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
Integrated SPECT/CT Systems
“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”

4. SPECT/CT – pubmed search
Keyword
All
Articles
Review 1.
SPECT-CT
700 86 2.
SPECT/CT 2 1 3
PET-CT
4903
741 4.
PET/CT
3744
530
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 - References 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):

6. Current SPECT/CT Systems
Vendor GE
SIEMENS
PHILIPS
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
Modality
Image Reconstruction 1.
SPECT
Iterative Reconstruction using CT Attenuation Map 2. CT
Multiplanar 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. SPECT/CT in Bone Scintigraphy
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Keyword
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Articles
Review
SPECT-CT and Bone
129 18
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):307-8.

9. Case # 1 – Whole Body Bone Scan

10. Case # 1 – Whole Body Bone Scan

11. Case # 2 – Whole Body Bone Scan

12. Case # 2 – Whole Body Bone Scan

13. Case # 3 – Whole Body Bone Scan

14. Case # 3 – Whole Body Bone Scan

15. Case # 4 – Three Phase Bone Scan

16. Case # 4 – Three Phase Bone Scan

17. SPECT/CT in Imaging Infection
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Articles
Review
SPECT-CT and Infection 39 8
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):

18. Case # 5 – Leukocyte Scintigraphy

19. Case # 5 – Leukocyte Scintigraphy

20. Case # 6 – Leukocyte Scintigraphy

21. Case # 6 – Leukocyte Scintigraphy

22. Case # 7 – Leukocyte Scintigraphy

23. Case # 7 – Leukocyte Scintigraphy

24. Case # 8 – Leukocyte Scintigraphy

25. Case # 8 – Leukocyte Scintigraphy

26. SPECT/CT in Endocrine Scintigraphy
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Articles
Review
SPECT-CT and Endocrine 33 10
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

28. Case # 9 – Parathyroid Scan

29. Case # 10 – Parathyroid Scan

30. Case # 10 – Parathyroid Scan

31. Case # 11 – Parathyroid Scan

32. Case # 11 – Parathyroid Scan

33. Case # 12 – Octreotide Scan

34. Case # 12 – Octreotide Scan

35. Case # 12 – Octreotide Scan

36. Case # 13 – Octreotide Scan

37. Case # 13 – Octreotide Scan

38. Case # 14 – MIBG Scan

39. Case # 14 – MIBG Scan

40. SPECT/CT in Thyroid Scintigraphy
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Articles
Review
SPECT-CT and Thyroid 64 6
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):

41. Case # 15 – I-131 Whole Body Scan

42. Case # 15 – I-131 Whole Body Scan

43. Case # 15 – I-131 Whole Body Scan

44. Case # 16 – I-123 Thyroid Scan

45. SPECT/CT in Prostascint Imaging
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Articles
Review
SPECT-CT and Prostascint 16 1
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):17-28.

46. Case # 17 – Prostascint Scan

47. Case # 17 – Prostascint Scan

48. Case # 18 – Prostascint Scan

49. Case # 18 – Prostascint Scan

50. SPECT/CT in Lymphoscintigraphy
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Articles
Review
SPECT-CT and Sentinel Node 65 7
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

51. Case # 19 – Lymphoscintigraphy

52. Case # 20 – Lymphoscintigraphy

53. Case # 21 – Sulfur Colloid Scan

54. Case # 21 – Sulfur Colloid Scan

55. Case # 22 – Hemangioma Scan

56. Case # 22 – Hemangioma Scan

57. Case # 22 – Hemangioma Scan

58. Case # 23 – Hepatobiliary Scan

59. SPECT/CT in Nuclear Cardiology
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SPECT-CT and Cardiac 72 19
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 Pulmonary Embolism
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SPECT-CT and Lung 77 11
SPECT/CT in V/Q scanning.
Roach PJ, Gradinscak DJ, Schembri GP, Bailey EA, Willowson KP, Bailey DL.
Semin Nucl Med Nov;40(6):

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