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      Differential impact of multi-focus fan beam collimation with L-mode and conventional systems on the accuracy of myocardial perfusion imaging: Quantitative evaluation using phantoms

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          Abstract

          Objective(s):

          A novel IQ-SPECT™ method has become widely used in clinical studies. The present study compares the quality of myocardial perfusion images (MPI) acquired using the IQ-SPECT™ (IQ-mode), conventional (180° apart: C-mode) and L-mode (90° apart: L-mode) systems. We assessed spatial resolution, image reproducibility and quantifiability using various physical phantoms.

          Methods:

          SPECT images were acquired using a dual-headed gamma camera with C-mode, L-mode, and IQ-mode acquisition systems from line source, pai and cardiac phantoms containing solutions of 99mTc. The line source phantom was placed in the center of the orbit and at ± 4.0, ± 8.0, ± 12.0, ± 16.0 and ± 20.0 cm off center. We examined quantifiability using the pai phantom comprising six chambers containing 0.0, 0.016, 0.03, 0.045, 0.062, and 0.074 MBq/mL of 99m-Tc and cross-calibrating the SPECT counts. Image resolution and reproducibility were quantified as myocardial wall thickness (MWT) and %uptake using polar maps.

          Results:

          The full width at half maximum (FWHM) of the IQ-mode in the center was increased by 11% as compared with C-mode, and FWHM in the periphery was increased 41% compared with FWHM at the center. Calibrated SPECT counts were essentially the same when quantified using IQ-and C-modes. IQ-SPECT images of MWT were significantly improved (P<0.001) over L-mode, and C-mode SPECT imaging with IQ-mode became increasingly inhomogeneous, both visually and quantitatively (C-mode vs. L-mode, ns; C-mode vs. IQ-mode, P<0.05).

          Conclusion:

          Myocardial perfusion images acquired by IQ-SPECT were comparable to those acquired by conventional and L-mode SPECT, but with significantly improved resolution and quality. Our results suggest that IQ-SPECT is the optimal technology for myocardial perfusion SPECT imaging.

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          Most cited references19

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          Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximization with 3-dimensional resolution recovery, attenuation, and scatter correction.

          We present a calibration method of a clinical SPECT/CT device for quantitative (99m)Tc SPECT. We use a commercially available reconstruction package including ordered-subset expectation maximization (OSEM) with depth-dependent 3-dimensional resolution recovery (OSEM-3D), CT-based attenuation correction, and scatter correction. We validated the method in phantom studies and applied it to images from patients injected with (99m)Tc-diphosponate. The following 3 steps were performed to derive absolute quantitative values from SPECT reconstructed images. In step 1, we used simulations to characterize the SPECT/CT system and derive emission recovery values for various imaging parameter settings. We simulated spheres of varying diameters and focused on the dependencies of activity estimation errors on structure size and position, pixel size, count density, and reconstruction parameters. In step 2, we cross-calibrated our clinical SPECT/CT system with the well counter using a large cylinder phantom. This step provided the mapping from image counts to kBq/mL. And in step 3, correction factors from steps 1 and 2 were applied to reconstructed images. We used a cylinder phantom with variable-sized spheres for verification of the method. For in vivo validation, SPECT/CT datasets from 16 patients undergoing (99m)Tc-diphosponate SPECT/CT examinations of the pelvis including the bladder were acquired. The radioactivity concentration in the patients' urine served as the gold standard. Mean quantitative accuracy and SEs were calculated. In the phantom experiments, the mean accuracy in quantifying radioactivity concentration in absolute terms was within 3.6% (SE, 8.0%), with a 95% confidence interval between -19.4% and +12.2%. In the patient studies, the mean accuracy was within 1.1% (SE, 8.4%), with a 95% confidence interval between -15.4% and +17.5%. Current commercially available SPECT/CT technology using OSEM-3D reconstruction, scatter correction, and CT-based attenuation correction allows quantification of (99m)Tc radioactivity concentration in absolute terms within 3.6% in phantoms and 1.1% in patients with a focus on the bladder. This opens up the opportunity of SPECT quantitation entering the routine clinical arena. Still, the imprecision caused by unavoidable measurement errors is a dominant factor for absolute quantitation in a clinical setup.
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            Compared performance of high-sensitivity cameras dedicated to myocardial perfusion SPECT: a comprehensive analysis of phantom and human images.

            Differences in the performance of cadmium-zinc-telluride (CZT) cameras or collimation systems that have recently been commercialized for myocardial SPECT remain unclear. In the present study, the performance of 3 of these systems was compared by a comprehensive analysis of phantom and human SPECT images.
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              Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration.

              The accuracy of myocardial perfusion SPECT improves with attenuation correction. Algorithms for attenuation correction in hybrid SPECT/CT systems have the potential for misregistration of emission and transmission scans because CT and SPECT are obtained sequentially. Misregistration will influence regional tracer distribution and may reduce diagnostic accuracy. This study focused on the role of misregistration in cardiac SPECT/CT and the performance of a software-based approach for reregistration. We included 105 consecutive patients who underwent clinical myocardial perfusion imaging on a SPECT/CT system. Images were quantitatively assessed for misregistration using fusion software. Results were recorded in millimeters in the x-, y-, and z-axes. Regional tracer uptake in 6 segments (anterior, septal, inferior, lateral, anteroapical, and inferoapical) for noncorrected and attenuation-corrected images before and after reregistration was obtained from polar maps. To determine the relative influence of misregistration, we correlated individual differences between noncorrected and attenuation-corrected images, as well as between attenuation-corrected images before and after reregistration, with the degree of misregistration in a multivariate analysis including additional clinical variables such as sex and body weight. The difference in regional radiotracer uptake was significant between noncorrected and attenuation-corrected images in all 6 segments and was most pronounced in the inferior wall. On multivariate analysis, misregistration contributed significantly to changes in radiotracer distribution in the anterior (P = 0.038), septal (P = 0.011), and inferior (P = 0.006) segments. The mean misregistration was 8.6 +/- 3.8 mm (1.25 +/- 0.55 pixel). Misregistration of one or more pixels was observed in 64% of studies. Reregistration of misalignment significantly affected regional radiotracer distribution in the segments shown to be influenced by misregistration. Misregistration occurs with SPECT/CT systems and influences regional tracer distribution on attenuation-corrected myocardial images. Reregistration of misaligned studies may be a useful tool for correction. The impact of this strategy on the diagnostic and prognostic accuracy of cardiac hybrid imaging needs to be determined.
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                Author and article information

                Journal
                Asia Ocean J Nucl Med Biol
                Asia Ocean J Nucl Med Biol
                AOJNMB
                Asia Oceania Journal of Nuclear Medicine and Biology
                Asia Oceania Journal of Nuclear Medicine & Biology (Iran )
                2322-5718
                2322-5726
                Autumn 2013
                : 1
                : 2
                : 28-34
                Affiliations
                [1 ]Program in Health and Welfare, Graduate on School of Comprehensive Scientific Research, Prefectural University of Hiroshima
                [2 ]Program in Biological System Sciences, Graduate on School of Comprehensive Scientific Research, Prefectural University of Hiroshima
                [3 ]Department of Radiology, Kurashiki Central Hospital
                [4 ]Department of Nursing, Hyogo University of Health Sciences
                Author notes
                * Corresponding author: Hideo Onishi, Program in Health and Welfare, Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, 1-1 Gakuenmachi, Mihara, Hiroshima, Japan 723-0053. Tel: +81-848-60-1268; Fax: +81-848-60-1186; E-mail: onisi@ 123456pu-hiroshima.ac.jp
                Article
                AOJNMB-1-28
                4927048
                27408847
                8b0c8071-c252-489d-b51e-2b9a123ea3f4
                Copyright: © mums.ac.ir

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 June 2013
                : 18 July 2013
                : 23 July 2013
                Categories
                Original Article

                multi-focus fan beam,collimator,image quality,acquisition mode

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