Overview of SPECT/CT Applications
way 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
Integrated SPECT/CT Systems
“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”
SPECT/CT – pubmed search
Search
Keyword
All
Articles
Review
Articles
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 - References
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.
Current SPECT/CT Systems
Vendor
Camera
Models
GE
Infinia
Hawkeye 4
SIEMENS
Symbia T
Symbia T2
Symbia T6
Discovery
NM/CT 670 Symbia T16
PHILIPS
BrightView
XCT
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 slipring 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”
SPECT/CT in Bone Scintigraphy
Search
Keyword
All
Articles
Review
Articles
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 # 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
SPECT/CT in Imaging Infection
Search
Keyword
All
Articles
Review
Articles
SPECT-CT
and Infection
39
8
Diabetic foot infection: usefulness of SPECT/CT for 99mTcHMPAO-labeled leukocyte imaging.
Filippi L, Uccioli L, Giurato L, Schillaci O.
J Nucl Med. 2009 Jul;50(7):1042-6.
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
Search
Keyword
All
Articles
Review
Articles
SPECT-CT and
Endocrine
33
10
Comparison of SPECT/CT, SPECT, and planar imaging with single- and dualphase (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
SPECT/CT in Thyroid Scintigraphy
Search
Keyword
All
Articles
Review
Articles
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 # 15 – I-131 Whole Body Scan
Case # 15 – I-131 Whole Body Scan
Case # 16 – I-123 Thyroid Scan
SPECT/CT in Prostascint Imaging
Search
Keyword
All
Articles
16
SPECT-CT
and Prostascint
Review
Articles
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
Case # 17 – Prostascint Scan
Case # 18 – Prostascint Scan
Case # 18 – Prostascint Scan
SPECT/CT in Lymphoscintigraphy
Search
Keyword
All
Articles
Review
Articles
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 # 22 – Hemangioma Scan
Case # 22 – Hemangioma Scan
Case # 23 – Hepatobiliary Scan
SPECT/CT in Nuclear Cardiology
Search
Keyword
All
Articles
Review
Articles
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
Search
Keyword
All
Articles
Review
Articles
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.
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
Improved Sensitivity and Specificity
Excellent anatomical localization
Morphological characterization
* More confident reporting
* CT quality
* Less indeterminate findings
* Reimbursement
* Biopsy assistance
* Radiation exposure
* Dosimetry
* Study time