Abdominal SPECT imaging

In vivo functional imaging with SPECT and PET

Nuclear medicine methods permit the visualisation of a variety of metabolic and physiological processes all over the body. Although planar scintigraphy has been found useful for many questions, detailed spatial information about the diseased organ can only be obtained with tomographic methods. Dependent on the radionuclide involved, two different tomographic procedures are available: single photon emission computed tomography (SPECT) and positron emission tomography (PET). The first part of this paper describes shortly the historical development of these methods as well as their technical and methodological basics. To elucidate the large variety of possible applications, an overview of SPECT and PET procedures utilised in research as well as in clinical practice are presented. Furthermore, both methods are compared and their individual advantages are pointed out.

Postprandial decrease in splenic volume demonstrated by magnetic resonance imaging and stereology

The aim of this study was to determine if the volume of the spleen changes after food intake. We applied an unbiased and efficient method for splenic volume estimation using magnetic resonance imaging (MRI) in combination with modern design stereology. MR images of the spleen were obtained for 10 healthy volunteers (five men and five women; mean age 28.9 years [range 23-35 years]) without a history of splenomegaly. The initial scans were performed in the morning after overnight fasting. Each volunteer then consumed a standard balanced meal weighing 500 g [2,460 kJ (627 kcal) energy] with 500 ml of still mineral water. Second identical MR scans were performed approximately 1 hr later. Postprandially, splenic volume decreased by an average of 6.6% (P = 0.005), probably due to increased splanchnic blood flow after food intake.

SPECT with In-111 autologous platelets to detect residual splenic tissue in two patients with relapsed thrombocytopenia

In two patients with relapsed thrombocytopenia, the authors used SPECT with In-111 labeled autologous platelets to identify residual splenic tissue after splenectomy. One case involved a previously splenectomized patient with idiopathic portal hypertension, while the other had relapsed chronic idiopathic thrombocytopenic purpura (ITP). In both patients, SPECT showed a higher In-111 uptake in the splenic tissues compared with planar images. In the patient with ITP, a small accessory spleen had been overlooked on abdominal CT because of post-operative changes, but it was identified by superimposition of SPECT/CT images. These cases indicate that In-111 platelet SPECT is useful in detecting and localizing residual accessory splenic tissue associated with relapsed thrombocytopenia.

Three-dimensional visualisation of the large bowel: a potential tool for assessing targeted drug delivery and colonic pathology

A study has been undertaken to assess the feasibility of three-dimensional imaging of the dispersion of a non-absorbable tracer released into the colon of normal subjects. Six healthy volunteers were selected who were participating in a scintigraphic study designed to assess the spreading of 1 MBq indium-111 Amberlite resin delivered from a delayed capsule system targeted to release in the ascending colon. In each case subjects were imaged using a rotating gamma camera over a data collection period of approximately 20 min. Three-dimensional volume rendered images demonstrated good visualisation of the dispersion of the tracer throughout the ascending, transverse and descending colon and provided good anatomical visualisation of the shape of the colon, not previously apparent from the planar views. The present study demonstrates for the first time, the successful three-dimensional imaging of a radiolabelled tracer dispersed throughout the colon and opens up the prospects for more detailed study of quantification of the volume and distribution of tracers contained within the colon.

New imaging modalities for follow-up of colorectal carcinoma

Recurrent disease after curative resection occurred in 37-44% of patients. The common sites of recurrent disease are at the anastomotic site, in the liver, in the lymph nodes, and in the peritoneal linings. Computed tomography (CT), barium enema, and endoscopy detected local recurrent disease in 61-88% of the patients, whereas magnetic resonance imaging (MRI) detected 80-88% of the cases reported in some Phase 1 studies. CT and MRI are equally effective in the detection of hepatic metastases when lesions are larger than 2 cm, with detectability rate of 95-100%. They are fair (50-60% detectability rate) when tumors are between 1 and 2 cm and poor (less than 40%) when tumors are smaller than 1 cm. For recurrent nodal metastases and peritoneal deposits, CT is the modality of choice.

Clinical applications of SPECT

The clinical use of single photon emission computed tomography (SPECT) has grown steadily over the last decade. SPECT is now an essential technique for certain studies such as cerebral blood flow imaging. Many other common nuclear medicine studies give better results when they are performed with SPECT. These include myocardial perfusion imaging with thallium-201 or the new technetium-99m perfusion agents, myocardial infarct imaging with infarct-avid agents, imaging of tumors or infections with agents such as gallium-67 or indium-111 WBC's, and certain cases of bone imaging. Still other studies such as liver/spleen imaging, most brain studies, and perhaps renal imaging may benefit from SPECT even though planar imaging gives satisfactory results. Future developments in 3D display techniques and faster computers may extend the clinical usefulness of SPECT to other areas such as pulmonary perfusion imaging and gated cardiac blood pool imaging.