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Yoon JY, Lee SJ, Yoon KS, Yoon PW. The diagnostic value of SPECT/CT in predicting the occurrence of osteonecrosis following femoral neck fracture: a prospective cohort study. BMC Musculoskelet Disord 2020; 21:517. [PMID: 32746824 PMCID: PMC7397520 DOI: 10.1186/s12891-020-03538-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/23/2020] [Indexed: 12/05/2022] Open
Abstract
Backgrounds One of the most significant complications after a femoral neck fracture is osteonecrosis of the femoral head (ONFH). The concomitant use of single-photon emission computed tomography (SPECT) with computed tomography (CT) increases the sensitivity for detecting the anatomic location and severity of ONFH. In this study, we evaluated the diagnostic value of SPECT/CT for the occurrence of ONFH by quantifying the perfusion status of the femoral head. Methods A total of 30 patients who had multiple pinnings for femur neck fractures were included in this study. We classified the perfusion status into three groups: normal perfusion, decreased perfusion, and avascular groups, and compared the occurrence of femoral head necrosis between them. For quantitative analysis, we evaluated the uptake ratio of both femur heads (head-to-head uptake ratio). If the patient’s contralateral hip was incomparable, we measured the uptake ratio from the superior dome of the ipsilateral acetabulum (head-to-acetabulum uptake ratio). Results Twenty-four patients out of 30 achieved bone union, whereas the others developed ONFH. When the population was divided into intact and defective perfusion groups on scintigraphy, the sensitivity, specificity, and accuracy of the test were 83.3, 75.0, and 76.7%, respectively. The mean head-to-head uptake ratio value with a 95% confidence interval (CI) was 1.10 (95% CI: 0.85–1.36). In the osteonecrosis group, the mean value of the head-to-head uptake ratio was 0.33 (95% CI: 0.28–0.38). In contrast, the ratio was 1.30 (95% CI: 1.03–1.57) in the non-osteonecrosis group, demonstrating a significant difference in the uptake ratio (P < 0.001). When the cutoff value of the uptake ratio was set to 0.5, both the sensitivity and specificity were 100%. There was also a significant difference in the head-to-acetabulum uptake ratio between the two groups (P < 0.001). Conclusions SPECT/CT was useful in evaluating the perfusion status of the femoral head, showing high accuracy in predicting the occurrence of avascular necrosis. To demonstrate the reliability and validity of SPECT/CT, further prospective studies on a larger scale are warranted.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Soong Joon Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Klausen TL, Mortensen J, de Nijs R, Andersen FL, Højgaard L, Beyer T, Holm S. Intravenous contrast-enhanced CT can be used for CT-based attenuation correction in clinical (111)In-octreotide SPECT/CT. EJNMMI Phys 2015; 2:3. [PMID: 26501805 PMCID: PMC4545801 DOI: 10.1186/s40658-015-0108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CT-based attenuation correction (CT-AC) using contrast-enhancement CT impacts (111)In-SPECT image quality and quantification. In this study we assessed and evaluated the effect. METHODS A phantom (5.15 L) was filled with an aqueous solution of In-111. Three SPECT/CT scans were performed: (A) no IV contrast, (B) with 100-mL IV contrast, and (C) with 200-mL IV contrast added. Scan protocol included a localization CT, a low-dose CT (LD), and a full-dose CT (FD). Phantom, LD and FD scan series were performed at 90, 120, and 140 kVp. Phantom data were evaluated looking at mean counts in a central volume. Ten patients referred for (111)In-octreotide scintigraphy were scanned according to our clinical (111)In-SPECT/CT protocol including a topogram, a LD (140 kVp), and a FD (120 kVp). The FD/contrast-enhanced CT was acquired in both arterial (FDAP) and venous phase (FDVP) following a mono-phasic IV injection of 125-mL Optiray (4.5 mL/s). For patient data, we report image quality, Krenning scores, and mean/max values for liver and tumor regions. RESULTS Phantoms: in uncorrected emission data, mean counts (average ± SD) decreased with increasing IV concentration: (A) 119 ± 9, (B) 113 ± 8, and (C) 110 ± 9. For all attenuation correction (AC) scans, the mean values increased with increasing iodine concentration. PATIENTS there were no visible artifacts in single photon emission computed tomography (SPECT) following CT-AC with contrast-enhanced CT. The average score of image quality was 4.1 ± 0.3, 3.8 ± 0.4, and 4.2 ± 0.4 for LD, arterial phase, and venous phase, respectively. A total of 16 lesions were detected. The Krenning scores of 13/16 lesions were identical across all scan series. The max pixel values for the 16 lesions showed generally lower values for LD than for contrast-enhanced CT. CONCLUSIONS In (111)In-SPECT/CT imaging of phantoms and patients, the use of IV CT contrast did neither degrade the SPECT image quality nor affect the clinical Krenning score. Reconstructed counts in healthy liver tissues were unaffected, and there was a generally lower count value in lesions following CT-AC based on the LD non-enhanced images. Overall, for clinical interpretation, no separate low-dose CT is required for CT-AC in (111)In-SPECT/CT.
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Affiliation(s)
- Thomas Levin Klausen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Robin de Nijs
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Flemming Littrup Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Thomas Beyer
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Center for Medical Physics and Biomedical Engineering, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria.
| | - Søren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
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Abstract
Recovery of spatial resolution lost through increasing lesion-to-detector distance can improve the spatial resolution of planar images. We compare two commercial solutions, HiScan (http://www.scivis.de) and Xact.bone (http://www.ultraspect.com), with unprocessed planar whole-body bone scans. Thirty-five patients with suspected bone metastases were scanned 3 h after injection of 600 MBq (99m)Tc-HMDP at 12 cm/min. Two patients with more than 20 lesions were used for reporter training and were excluded from the analysis. Two blinded reporters categorized each scan as benign, indeterminate or malignant and assigned individual lesions to those same categories. Image quality was first graded on a 1 (worst) to 10 (best) scale for each individual scan, and then all three scans of each patient were ranked according to image quality. Reporter A detected 65, 90 and 83 malignant lesions with the unprocessed scan, HiScan and Xact.bone and 23, 24 and 17 indeterminate lesions, respectively. Reporter B detected 60, 80 and 75 malignant lesions with the unprocessed scan, HiScan and Xact.bone and 17, 16 and 14 indeterminate lesions, respectively. To summarize, reporters A/B detected 38/33% and 28/25% more malignant lesions with HiScan and Xact.bone than with the unprocessed scan, respectively (Friedman's test, P<0.05). The number of indeterminate lesions did not increase, but the percentage of unclear lesions decreased. Mean image quality for the unprocessed scan, HiScan and Xact.bone was 6.5, 9.1 and 7.9 for reporter A and 5.6, 7.5 and 6.7 for reporter B, respectively (P<0.0001). HiScan was ranked best for image quality in 82% of patients and Xact.bone in 18%. Resolution recovery in planar whole-body bone scans significantly increases the absolute number of detectable malignant lesions, decreases the percentage of indeterminate lesions, significantly increases image quality and is an easy-to-implement addition to routine clinical practice.
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Computer-aided evaluation of the anatomical accuracy of hybrid SPECT/spiral-CT imaging of lesions localized in the neck and upper abdomen. Nucl Med Commun 2012; 33:1153-9. [PMID: 22922735 DOI: 10.1097/mnm.0b013e32835839cc] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the anatomical accuracy of hardware-based single-photon emission computed tomography/computed tomography (SPECT/CT) registration in the upper abdomen and neck. METHODS The database consisted of 90 patients referred for SPECT/CT for diagnostic workup of either thyroid/parathyroid disease (n=46) or abdominal neuroendocrine tumours (n=44). In the first group, 99mTc-MIBI was used as the tracer and in the second 123I-metaiodobenzylguanidine (n=13), 111In-octreotide (n=28) or 99mTc-octreotide (n=3). For predefined structures represented by both modalities, the distances between the centres of gravity of their CT and SPECT representation were determined in a semiautomated manner. In cervical data sets, this analysis was performed for the submandibular salivary glands (n=92) and in abdominal data sets for 69 neoplastic foci. RESULTS The mean distances were 5.7 ± 2.0 mm (range: 1.84-9.67 mm) in the neck and 6.8 ± 3.3 mm (range: 1.4-19.7 mm) in the abdomen. In 42 out of 92 of the cervical and 40 out of 69 of the abdominal data sets at least one of the X-direction-determined, Y-direction-determined, and Z-direction-determined distances was greater than the SPECT pixel width of 4.6 mm. CONCLUSION The anatomical accuracy of hardware-based SPECT/CT fusion depends also on the region of the body studied. For example, in the neck and upper abdomen the accuracy is lower than in the lower lumbar spine. In clinical routine, SPECT/CT data sets acquired for the neck and upper abdomen should be regularly checked and corrected for SPECT/CT misalignment. This is, in particular, important when CT-based corrections of SPECT involving pixelwise data integration such as for attenuation correction are made.
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Javadi H, Mogharrabi M, Asli IN, Shafiei B, Bahtoee M, Seyedabadi M, Nabipour I, Assadi M. Bone single photon emission computed tomography (SPECT) in a patient with Pancoast tumor: a case report. SAO PAULO MED J 2010; 128:239-43. [PMID: 21120438 PMCID: PMC10938993 DOI: 10.1590/s1516-31802010000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS) for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
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Affiliation(s)
- Hamid Javadi
- MD. Head of Department of Nuclear Medicine, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Mehdi Mogharrabi
- MD. Assistant professor of Nuclear Medicine, Department of Nuclear Medicine, 5 Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Isa Neshandar Asli
- MD. Head of Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Babak Shafiei
- Assistant professor of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehrzad Bahtoee
- MD. Assistant professor of Internal Medicine, Tropical and Geographical Research Center, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mohammad Seyedabadi
- PhD. Pharmacologist and researcher in the Bushehr Research Center for Nuclear Medicine, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Iraj Nabipour
- MD. Professor of Internal Medicine, Tropical and Geographical Research Center, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Majid Assadi
- MD. Head of Bushehr Research Center for Nuclear Medicine, Persian Gulf Biomedical Sciences Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
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Attenuation correction of somatostatin receptor SPECT by integrated low-dose CT: is there an impact on sensitivity? Clin Nucl Med 2010; 34:869-73. [PMID: 20139819 DOI: 10.1097/rlu.0b013e3181becfcb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Somatostatin receptor scintigraphy (SRS) is an established imaging modality for neuroendocrine tumors (NET). Additional single photon emission computed tomography (SPECT-CT) not only permits image fusion but also attenuation correction (AC) of SPECT data. This study evaluated whether attenuation corrected SPECT-images (SPECT[AC]) are more sensitive than nonattenuation corrected SPECT-reconstructions (SPECT[NAC]) for the detection of NET lesions. METHODS The imaging data (planar In-111-octreotide scintigraphy and SPECT-CT) of 50 consecutive patients (28 male; 22 female; age, 34-80; mean, 65 years) with NET were included in this retrospective analysis. SPECT data were reconstructed with and without integrated CT-based AC and then analyzed by 2 experienced readers for the presence of pathologic uptake in a blinded consensus reading. Fused SPECT-CT, contemporary CT/MRI, and clinical as well as imaging follow-up served as a reference standard. All foci were rated in both the SPECT(NAC)- and SPECT(AC)-reconstructions for intensity and contrast using a 6-point-score ("0 = no uptake/no delineation from surrounding tissue" to "5 = very high uptake/very strong delineation from surrounding tissue"). The scores were analyzed in a 6 x 6 contingency table using the McNemar Bowker test. RESULTS A total of 222 pathologic foci were detected by SPECT(NAC) and 227 foci by SPECT(AC), respectively. In 67 of 227 foci (29.5%), focus intensity/contrast increased after AC, whereas only 5 foci showed a decrease (P < 0.001). Sensitivity increased by 2.2% (P = 0.025; 95% CI: 0.02%-4.1%) as 5 foci were detected only by SPECT(AC). However, as these 3 patients were already diagnosed with systemic disease, there was no influence on the therapeutic strategy chosen. CONCLUSION Attenuation correction of somatostatin receptor scintigraphy-SPECT significantly improves focus visualization and, albeit slightly, also significantly increases sensitivity.
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Bockisch A, Freudenberg LS, Schmidt D, Kuwert T. Hybrid Imaging by SPECT/CT and PET/CT: Proven Outcomes in Cancer Imaging. Semin Nucl Med 2009; 39:276-89. [PMID: 19497404 DOI: 10.1053/j.semnuclmed.2009.03.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin Nucl Med 2008; 38:177-98. [PMID: 18396178 DOI: 10.1053/j.semnuclmed.2008.01.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Single-photon emission computed tomography/computed tomography (SPECT/CT) has emerged during the past decade as a means of correlating anatomical information from CT with functional information from SPECT. The integration of SPECT and CT in a single imaging device facilitates anatomical localization of the radiopharmaceutical to differentiate physiological uptake from that associated with disease and patient-specific attenuation correction to improve the visual quality and quantitative accuracy of the SPECT image. The first clinically available SPECT/CT systems performed emission-transmission imaging using a dual-headed SPECT camera and a low-power x-ray CT subsystem. Newer SPECT/CT systems are available with high-power CT subsystems suitable for detailed anatomical diagnosis, including CT coronary angiography and coronary calcification that can be correlated with myocardial perfusion measurements. The high-performance CT capabilities also offer the potential to improve compensation of partial volume errors for more accurate quantitation of radionuclide measurement of myocardial blood flow and other physiological processes and for radiation dosimetry for radionuclide therapy. In addition, new SPECT technologies are being developed that significantly improve the detection efficiency and spatial resolution for radionuclide imaging of small organs including the heart, brain, and breast, and therefore may provide new capabilities for SPECT/CT imaging in these important clinical applications.
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Affiliation(s)
- Youngho Seo
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
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Ruf J, Steffen I, Mehl S, Rosner C, Denecke T, Pape UF, Plotkin M, Amthauer H. Influence of attenuation correction by integrated low-dose CT on somatostatin receptor SPECT. Nucl Med Commun 2007; 28:782-8. [PMID: 17728608 DOI: 10.1097/mnm.0b013e3282efa1a9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM Somatostatin receptor scintigraphy (SRS) is well-established in neuroendocrine tumour (NET) imaging. This study evaluated the impact of attenuation correction (AC) on SRS SPECT data in patients examined by SPECT-CT. METHODS Planar scintigraphy and SPECT-CT of 17 patients (10 men, seven women; age, 40-74 years; mean, 62 years) suffering from NET were included. For the visual assessment of AC, the intensity and contrast of foci classified as pathological were rated in both the non-attenuation corrected (NAC) and the attenuation corrected (AC) SPECT images using a 5-point score. The change in signal intensity after AC was semiquantified two-fold for each focus in both SPECT(AC) and SPECT(NAC): firstly by using tumour-to-background (TB) ratios (defined as T(max)/B(mean)) for the determination of a TB(AC)/TB(NAC) ratio. Secondly, by a T(max,AC)/T(max,NAC) ratio. Both ratios were correlated to the focus depth. RESULTS A total of 46 pathological foci were found. Focus contrast and intensity significantly increased in 14/46 foci (30%) after AC (mean, 3.7-4.0) in the visual analysis (P<0.001). While TB ratios increased only in 24/46 foci after AC and no correlation between the T(BAC)/T(BNAC) ratio and focus depth (r=0.027; P=0.856) was found, T(max) was higher after AC in all foci and the T(max,AC)/T(max,NAC) ratio showed the expected correlation to focus depth (r=0.650; P<0.01), indicating the superiority of the Tmax approach for the demonstration of the effects of attenuation correction on focal uptake. CONCLUSION Attenuation correction of SRS SPECT data by SPECT-CT results in visually more clearly contrasted foci. Moreover, as focus intensity increases, especially in the more centrally localised foci, CT-based AC has a potential to further improve the sensitivity of SRS SPECT.
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Affiliation(s)
- Juri Ruf
- Klinik für Strahlenheilkunde, Charité, Centrum 6 für diagnostische und interventionelle Radiologie und Nuklearmedizin, Charité--Universitätsmedizin Berlin, Germany.
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