Overview of SPECT/CT Applications - Nuclear MD.com
Overview of SPECT/CT Applications - Nuclear MD.com
Overview of SPECT/CT Applications - Nuclear MD.com
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<strong>Overview</strong> <strong>of</strong> <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> <strong>Applications</strong><br />
way to “new & clear” medicine<br />
Peeyush Bhargava M.D, M.S<br />
Attending in <strong>Nuclear</strong> Medicine, MEDVAMC<br />
Associate Pr<strong>of</strong>essor <strong>of</strong> Radiology, BCM<br />
www.nuclearmd.<strong>com</strong>
<strong>SPE<strong>CT</strong></strong> & <strong>CT</strong> - Definitions<br />
• <strong>SPE<strong>CT</strong></strong> (Single Photon Emission Computed Tomography) –<br />
“tomographic scintigraphy where <strong>com</strong>puter generated three<br />
dimensional images <strong>of</strong> radioactive tracer distribution are<br />
produced by detection <strong>of</strong> single photons from acquired<br />
multiple planar images”<br />
• <strong>CT</strong> (Computed Tomography) – “tomographic imaging<br />
performed with an external x-ray source to derive three<br />
dimensional anatomic image data”
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> - Definitions<br />
Integrated <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> Systems<br />
“that can perform both functions on one gantry and<br />
provide fused functional and anatomic data in a single<br />
imaging session”<br />
“enables a direct correlation <strong>of</strong> anatomic information and<br />
functional information resulting in better localization and<br />
definition <strong>of</strong> scintigraphic findings”
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> – pubmed search<br />
Search<br />
Keyword<br />
All<br />
Articles<br />
1. <strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> 700 86<br />
2. <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> 2 1<br />
3 PET-<strong>CT</strong> 4903 741<br />
4. PET/<strong>CT</strong> 3744 530<br />
Hybrid <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>: the end <strong>of</strong> "unclear" medicine.<br />
Patel CN, Chowdhury FU, Scarsbrook AF.<br />
Postgrad Med J. 2009 Nov;85(1009):606-13.<br />
Review<br />
Articles<br />
“Single photon emission <strong>com</strong>puted tomography/<strong>CT</strong> (<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>) is a dual<br />
modality technique which increases the sensitivity and specificity <strong>of</strong> existing<br />
radionuclide imaging and helps characterize equivocal lesions detected by<br />
other imaging methods.”
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> - References<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>.<br />
Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K,<br />
Scheidhauer K, Wester HJ, Rummeny EJ, Schwaiger M, Drzezga A.<br />
J Nucl Med. 2008 Aug;49(8):1305-19.<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> imaging: clinical utility <strong>of</strong> an emerging technology.<br />
Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira<br />
<strong>MD</strong>. Radiographics. 2008 Jul-Aug;28(4):1097-113.<br />
A review on the clinical uses <strong>of</strong> <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>.<br />
Mariani G, Bruselli L, Kuwert T, Kim EE, Flotats A, Israel O, Dondi M,<br />
Watanabe N.<br />
Eur J Nucl Med Mol Imaging. 2010 Oct;37(10):1959-85.
Current <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> Systems<br />
Vendor GE SIEME�S PHILIPS<br />
Camera<br />
Models<br />
Infinia<br />
Hawkeye 4<br />
Symbia T<br />
Symbia T2<br />
Symbia T6<br />
Symbia T16<br />
BrightView<br />
X<strong>CT</strong><br />
Discovery<br />
Precedence<br />
NM/<strong>CT</strong> 670 <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong><br />
Gamma camera-mounted anatomical X-ray tomography: technology,<br />
system characteristics and first images.<br />
Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, Chisin R.<br />
Eur J Nucl Med. 2000 Jun;27(6):619-27.<br />
“In order to produce anatomical images that are inherently registered<br />
with images <strong>of</strong> emission <strong>com</strong>puterized tomography acquired with a<br />
gamma camera, an X-ray transmission system was mounted on the slipring<br />
gantry <strong>of</strong> a GEMS Millennium VG gamma camera.”
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> Image Processing<br />
Modality Image Reconstruction<br />
1. <strong>SPE<strong>CT</strong></strong> Iterative Reconstruction using<br />
<strong>CT</strong> Attenuation Map<br />
2. <strong>CT</strong> Multiplanar Reconstruction<br />
3. Image<br />
Coregistration<br />
Automated S<strong>of</strong>tware<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> imaging: clinical utility <strong>of</strong> an emerging technology.<br />
Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G,<br />
Cerqueira <strong>MD</strong>.<br />
Radiographics. 2008 Jul-Aug;28(4):1097-113.<br />
“The attenuation map is then used by an iterative<br />
reconstruction algorithm to perform attenuation correction <strong>of</strong><br />
the emission data”
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Bone Scintigraphy<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong><br />
and Bone<br />
All<br />
Articles<br />
129 18<br />
Review<br />
Articles<br />
Multislice <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in benign and malignant bone disease:<br />
when the ordinary turns into the extraordinary.<br />
Gnanasegaran G, Barwick T, Adamson K, Mohan H, Sharp D,<br />
Fogelman I.<br />
Semin Nucl Med. 2009 Nov;39(6):431-42.<br />
Bone <strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> with 99mTc-labelled bisphosphonates.<br />
Rasilla JM, Arboniés JC, Gutiérrez LL.<br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Imaging Infection<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong><br />
and Infection<br />
All<br />
Articles<br />
39 8<br />
Review<br />
Articles<br />
Diabetic foot infection: usefulness <strong>of</strong> <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> for 99mTc-<br />
HMPAO-labeled leukocyte imaging.<br />
Filippi L, Uccioli L, Giurato L, Schillaci O.<br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Endocrine Scintigraphy<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> and<br />
Endocrine<br />
All<br />
Articles<br />
33 10<br />
Review<br />
Articles<br />
Comparison <strong>of</strong> <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>, <strong>SPE<strong>CT</strong></strong>, and planar imaging with single- and dualphase<br />
(99m)Tc-sestamibi parathyroid scintigraphy.<br />
Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, Dackiw<br />
AP, Tufano RP, Zeiger MA, Ziessman HA.<br />
J Nucl Med. 2007 Jul;48(7):1084-9.<br />
“These findings strongly suggest that dual-phase imaging, with early<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> whenever possible, should be part <strong>of</strong> the routine preoperative<br />
evaluation <strong>of</strong> patients with primary hyperparathyroidism in this new age <strong>of</strong><br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Thyroid Scintigraphy<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong><br />
and Thyroid<br />
All<br />
Articles<br />
64 6<br />
Review<br />
Articles<br />
Hybrid <strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> and PET-<strong>CT</strong> imaging <strong>of</strong> differentiated thyroid<br />
carcinoma.<br />
Wong KK, Zarzhevsky N, Cahill JM, Frey KA, Avram AM.<br />
Br J Radiol. 2009 Oct;82(982):860-76.<br />
Incremental value <strong>of</strong> 131I <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in the management <strong>of</strong><br />
patients with differentiated thyroid carcinoma.<br />
Chen L, Luo Q, Shen Y, Yu Y, Yuan Z, Lu H, Zhu R.<br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Prostascint Imaging<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong><br />
and Prostascint<br />
All<br />
Articles<br />
16 1<br />
Review<br />
Articles<br />
Synergistic value <strong>of</strong> single-photon emission <strong>com</strong>puted<br />
tomography/<strong>com</strong>puted tomography fusion to<br />
radioimmunoscintigraphic imaging <strong>of</strong> prostate cancer.<br />
Sodee DB, Sodee AE, Bakale G.<br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Lymphoscintigraphy<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> and<br />
Sentinel Node<br />
All<br />
Articles<br />
65 7<br />
Review<br />
Articles<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> for preoperative sentinel node localization.<br />
Vermeeren L, van der Ploeg IM, Olmos RA, Meinhardt W, Klop WM,<br />
Kroon BB, Nieweg OE.<br />
J Surg Oncol. 2010 Feb 1;101(2):184-90.<br />
Evaluation and localization <strong>of</strong> lymphatic drainage and sentinel lymph<br />
nodes in patients with head and neck melanomas by hybrid <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong><br />
lymphoscintigraphic imaging.<br />
Mar MV, Miller SA, Kim EE, Macapinlac HA.<br />
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
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in <strong>Nuclear</strong> Cardiology<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> and<br />
Cardiac<br />
All<br />
Articles<br />
72 19<br />
Review<br />
Articles<br />
Hybrid <strong>SPE<strong>CT</strong></strong>-<strong>CT</strong>: integration <strong>of</strong> <strong>CT</strong> coronary artery calcium scoring and<br />
angiography with myocardial perfusion.<br />
Mahmarian JJ.<br />
Curr Cardiol Rep. 2007 Apr;9(2):129-35.<br />
“Hybrid imaging with <strong>SPE<strong>CT</strong></strong> and <strong>CT</strong> angiography may prove important from<br />
a diagnostic and therapeutic view point in several clinical scenarios, and it<br />
is likely that over the next decade fusion imaging may more precisely tailor<br />
therapy, reduce healthcare costs, and improve patient out<strong>com</strong>e.”
Case # 24 – Myocardial Perfusion Imaging
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in Pulmonary Embolism<br />
Search<br />
Keyword<br />
<strong>SPE<strong>CT</strong></strong>-<strong>CT</strong> and<br />
Lung<br />
All<br />
Articles<br />
77 11<br />
Review<br />
Articles<br />
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong> in V/Q scanning.<br />
Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA,<br />
Willowson KP, Bailey DL.<br />
Semin Nucl Med. 2010 Nov;40(6):455-66.
Case # 25 – Lung Scan<br />
Acute pulmonary embolism detected by perfusion <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong><br />
masquerading as an intermediate probability planar V/Q scan.<br />
Lu Y, Fox JJ.<br />
Clin Nucl Med. 2010 Dec;35(12):941-3.
Case # 25 – Lung Scan<br />
Acute pulmonary embolism detected by perfusion <strong>SPE<strong>CT</strong></strong>/<strong>CT</strong><br />
masquerading as an intermediate probability planar V/Q scan.<br />
Lu Y, Fox JJ.<br />
Clin Nucl Med. 2010 Dec;35(12):941-3.
Case # 26 – Lung Scan
<strong>SPE<strong>CT</strong></strong>/<strong>CT</strong>: Conclusions and Issues<br />
Improved Sensitivity and Specificity<br />
Excellent anatomical localization<br />
Morphological characterization<br />
* More confident reporting<br />
* Less indeterminate findings<br />
* Biopsy assistance<br />
* Dosimetry<br />
* <strong>CT</strong> quality<br />
* Reimbursement<br />
* Radiation exposure<br />
* Study time
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