Single photon emission tomography in neurological studies: Instrumentation and clinical applications

One triple head and two single head gamma camera systems were used for single photon emission tomography (SPET) imaging of both patients and brain phantoms. Studies with an anatomical brain phantom were performed for evaluation of reconstruction and correction methods in brain perfusion SPET studies. The use of the triple head gamma camera system resulted in a significant increase in image contrast and resolution. This was mainly due to better imaging geometry and the use of a high resolution collimator. The conventional Chang attenuation correction was found suitable for the brain perfusion studies. In the brain perfusion studies region of interest (ROI) based semiquantitation methods were used. A ROI map based on anatomical areas was used in 70 elderly persons (age range 55-85 years) without neurological diseases and in patients suffering from encephalitis or having had a cardiac arrest. Semiquantitative reference values are presented. For the 14 patients with encephalitis the right-to-left side differences were calculated. Defect volume indexes were calculated for 64 patients with brain infarcts. For the 30 cardiac arrest patients the defect percentages and the anteroposterior ratios were used for semiquantitation. It is concluded that different semiquantitation methods are needed for the various patient groups. Age-related reference values will improve the interpretation of SPET data. For validation of the basal ganglia receptor studies measurements were performed using a cylindrical and an anatomical striatal phantom. In these measurements conventional and transmission imaging based non-uniform attenuation corrections were compared. A calibration curve was calculated for the determination of the specific receptor uptake ratio. In the phantom studies using the triple head camera the uptake ratio obtained from simultaneous transmission-emission protocol (STEP) acquisition and iterative reconstruction was closest to the true activity ratio. Conventional acquisition and uniform Chang attenuation correction gave 40% lower values. The effect of dual window scatter correction was also measured. In conventional reconstruction dual window scatter correction increased the uptake ratios when using a single head camera, but when using the triple head camera this correction did not have a significant effect on the ratios. Semiquantitative values for striatal 123I-labelled β-carbomethoxy-3β-(4-iodophenyl)tropane (23I-βCIT) dopamine transporter uptake in 20 adults (mean age 52±15 years) are presented. The mean basal ganglia to cerebellum ratio was 6.5±0.9 and the mean caudatus to putamen ratio was 1.2. The registration of brain SPET and magnetic resonance (MR) studies provides the necessary anatomical information for determination of the ROIs. A procedure for registration and simultaneous display of brain SPET and MR images based on six external skin markers is presented. The usefulness of this method was demonstrated in selected patients. The registration accuracy was determined for single and triple head gamma camera systems using brain phantom and simulation studies. The registration residual for three internal test markers was calculated using 4 to 13 external markers in the registration. For 6 external markers, as used in the registration in the patient studies, the mean RMS residuals of the test markers for the single head camera and the triple head camera were 3.5 mm and 3.2 mm, respectively. According to the simulation studies the largest inaccuracy is due mainly to the spatial resolution of SPET. The use of six markers, as in the patient studies, is adequate for accurate registration. (orig.)