algorithms in single photon emission computed tomography (SPECT)

A computer based simulation method was developed to assess the relative effectiveness and availability of various attenuation compensation algorithms in single photon emission computed tomography (SPECT). The effect of the nonuniformity of attenuation coefficient distribution in the body, the errors in determining a body contour and the statistical noise on reconstruction accuracy and the computation time in using the algorithms were studied. The algorithms were classified into three groups: precorrection, post correction and iterative correction methods. Furthermore, a hybrid method was devised by combining several methods. This study will be useful for understanding the characteristics, limitations and strengths of the algorithms and searching for a practical correction method for photon attenuation in SPECT.     

Simulation and experimental study of respiratory motion effect on image quality of single photon emission computed tomography (SPECT)

The effect of respiratory motion on the image quality of single photon emission computed tomography (SPECT) was investigated by computer simulation and experimentation. In the computer simulation, the phantom was assumed to be cylindrical with a uniform background and a spherical cold or hot spot. To simulate respiratory motion, a cyclic linear motion parallel to the axis of rotation of a gamma camere was assumed. The contrast in the transaxial images was calculated for various respiratory amplitudes and its dependence on lesion size and object contrast was investigated. In the experiments, a moving phantom was used to simulate respiratory motion. The simulation and the experimenal results were in good agreement within the range of statistical error. The effect on the lesion detectability was investigated using receiver operating characteristics (ROC) analysis, and a method for correcting respiratory motion was devised.     

Quantitative analysis in single photon emission tomography (SPET)

Quantitative analysis can improve the sensitivity and specificity of single photon emission tomography (SPET) procedures, as well as reduce inter- and intraobserver variabilities. Quantification of the radioactivity distribution is the ultimate goal of SPCT. In this review we consider the basic requirements for an optimum three-dimensional reconstruction of the radionuclide distribution to enable quantification. Attenuation and scatter correction as well as varying resolution are the major problems. In the older SPET systems quantification was hampered by the lack of system sensitivity and sufficient computer power. Therefore, the imaging system was often assumed to be shift invariant and linear and the attenuation throughout the object uniform. More sophisticated solutions have been proposed and with more or less success implemented, but not for application in daily practice. Knowledge (measurement) of the attenuation is often required. New generation SPET systems employing multi-detectors and super minicomputers will ease the implementation of these solutions. Offprint requests to: J.A.K. Blokland     

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     

Improving the quantitation accuracy in noninvasive small animal single photon emission computed tomography imaging

Introduction

Noninvasive imaging of small animals to measure biodistributions and pharmacokinetics of radiolabeled agents is increasingly seen as an effective alternative to external counting of tissues obtained by sacrifice and dissection. However, we have observed important disagreements in measuring the accumulation of ¹¹¹In-labeled antibodies in organs such as liver and kidneys when comparing imaging to ex vivo counting in the same animals. This study was conducted to establish whether this discrepancy could be minimized by selecting the region of interest (ROI) in images at the appropriate color threshold and by correcting for the estimated radioactivity within the blood pool of these organs during imaging.

Methods

Vials with known concentrations of ¹¹¹In as phantoms were imaged on a Bioscan NanoSPECT/CT. Thereafter, an ¹¹¹In-DTPA-IgG antibody as the test agent was administered intravenously to normal rats, and whole body acquisitions were obtained at 2, 24 or 48 h. Immediately following imaging, the animals were sacrificed, the tissues were removed for ex vivo counting and the radioactivity accumulations were then compared.

Results

The phantom measurements showed that accuracy depended upon setting the correct ROI and that, in turn, depended upon setting the appropriate threshold of the color scale. Under the most unfavorable conditions, this error did not exceed 60%. Compared to the results of ex vivo counting, quantitation by imaging provided high values in liver and kidneys at all three time points by as much as 140%. However, by using the blood radioactivity at the time of sacrifice and the known blood volume in these organs, the disagreement was reduced in all cases to below 25%.

Conclusion

In this study, the discrepancy in quantitating organ radioactivity accumulations between noninvasive imaging and necropsy was primarily due to blood pool radioactivity contributing to the in vivo images. The discrepancy may be minimized by subtracting an estimate of this contribution.     

Clinical validation of SPECT attenuation correction using x-ray computed tomography—derived attenuation maps: Multicenter clinical trial with angiographic correlation

BACKGROUND: Nonuniform attenuation artifacts cause suboptimal specificity of stress single photon emission computed tomography (SPECT) myocardial perfusion images. In phantoms, normal subjects, and patients suspected of having coronary artery disease (CAD), we evaluated a new hybrid attenuation correction (AC) system that combines x-ray computed tomography (CT) with conventional stress SPECT imaging. METHODS AND RESULTS: The effect of CT-based AC was evaluated in phantoms by assessing homogeneity of normal cardiac inserts. AC improved homogeneity of normal cardiac phantoms from 11% +/- 2% to 5% +/- 1% (P < .001). Attenuation-corrected normal patient files were created from 37 normal subjects with a low likelihood (<3%) of CAD. The diagnostic performance of AC for detection of CAD was evaluated in 118 patients who had stress technetium 99m sestamibi or tetrofosmin stress SPECT imaging and coronary angiography. SPECT images with and without AC were interpreted by 4 blinded readers with different interpretative attitudes. Overall, AC improved the diagnostic performance of all readers, particularly the normalcy rate. The degree of improvement depended on interpretative attitude. Readers prone to high sensitivity or with less experience had the greatest gain in the normalcy rate, whereas a reader prone to higher specificity had improvements in sensitivity and specificity but not the normalcy rate. Importantly, improvement of one diagnostic variable was not associated with worsening of other variables. CONCLUSION: CT-based AC of SPECT images consistently improved overall diagnostic performance of readers with different interpretive attitudes and experience. CT-based AC is well suited for routine use in clinical practice.     

Improvement of quantification in SPECT studies by scatter and attenuation compensation

The filtered backprojection images obtained from classical SPECT studies are not adequate for evaluation of volumes or parameters of clinical interest. Noise, scattering, boundary accuracy and attenuation are the main problems of SPECT quantification. It is the aim of the following study to overcome these difficulties. The first step of all correction algorithm is the contour detection of the attenuation medium. A new procedure, previously described by the authors, accurately and automatically found the boundaries of the surrounding body. The Compton scattering climination is carried out by a modified version of Jaszczak's method. This alteration is essential to implement the iterative attenuation correction algorithm derived from Chang's method. Results obtained using computer simulation and real phantoms or clinical studies demonstrate the high improvement of contrast and count levels in the corrected slices. The process is fully automatic and the efficiency of the procedures allow fast processing of the daily SPECT examination.     

Assessment of geometrical distortion and activity distribution after attenuation correction: A SPECT phantom study

BACKGROUND: If single photon emission computed tomography (SPECT) images are reconstructed with filtered backprojection (FBP), not accounting for photon attenuation, artifacts can occur related to geometrical distortion and inaccurate estimation of regional distribution of radioactivity. By reconstructing the images with an iterative algorithm such as the maximum likelihood-expectation maximization (ML-EM) that incorporates the attenuation distribution information, it is possible to compensate for nonuniform attenuation. The aim of this study was to assess whether correction for nonuniform attenuation in SPECT can reduce the geometrical distortion and improve the activity quantitation. METHODS AND RESULTS: Three capillary sources containing the same amount of technetium 99m were imaged by a dual-headed SPECT system provided with two gadolinium 153 scanning transmission line sources, in nonuniform attenuation conditions. The images were reconstructed (1) with the use of FBP, (2) with the iterative ML-EM algorithm, and (3) with the iterative ML-EM algorithm incorporating attenuation maps. The geometrical distortion was estimated by comparing the spread that occurred in 2 orthogonal directions in the reconstructed transverse slices, expressed by full width at half maximum related to the x-axis and y-axis line spread functions. The accuracy of activity quantitation was analyzed by comparing the counts in regions of interest placed over the transverse slices of the 3 sources, located in different attenuating areas. The FBP-reconstructed slices showed a spread of image intensity toward the direction of minor attenuation; the source shape improved in the iterative ML-EM images, as well as in the iterative attenuation-corrected ML-EM images. The sources located deep in the phantom showed an apparent decrease in image intensity in both FBP and ML-EM images, which became less evident in the iterative attenuation-corrected ML-EM images. CONCLUSIONS: Image reconstruction with the iterative ML-EM algorithm, without the use of attenuation maps, can reduce geometrical distortion and eliminate streak artifacts, leading to an improvement in the object's shape and size, but does not reduce activity underestimation and inaccurate quantitation. In the iterative attenuation-corrected ML-EM images, there was a significant improvement in the accurate quantitation of activity distribution and a further reduction in geometrical distortion. In conclusion, nonisotropic attenuation correction with iterative ML-EM reduced the geometrical distortion of images and improved the accuracy of activity quantitation.     

Anatomically derived attenuation coefficients for use in quantitative single photon emission tomography studies of the thorax

Elimination of errors due to poor attenuation correction is an essential part of any quantitative single photon emission tomography (SPET) technique. Attenuation coefficients (_Tc) for use in attenuation correction of SPET data were determined using technetium 99m and cobalt 57 flood sources and using topographical information obtained from computed tomography (CT) scans and magnetic resonance (MR) images. In patients with carcinoma of the bronchus, the mean attenuation coefficient for ^99mTc was 0.096 cm^–1 when determined across a transverse section of the thorax at the level of the tumour by means of a ⁵⁷CO flood source (13 patients) and 0.093 and 0.074 cm^–1 as determined from CT scans for points in the centre of the tumour and contralateral normal lung, respectively (21 patients). In 18 patients with breast tumours, the mean attenuation coefficient for ^99mTc was 0.110 and 0.076 cm^–1 when determined from MRI cross-sections for points in the centre of the tumour and normal contralateral lung, respectively. This indicates significant overcorrection for attenuation when the conventional value of 0.12 cm^–1 is used. A value in the range 0.08–0.09 cm^–1 would be more appropriate for SPET studies of the thorax. An alternative approach to quantitative region of interest (ROI) analysis is to perform attenuation correction appropriate to the centre of each ROI (using topographical information derived from CT or MRI) on non-attenuation-corrected reconstructions.     

A Bayesian iterative transmission gradient reconstruction algorithm for cardiac SPECT attenuation correction

Background  High-quality attenuation maps are critical for attenuation correction of myocardial perfusion single photon emission computed tomography studies. The filtered backprojection (FBP) approach can introduce errors, especially with low-count transmission data. We present a new method for attenuation map reconstruction and examine its performance in phantom and patient data. Methods and Results  The Bayesian iterative transmission gradient algorithm incorporates a spatially varying gamma prior function that preferentially weights estimated attenuation coefficients toward the soft-tissue value while allowing data-driven solutions for lung and bone regions. The performance with attenuation-corrected technetium 99m sestamibi clinical images was evaluated in phantom studies and in 50 low-likelihood patients grouped by body mass index (BMI). The algorithm converged in 15 iterations in the phantom studies. For the clinical studies, soft-tissue estimates had significantly greater uniformity of mediastinal coefficients (mean SD, 0.005 cm⁻¹ vs 0.011 cm⁻¹; P<.0001). The accuracy and uniformity of the Bayesian iterative transmission gradient algorithm were independent of BMI, whereas both declined at higher BMI values with FBP. Attenuation-corrected perfusion images showed improvement in myocardial wall variability (4.8% to 4.1%, P=.02) for all BMI groups with the new method compared with FBP. Conclusion  This new method for attenuation map reconstruction provides rapidly converging and accurate attenuation maps over a wide spectrum of patient BMI values and significantly improves attenuation-corrected perfusion images.     

Time sequential single photon emission computed tomography studies in brain tumour using thallium-201

Time sequential single photon emission computed tomography (SPECT) studies using thallium-201 were performed in 25 patients with brain tumours to evaluate the kinetics of thallium in the tumour and the biological malignancy grade preoperatively. After acquisition and reconstruction of SPECT data from 1 min post injection to 48 h (1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 15–20 min, followed by 4–6, 24 and 48 h), the thallium uptake ratio in the tumour versus the homologous contralateral area of the brain was calculated and compared with findings of X-ray CT, magnetic resonance imaging, cerebral angiography and histological investigations. Early uptake of thallium in tumours was related to tumour vascularity and the disruption of the blood-brain barrier. High and rapid uptake and slow reduction of thallium indicated a hypervascular malignant tumour; however, high and rapid uptake but rapid reduction of thallium indicated a hypervascular benign tumour, such as meningioma. Hypovascular and benign tumours tended to show low uptake and slow reduction of thallium. Long-lasting retention or uptake of thallium indicates tumour malignancy. Correspondence to: T. Ueda     

A hybrid method of attenuation correction for positron emission tomography brain studies

A hybrid method for attenuation correction (HAC) in positron emission tomography (PET) brain studies is proposed. The technique requires the acquisition of two short (1 min) transmission scans immediately before or after the emission study, with the patient and the head fixation system in place and after removing the patient from the scanner with the head fixation system alone. The method combines a uniform map of attenuation coefficients for the patient's head with measured attenuation coefficients for the head fixation system to generate a hybrid attenuation map. The HAC method was calibrated on 30 PET cerebral studies for comparison with the conventional measured attenuation correction method by ROI analysis. Average differences of less than 3% were found for cortical and subcortical regions. The HAC technique is particularly suitable in a PET clinical environment, allowing a reduction of the total study time, greater comfort for patients and an increase in patient throughput.     

Automatic detection of the left ventricular myocardium long axis and center in thallium-201 single photon emission computed tomography

A new method for centering and reorienting automatically the left ventricle in thallium-201 myocardial single photon emission computed tomography (SPET) is proposed. The processing involves the following steps: (a) the transverse sections of the left ventricle are segmented, (b) the three-dimensional skeleton of the left ventricle is extracted using tools of mathematical morphology, (c) the skeleton is fitted to a quadratic surface by the least-squares method, (d) the left ventricle is reoriented and centered using the long axis and the coordinates of the centre of the quadratic surface. A series of 30 consecutive exercise and redistribution ²⁰¹T1 SPET studies were centered and reoriented by two operators twice with this method, and twice manually. There was no significant difference in the mean realignment performed by the automatic and the manual methods while centering differed moderately in some instances. In all cases and for all parameters, the reproducibility of the automatic method was 1.00, while it ranged between 0.74 and 0.98 with the manual centering and reorientation. This automatic approach provides a fast and highly reproducible method for the reconstruction of short- and long-axis sections of the left ventricle in ²⁰¹T1 SPET. Correspondence to: J.C. Cauvin     

Use of coronary calcium score scans from stand-alone multislice computed tomography for attenuation correction of myocardial perfusion SPECT

Purpose To evaluate the use of CT attenuation maps, generated from coronary calcium scoring (CCS) scans at in- and expiration with a 64-slice CT scanner, for attenuation correction (AC) of myocardial perfusion SPECT images. Methods Thirty-two consecutive patients underwent ^99mTc-tetrofosmin gated adenosine stress/rest SPECT scan on an Infinia Hawkeye SPECT-CT device (GE Medical Systems) followed by CCS and CT angiography on a 64-slice CT. AC of the iteratively reconstructed images was performed with AC maps obtained: (a) from the “Hawkeye” low-resolution X-ray CT facility attached to the Infinia camera (IRAC); (b) from the CCS scan acquired on a 64-slice CT scanner during maximal inspiration (AC_INSP) and (c) during normal expiration (AC_EXP). Automatically determined uptake values of stress scans (QPS, Cedars Medical Sinai) from AC_INSP and AC_EXP were compared with IRAC. Agatston score (AS) values using AC_INSPversus AC_EXP were also compared. Results AC_INSP and AC_EXP resulted in identical findings versus IRAC by visual analysis. A good correlation for uptake values between IRAC and AC_INSP was found (apex, r=0.92; anterior, r=0.85; septal, r=0.91; lateral, r=0.86; inferior, r=0.90; all p<0.0001). The correlation was even closer between IRAC and AC_EXP (apex, r=0.97; anterior, r=0.91; septal, r=0.94; lateral, r=0.92; inferior, r=0.97; all p<0.0001). The mean AS during inspiration (319±737) and expiration(317±778) was comparable (p=NS). Conclusion Attenuation maps from CCS allow accurate AC of SPECT MPI images. AC_EXP proved superior to AC_INSP, suggesting that in hybrid scans CCS may be performed during normal expiration to allow its additional use for AC of SPECT MPI.     

Assessment of malignancy of glioma by positron emission tomography with 18F-fluorodeoxyglucose and single photon emission computed tomography with thallium-201 chloride

The histological diagnosis and proliferative potential measured by bromodeoxyuridine (BrdU) labelling index (LI) were corelated with preoperative CT and contrast-enhanced, MRI, ¹⁸F-flurodeoxyglucose positron emission tomography (PET) and ²⁰¹T1 single photon emission computed tomography (SPECT) in 43 patients with various grades of glioma. ²⁰¹T1 SPECT had slightly higher sensitivity to tumours with BrdU LI N 5 % (showing 10/10) than ¹⁸F-FDG PET (7/8 tumours). ¹⁸F-FDG PET was better for identifying tumours of BrdU LI < 1 % (13/15) than ²⁰¹T1 SPECT (13/22). Accumulation of ²⁰¹T1 in the tumour was slightly different from contrast enhancement on CT and/or MRI, and gave “false-postive” results in some low-grade gliomas. However, ²⁰¹T1 SPECT, which is available in many hospitals and may cost less, provided useful information to supplement that from CT and MRI. Received: 25 November 1996 Accepted: 8 September 1997     

A comparative study of attenuation correction algorithms in single photon emission computed tomography (SPECT)

A computer based simulation method was developed to assess the relative effectiveness and availability of various attenuation compensation algorithms in single photon emission computed tomography (SPECT). The effect of the nonuniformity of attenuation coefficient distribution in the body, the errors in determining a body contour and the statistical noise on reconstruction accuracy and the computation time in using the algorithms were studied. The algorithms were classified into three groups: precorrection, post correction and iterative correction methods. Furthermore, a hybrid method was devised by combining several methods. This study will be useful for understanding the characteristics, limitations and strengths of the algorithms and searching for a practical correction method for photon attenuation in SPECT.     

Value of image fusion using single photon emission computed tomography with integrated low dose computed tomography in comparison with a retrospective voxel-based method in neuroendocrine tumours

The objective was the evaluation of single photon emission computed tomography (SPECT) with integrated low dose computed tomography (CT) in comparison with a retrospective fusion of SPECT and high-resolution CT and a side-by-side analysis for lesion localisation in patients with neuroendocrine tumours. Twenty-seven patients were examined by multidetector CT. Additionally, as part of somatostatin receptor scintigraphy (SRS), an integrated SPECT–CT was performed. SPECT and CT data were fused using software with a registration algorithm based on normalised mutual information. The reliability of the topographic assignment of lesions in SPECT–CT, retrospective fusion and side-by-side analysis was evaluated by two blinded readers. Two patients were not enrolled in the final analysis because of misregistrations in the retrospective fusion. Eighty-seven foci were included in the analysis. For the anatomical assignment of foci, SPECT–CT and retrospective fusion revealed overall accuracies of 91 and 94% (side-by-side analysis 86%). The correct identification of foci as lymph node manifestations (n=25) was more accurate by retrospective fusion (88%) than from SPECT–CT images (76%) or by side-by-side analysis (60%). Both modalities of image fusion appear to be well suited for the localisation of SRS foci and are superior to side-by-side analysis of non-fused images especially concerning lymph node manifestations.     

Quantitative single photon emission tomography: verification for sources in an elliptical water phantom

Accurate absorbed dose calculations are important for a proper dose planning in internal radionuclide therapy. The activity distribution must be measured and the target volume defined. This can be done with single photon emission tomography (SPET) if proper attenuation and scatter correction are employed. This study investigated the calculation of the activity and the volume of different spherical sources. These two parameters are essential for a proper dose calculation. The scatter and attenuation correction method is based on spatially variant scatter functions and density maps. The volume calculation method is based on obtaining a threshold from a grey-level histogram. Both point sources and spheres of different diameters containing technetium-99m were placed in different locations in an elliptical water phantom and imaged by SPET. The activity and the volume of the spheres were calculated from the SPET images and compared with known activities. Results show a quantification of activity within 10% for most of the sources. Important influences on the quantification are (a) the presence of artefacts due to improper reconstruction and (b) the finite spatial resolution which affects the total number of counts within the determined volume. Correspondence to: M.H. Ljungberg     

SPECT定义活性骨髓优化宫颈癌术后调强放疗计划的剂量学研究

目的 探讨单光子发射计算机断层扫描（SPECT）骨髓显像结合宫颈癌骨髓保护调强放疗计划的剂量学特点。方法 20例宫颈癌术后患者放疗前行⁹⁹Tc^m硫胶体SPECT骨髓显像确定盆骨中活性骨髓,采用图像融合技术将SPECT与定位CT融合。根据SPECT和盆骨外轮廓定义的骨髓体积,分别制定SPECT-IMRT（SPECT-intensity modulated radiotherapy）和骨髓剂量保护的调强放疗（bone marrow sparing-intensity modulated radiotherapy,BMS-IMRT）计划,比较两种计划的靶区和危及器官（骨髓、小肠、直肠和膀胱）剂量分布。靶区处方剂量45 Gy/25次。结果 SPECT-IMRT计划和BMS-IMRT计划定义的骨髓体积分别为（238.15±36.82）和（1 100.61±109.92）cm³（t=33.273,P<0.05）;SPECT-IMRT计划的骨髓高剂量辐射区V₃₀、V₄₀和V₄₅的平均体积较BMS-IMRT计划分别降低6.9%、5.7%和2.6%,差异有统计学意义（t=3.540、3.426、3.448,P<0.05）;而低剂量辐射区V₁₀和V₂₀的平均体积比较差异无统计学意义（P>0.05）;两种计划PTV的覆盖率和其他危及器官（膀胱、小肠和直肠）的受照剂量差异均无统计学意义（P>0.05）。结论 SPECT骨髓显像能较清晰地在CT断层图像上显示活性骨髓的范围。与BMS-IMRT比较,SPECT-IMRT能进一步降低高剂量辐射的剂量体积（V₃₀、V₄₀和V₄₅）。     

发作间期SPECT对难治性颞叶癫痫的诊断价值

目的:探讨难治性颞叶癫痫(TLE)单光子发射计算机断层(SPECT)的影像特征及定位诊断价值.方法:选择35例经临床手术证实的难治性TLE,术前均行发作间期SPECT脑血流灌注显像和常规MRI扫描.以临床定位结果做对照,观察难治性TLE的SPECT影像改变,分析发作间期脑血流灌注显像定位诊断颞叶致痫灶的临床应用价值.结果:难治性颞叶癫痫SPECT的影像特征为致痫灶侧前颞叶内侧和/或外侧皮质的血流灌注减低,对侧前颞叶的内侧皮质可出现轻度的灌注减低.常合并与患侧同侧的一处或以上脑区的灌注减低.SPECT致痫灶定位诊断的阳性率达77.14％00(27/35),尤其能检出52.94％ (9/17) MRI阴性TLE的致痫灶.结论:发作间期SPECT脑血流灌注显像能丰富难治性TLE的定位诊断信息,提高定位MRI阴性TLE患者致痫灶的比例.