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Overview of SPECT/CT Applications way to “new & clear” medicine Peeyush Bhargava M.D, M.S Attending in Nuclear Medicine, MEDVAMC Associate Professor of.

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Presentation on theme: "Overview of SPECT/CT Applications way to “new & clear” medicine Peeyush Bhargava M.D, M.S Attending in Nuclear Medicine, MEDVAMC Associate Professor of."— Presentation transcript:

1 Overview of SPECT/CT Applications way to “new & clear” medicine Peeyush Bhargava M.D, M.S Attending in Nuclear Medicine, MEDVAMC Associate Professor of Radiology, BCM

2 SPECT & CT - Definitions SPECT (Single Photon Emission Computed Tomography) – “tomographic scintigraphy where computer generated three dimensional images of radioactive tracer distribution are produced by detection of single photons from acquired multiple planar images” CT (Computed Tomography) – “tomographic imaging performed with an external x-ray source to derive three dimensional anatomic image data”

3 SPECT/CT - Definitions “that can perform both functions on one gantry and provide fused functional and anatomic data in a single imaging session” “enables a direct correlation of anatomic information and functional information resulting in better localization and definition of scintigraphic findings” Integrated SPECT/CT Systems

4 SPECT/CT – pubmed search Search Keyword All Articles Review Articles 1.SPECT-CT SPECT/CT21 3 PET-CT PET/CT Hybrid SPECT/CT: the end of "unclear" medicine. Patel CN, Chowdhury FU, Scarsbrook AF. Postgrad Med J Nov;85(1009): “Single photon emission computed tomography/CT (SPECT/CT) is a dual modality technique which increases the sensitivity and specificity of existing radionuclide imaging and helps characterize equivocal lesions detected by other imaging methods.”

5 SPECT/CT. Buck AK, Nekolla S, Ziegler S, Beer A, Krause BJ, Herrmann K, Scheidhauer K, Wester HJ, Rummeny EJ, Schwaiger M, Drzezga A. J Nucl Med Aug;49(8): SPECT/CT imaging: clinical utility of an emerging technology. Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. Radiographics Jul-Aug;28(4): A review on the clinical uses of SPECT/CT. Mariani G, Bruselli L, Kuwert T, Kim EE, Flotats A, Israel O, Dondi M, Watanabe N. Eur J Nucl Med Mol Imaging Oct;37(10): SPECT/CT - References

6 Current SPECT/CT Systems Vendor GESIEMENSPHILIPS Camera Models Infinia Hawkeye 4 Symbia T Symbia T2 Symbia T6 Symbia T16 BrightView XCT Discovery NM/CT 670 Precedence SPECT/CT Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images. Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, Chisin R. Eur J Nucl Med Jun;27(6): “In order to produce anatomical images that are inherently registered with images of emission computerized tomography acquired with a gamma camera, an X-ray transmission system was mounted on the slip- ring gantry of a GEMS Millennium VG gamma camera.”

7 SPECT/CT Image Processing ModalityImage Reconstruction 1.SPECT Iterative Reconstruction using CT Attenuation Map 2. CTMultiplanar Reconstruction 3. Image Coregistration Automated Software SPECT/CT imaging: clinical utility of an emerging technology. Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. Radiographics Jul-Aug;28(4): “The attenuation map is then used by an iterative reconstruction algorithm to perform attenuation correction of the emission data”

8 Multislice SPECT/CT in benign and malignant bone disease: when the ordinary turns into the extraordinary. Gnanasegaran G, Barwick T, Adamson K, Mohan H, Sharp D, Fogelman I. Semin Nucl Med Nov;39(6): Bone SPECT-CT with 99mTc-labelled bisphosphonates. Rasilla JM, Arboniés JC, Gutiérrez LL. Rev Esp Med Nucl Nov-Dec;28(6): SPECT/CT in Bone Scintigraphy Search Keyword All Articles Review Articles SPECT-CT and Bone 12918

9 Case # 1 – Whole Body Bone Scan

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11 Case # 2 – Whole Body Bone Scan

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13 Case # 3 – Whole Body Bone Scan

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15 Case # 4 – Three Phase Bone Scan

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17 Diabetic foot infection: usefulness of SPECT/CT for 99mTc- HMPAO-labeled leukocyte imaging. Filippi L, Uccioli L, Giurato L, Schillaci O. J Nucl Med Jul;50(7): SPECT/CT in Imaging Infection Search Keyword All Articles Review Articles SPECT-CT and Infection 398

18 Case # 5 – Leukocyte Scintigraphy

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20 Case # 6 – Leukocyte Scintigraphy

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22 Case # 7 – Leukocyte Scintigraphy

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24 Case # 8 – Leukocyte Scintigraphy

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26 SPECT/CT in Endocrine Scintigraphy Search Keyword All Articles Review Articles SPECT-CT and Endocrine 3310 Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual- phase (99m)Tc-sestamibi parathyroid scintigraphy. Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, Dackiw AP, Tufano RP, Zeiger MA, Ziessman HA. J Nucl Med Jul;48(7): “These findings strongly suggest that dual-phase imaging, with early SPECT/CT whenever possible, should be part of the routine preoperative evaluation of patients with primary hyperparathyroidism in this new age of minimally invasive parathyroidectomy.”

27 Case # 9 – Parathyroid Scan

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29 Case # 10 – Parathyroid Scan

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31 Case # 11 – Parathyroid Scan

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33 Case # 12 – Octreotide Scan

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36 Case # 13 – Octreotide Scan

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38 Case # 14 – MIBG Scan

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40 Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma. Wong KK, Zarzhevsky N, Cahill JM, Frey KA, Avram AM. Br J Radiol Oct;82(982): Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma. Chen L, Luo Q, Shen Y, Yu Y, Yuan Z, Lu H, Zhu R. J Nucl Med Dec;49(12): SPECT/CT in Thyroid Scintigraphy Search Keyword All Articles Review Articles SPECT-CT and Thyroid 646

41 Case # 15 – I-131 Whole Body Scan

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44 Case # 16 – I-123 Thyroid Scan

45 Synergistic value of single-photon emission computed tomography/computed tomography fusion to radioimmunoscintigraphic imaging of prostate cancer. Sodee DB, Sodee AE, Bakale G. Semin Nucl Med Jan;37(1): SPECT/CT in Prostascint Imaging Search Keyword All Articles Review Articles SPECT-CT and Prostascint 161

46 Case # 17 – Prostascint Scan

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48 Case # 18 – Prostascint Scan

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50 SPECT/CT for preoperative sentinel node localization. Vermeeren L, van der Ploeg IM, Olmos RA, Meinhardt W, Klop WM, Kroon BB, Nieweg OE. J Surg Oncol Feb 1;101(2): Evaluation and localization of lymphatic drainage and sentinel lymph nodes in patients with head and neck melanomas by hybrid SPECT/CT lymphoscintigraphic imaging. Mar MV, Miller SA, Kim EE, Macapinlac HA. J Nucl Med Technol Mar;35(1):10-6 SPECT/CT in Lymphoscintigraphy Search Keyword All Articles Review Articles SPECT-CT and Sentinel Node 657

51 Case # 19 – Lymphoscintigraphy

52 Case # 20 – Lymphoscintigraphy

53 Case # 21 – Sulfur Colloid Scan

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55 Case # 22 – Hemangioma Scan

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58 Case # 23 – Hepatobiliary Scan

59 SPECT/CT in Nuclear Cardiology Search Keyword All Articles Review Articles SPECT-CT and Cardiac 7219 Hybrid SPECT-CT: integration of CT coronary artery calcium scoring and angiography with myocardial perfusion. Mahmarian JJ. Curr Cardiol Rep Apr;9(2): “Hybrid imaging with SPECT and CT angiography may prove important from a diagnostic and therapeutic view point in several clinical scenarios, and it is likely that over the next decade fusion imaging may more precisely tailor therapy, reduce healthcare costs, and improve patient outcome.”

60 Case # 24 – Myocardial Perfusion Imaging

61 SPECT/CT in V/Q scanning. Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA, Willowson KP, Bailey DL. Semin Nucl Med Nov;40(6): SPECT/CT in Pulmonary Embolism Search Keyword All Articles Review Articles SPECT-CT and Lung 7711

62 Case # 25 – Lung Scan Acute pulmonary embolism detected by perfusion SPECT/CT masquerading as an intermediate probability planar V/Q scan. Lu Y, Fox JJ. Clin Nucl Med Dec;35(12):941-3.

63 Case # 25 – Lung Scan Acute pulmonary embolism detected by perfusion SPECT/CT masquerading as an intermediate probability planar V/Q scan. Lu Y, Fox JJ. Clin Nucl Med Dec;35(12):941-3.

64 Case # 26 – Lung Scan

65 SPECT/CT: Conclusions and Issues * More confident reporting * Less indeterminate findings * Biopsy assistance * Dosimetry * CT quality * Reimbursement * Radiation exposure * Study time Improved Sensitivity and Specificity Excellent anatomical localization Morphological characterization


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