SPECT image (bone tracer) of a mouse Animation of a SPECT scanning procedure.
Single-photon emission computed tomography (SPECT, or less commonly, SPET) is a imaging technique using . It is very similar to conventional nuclear medicine planar imaging using a (that is, ). However, it is able to provide information. This information is typically presented as cross-sectional slices through the patient, but can be freely reformatted or manipulated as required.
The technique requires delivery of a gamma-emitting (a ) into the patient, normally through injection into the bloodstream. On occasion, the radioisotope is a simple soluble dissolved ion, such as an (III). Most of the time, though, a marker radioisotope is attached to a specific ligand to create a , whose properties bind it to certain types of tissues. This marriage allows the combination of ligand and to be carried and bound to a place of interest in the body, where the ligand concentration is seen by a gamma camera.
PrinciplesA Siemens brand SPECT scanner, consisting of two gamma cameras.
Instead of just "taking a picture of anatomical structures", a SPECT scan monitors level of biological activity at each place in the 3-D region analyzed. Emissions from the radionuclide indicate amounts of blood flow in the capillaries of the imaged regions. In the same way that a plain is a 2-dimensional (2-D) view of a 3-dimensional structure, the image obtained by a is a 2-D view of 3-D distribution of a .
SPECT imaging is performed by using a gamma camera to acquire multiple 2-D images (also called ), from multiple angles. A computer is then used to apply a algorithm to the multiple projections, yielding a 3-D data set. This data set may then be manipulated to show thin slices along any chosen axis of the body, similar to those obtained from other tomographic techniques, such as (MRI), (X-ray CT), and (PET).
SPECT is similar to PET in its use of radioactive tracer material and detection of gamma rays. In contrast with PET, however, the tracers used in SPECT emit gamma radiation that is measured directly, whereas PET tracers emit positrons that annihilate with electrons up to a few millimeters away, causing two gamma photons to be emitted in opposite directions. A PET scanner detects these emissions "coincident" in time, which provides more radiation event localization information and, thus, higher spatial resolution images than SPECT (which has about 1 cm resolution). SPECT scans, however, are significantly less expensive than PET scans, in part because they are able to use longer-lived more easily obtained radioisotopes than PET.
Because SPECT acquisition is very similar to planar gamma camera imaging, the same may be used. If a patient is examined in another type of nuclear medicine scan, but the images are non-diagnostic, it may be possible to proceed straight to SPECT by moving the patient to a SPECT instrument, or even by simply reconfiguring the camera for SPECT image acquisition while the patient remains on the table.SPECT machine performing a total body bone scan. The patient lies on a table that slides through the machine, while a pair of gamma cameras rotate around her.
To acquire SPECT images, the gamma camera is rotated around the patient. Projections are acquired at defined points during the rotation, typically every 3–6 degrees. In most cases, a full 360-degree rotation is used to obtain an optimal reconstruction. The time taken to obtain each projection is also variable, but 15–20 seconds is typical. This gives a total scan time of 15–20 minutes.
Multi-headed gamma cameras can provide accelerated acquisition. For example, a dual-headed camera can be used with heads spaced 180 degrees apart, allowing two projections to be acquired simultaneously, with each head requiring 180 degrees of rotation. Triple-head cameras with 120-degree spacing are also used.
Cardiac are possible with SPECT, just as with planar imaging techniques such as (MUGA). Triggered by (EKG) to obtain differential information about the heart in various parts of its cycle, gated myocardial SPECT can be used to obtain quantitative information about myocardial perfusion, thickness, and contractility of the myocardium during various parts of the cardiac cycle, and also to allow calculation of , stroke volume, and cardiac output.
SPECT can be used to complement any gamma imaging study, where a true 3D representation can be helpful, e.g., tumor imaging, infection () imaging, thyroid imaging or .
Because SPECT permits accurate localisation in 3D space, it can be used to provide information about localised function in internal organs, such as functional cardiac or brain imaging.
Myocardial perfusion imaging
Myocardial perfusion imaging (MPI) is a form of functional cardiac imaging, used for the diagnosis of . The underlying principle is that under conditions of stress, diseased receives less blood flow than normal myocardium. MPI is one of several types of .
A cardiac specific radiopharmaceutical is administered, e.g., 99mTc- (Myoview, GE healthcare), 99mTc-sestamibi (Cardiolite, Bristol-Myers Squibb) or chloride. Following this, the heart rate is raised to induce myocardial stress, either by exercise on a or pharmacologically with , , or ( can be used to reverse the effects of dipyridamole).
SPECT imaging performed after stress reveals the distribution of the radiopharmaceutical, and therefore the relative blood flow to the different regions of the myocardium. Diagnosis is made by comparing stress images to a further set of images obtained at rest which are normally acquired prior to the stress images.
MPI has been demonstrated to have an overall accuracy of about 83% (: 85%; : 72%), and is comparable with (or better than) other non-invasive tests for ischemic heart disease.
Functional brain imaging
Usually, the gamma-emitting tracer used in functional brain imaging is (hexamethylpropylene amine oxime). is a metastable that emits gamma rays that can be detected by a gamma camera. Attaching it to HMPAO allows 99mTc to be taken up by brain tissue in a manner proportional to brain blood flow, in turn allowing to be assessed with the nuclear gamma camera.
Because blood flow in the brain is tightly coupled to local brain metabolism and energy use, the 99mTc-HMPAO tracer (as well as the similar 99mTc-EC tracer) is used to assess brain metabolism regionally, in an attempt to diagnose and differentiate the different causal pathologies of . Meta-analysis of many reported studies suggests that SPECT with this tracer is about 74% sensitive at diagnosing Alzheimer's disease vs. 81% sensitivity for clinical exam (, etc.). More recent studies have shown the accuracy of SPECT in Alzheimer's diagnosis may be as high as 88%. In meta analysis, SPECT was superior to clinical exam and clinical criteria (91% vs. 70%) in being able to differentiate Alzheimer's disease from vascular dementias. This latter ability relates to SPECT's imaging of local metabolism of the brain, in which the patchy loss of cortical metabolism seen in multiple strokes differs clearly from the more even or "smooth" loss of non-occipital cortical brain function typical of Alzheimer's disease. Another recent review article showed that multi-headed SPECT cameras with quantitative analysis result in an overall sensitivity of 84-89% and an overall specificity of 83-89% in cross sectional studies and sensitivity of 82-96% and specificity of 83-89% for longitudinal studies of dementia.
99mTc-HMPAO SPECT scanning competes with (FDG) scanning of the brain, which works to assess regional brain glucose metabolism, to provide very similar information about local brain damage from many processes. SPECT is more widely available, because the radioisotope used is longer-lasting and far less expensive in SPECT, and the gamma scanning equipment is less expensive as well. While 99mTc is extracted from relatively simple , which are delivered to hospitals and scanning centers weekly to supply fresh radioisotope, FDG PET relies on FDG, which is made in an expensive medical and "hot-lab" (automated chemistry lab for radiopharmaceutical manufacture), and then delivered immediately to scanning sites because of the natural short 110-minute half-life of .
Applications in nuclear technology
In the nuclear power sector, the SPECT technique can be applied to image radioisotope distributions in irradiated nuclear fuels. Due to the irradiation of nuclear fuel (e.g. uranium) with neutrons in a nuclear reactor, a wide array of gamma-emitting radionuclides are naturally produced in the fuel, such as fission products (, and ) and activation products ( and ). These may be imaged using SPECT in order to verify the presence of fuel rods in a stored fuel assembly for purposes, to validate predictions of core simulation codes, or to study the behavior of the nuclear fuel in normal operation, or in accident scenarios.
Reconstructed images typically have resolutions of 64×64 or 128×128 pixels, with the pixel sizes ranging from 3–6 mm. The number of projections acquired is chosen to be approximately equal to the width of the resulting images. In general, the resulting reconstructed images will be of lower resolution, have increased noise than planar images, and be susceptible to .
Scanning is time consuming, and it is essential that there is no patient movement during the scan time. Movement can cause significant degradation of the reconstructed images, although movement compensation reconstruction techniques can help with this. A highly uneven distribution of radiopharmaceutical also has the potential to cause artifacts. A very intense area of activity (e.g., the bladder) can cause extensive streaking of the images and obscure neighboring areas of activity. This is a limitation of the reconstruction algorithm. is an alternative algorithm that is growing in importance, as it is less sensitive to artifacts and can also correct for attenuation and depth dependent blurring. Furthermore, iterative algorithms can be made more efficacious using the methodology.
Attenuation of the gamma rays within the patient can lead to significant underestimation of activity in deep tissues, compared to superficial tissues. Approximate correction is possible, based on relative position of the activity. However, optimal correction is obtained with measured attenuation values. Modern SPECT equipment is available with an integrated X-ray CT scanner. As X-ray CT images are an attenuation map of the tissues, this data can be incorporated into the SPECT reconstruction to correct for attenuation. It also provides a precisely CT image, which can provide additional anatomical information.
Scatter of the gamma rays as well as the random nature of gamma rays can also lead to the degradation of quality of SPECT images and cause loss of resolution. Scatter correction and resolution recovery are also applied to improve resolution of SPECT images.
Typical SPECT acquisition protocolsStudy Emission energy (keV) Activity () Rotation (degrees) Projections Image resolution Time per projection (s) Bone scan 140 6 hours Phosphonates / Bisphosphonates 800 360 120 128 x 128 30 technetium-99m 140 6 hours tetrofosmin; 700 180 60 64 x 64 25 technetium-99m 140 6 hours Brain scan technetium-99m 140 6 hours ; ECD 555-1110 360 64 128 x 128 30 Neuroendocrine or neurological tumor scan or 159 13 hours or 8 days 400 360 60 64 x 64 30 White cell scan & technetium-99m 171 & 245 67 hours in vitro labelled leucocytes 18 360 60 64 x 64 30
In some cases a SPECT gamma scanner may be built to operate with a , with coregistration of images. As in , this allows location of tumors or tissues which may be seen on SPECT scintigraphy, but are difficult to locate precisely with regard to other anatomical structures. Such scans are most useful for tissues outside the brain, where location of tissues may be far more variable. For example, SPECT/CT may be used in applications, where the technique is useful in locating ectopic parathyroid adenomas which may not be in their usual locations in the thyroid gland.
Use in court
In 2013 SPECT was used in the Belgian case in an attempt to assess whether or not Kim de Gelder was accountable for his actions. He was on trial for the murder of two infants and one nanny in 2009. The defense argued that De Gelder was suffering from , which in their opinion could be inferred from a SPECT scan of his brain. There was a sizable public debate over whether neuroimaging techniques of this kind have a place in the courtroom. On March 22, 2013 Kim de Gelder was found guilty of four counts of murder and was sentenced to .
The overall performance of SPECT systems can be performed by quality control tools such as the .
- at the US National Library of Medicine (MeSH)
- Scuffham J W (2012). "A CdTe detector for hyperspectral SPECT imaging". Journal of Instrumentation. IOP Journal of Instrumentation. 7: P08027. :.
- Elhendy, A; Bax, JJ; Poldermans, D (2002). . Journal of Nuclear Medicine. 43 (12): 1634–46. .
- Bonte FJ, Harris TS, Hynan LS, Bigio EH, White CL (2006). "Tc-99m HMPAO SPECT in the differential diagnosis of the dementias with histopathologic confirmation". Clin Nucl Med. 31 (7): 376–8. :. .
- Dougall NJ, Bruggink S, Ebmeier KP (2004). "Systematic review of the diagnostic accuracy of 99mTc-HMPAO-SPECT in dementia". Am J Geriatr Psychiatry. 12 (6): 554–70. :. .
- Henderson, Theodore (December 2012). "The diagnosis and evaluation of dementia and mild cognitive impairment with emphasis on SPECT perfusion neuroimaging". CNS Spectrums. 17 (4): 188–89. :. .
- Jacobsson Svärd Staffan, Håkansson Ane, Bäcklin Anders, Osifo Otasowie, Willman Christopher, Jansson Peter (2005). "Nondestructive Experimental Determination of the Pin-Power Distribution in Nuclear Fuel Assemblies". Nuclear Technology. 151: 70–76. :. CS1 maint: Multiple names: authors list ()
- Andersson P (2017). "A computerized method (UPPREC) for quantitative analysis of irradiated nuclear fuel assemblies with gamma emission tomography at the Halden reactor". Annals of Nuclear Energy. 110: 88–97. :.
- Biard B (2013). "Quantitative analysis of the fission product distribution in a damaged fuel assembly using gamma-spectrometry and computed tomography for the Phébus FPT3 test". Nuclear Engineering and Design. 262: 469–483. :.
- Luo, S, Zhou, T (2014). "Superiorization of EM algorithm and its application in single-photon emission computed tomography (SPECT)". Inverse Problems and Imaging. 8: 88–97. : . :.
- . Retrieved 10 January 2016.
- Neumann DR, Obuchowski NA, Difilippo FP (2008). "Preoperative 123I/99mTc-sestamibi subtraction SPECT and SPECT/CT in primary hyperparathyroidism". J Nucl Med. 49: 2012–7. :. 18997051. CS1 maint: Multiple names: authors list ()
- Jennifer Prekeges. Nuclear Medicine Instrumentation. Jones & Bartlett Publishers. 2012. p.189
- M. D. Cerqueira, A. F. Jacobson: Assessment of myocardial viability with SPECT and PET imaging. In: American Journal of Roentgenology. Band 153, Nr. 3, 1989, S. 477–483
- Bruyant, P.P. Journal of Nuclear Medicine 43(10):1343-1358, 2002
- (2009). Fundamentals of Computerized Tomography: Image Reconstruction from Projections (2nd ed.). Springer. . .
- A review on brain-imaging applications of SPECT: W. Gordon Frankle, Mark Slifstein, Peter S. Talbot, and Marc Laruelle (2005). "Neuroreceptor Imaging in Psychiatry: Theory and Applications". International Review of Neurobiology, 67: 385–440. :
- Practical SPECT/CT In Nuclear Medicine - Jones / Hogg / Seeram - Release Date: 31 Mar 2013 Edition: 2013
- Willowson K, Bailey DL, Baldock C, 2008. Quantitative SPECT reconstruction using CT-derived corrections. Phys. Med. Biol. 53 3099-3112.