Akihiro Takaki

Optimum energy window setting on Hg-201 x-rays photopeak for effective Tl-201 imaging

For more effective Tl-201 imaging, the location and width of the energy window set on the Hg-201 x-rays photopeak was investigated using Monte Carlo simulation and phantom experiments. We calculated energy spectra and investigated the amount of primary and scattered photons within various energy windows set on the x-rays photopeak. The energy resolution (ER) at 71 keV (the peak of the x-rays photopeak) was changed to 10%, 12%, 14% and 16%. The relationships between the energy window and the primary counts rate or the scatter fraction (= scattered counts/primary counts, SF) were obtained. By compromise between the primary counts rate and the SF for ER = 12%, the optimum energy window was determined as a wider off-peak window, 77 keV ± 14.3% (66–88 keV). This off-peak window increased the primary counts rate by 12.5% and decreased the SF by ~17% as compared with the conventional on-peak energy window (71 keV ± 10%, 64–78 keV). When this off-peak widow acquisition was compared with the conventional on-peak window one on a gamma camera, planar and SPECT images using the off-peak widow clearly showed superior results qualitatively and quantitatively.

Behaviors of cost functions in image registration between 201Tl brain tumor single-photon emission computed tomography and magnetic resonance images.

ObjectiveWe studied the behaviors of cost functions in the registration of thallium-201 (201Tl) brain tumor single-photon emission computed tomography (SPECT) and magnetic resonance (MR) images, as the similarity index of image positioning.MethodsA marker for image registration [technetium-99m (99mTc) point source] was attached at three sites on the heads of 13 patients with brain tumor, from whom 42 sets of 99mTc-201Tl SPECT (the dual-isotope acquisition) and MR images were obtained. The 201Tl SPECT and MR images were manually registered according to the markers. From the positions where the two images were registered, the position of the 201Tl SPECT was moved to examine the behaviors of the three cost functions, i.e., ratio image uniformity (RIU), mutual information (MI), and normalized MI (NMI).ResultsThe cost functions MI and NMI reached the maximum at positions adjacent to those where the SPECT and MR images were manually registered. As for the accuracy of image registration in terms of the cost functions MI and NMI, on average, the images were accurately registered within 3° of rotation around the X-, Y-, and Z-axes, and within 1.5 mm (within 2 pixels), 3 mm (within 3 pixels), and 4 mm (within 1 slice) of translation to the X-, Y-, and Z-axes, respectively. In terms of rotation around the Z-axis, the cost function RIU reached the minimum at positions where the manual registration of the two images was substantially inadequate.ConclusionsThe MI and NMI were suitable cost functions in the registration of 201Tl SPECT and MR images. The behavior of the RIU, in contrast, was unstable, being unsuitable as an index of image registration.

Improvement of image quality using interpolated projection data estimation method in SPECT

ObjectiveGeneral data acquisition for single photon emission computed tomography (SPECT) is performed in 90 or 60 directions, with a coarse pitch of approximately 4–6° for a rotation of 360° or 180°, using a gamma camera. No data between adjacent projections will be sampled under these circumstances. The aim of the study was to develop a method to improve SPECT image quality by generating lacking projection data through interpolation of data obtained with a coarse pitch such as 6°.MethodsThe projection data set at each individual degree in 360 directions was generated by a weighted average interpolation method from the projection data acquired with a coarse sampling angle (interpolated projection data estimation processing method, IPDE method). The IPDE method was applied to the numerical digital phantom data, actual phantom data and clinical brain data with Tc-99m ECD. All SPECT images were reconstructed by the filtered back-projection method and compared with the original SPECT images.ResultsThe results confirmed that streak artifacts decreased by apparently increasing a sampling number in SPECT after interpolation and also improved S/N ratio of the root mean square uncertainty value. Furthermore, the normalized mean square error values, compared with standard images, had similar ones after interpolation. Moreover, the contrast and concentration ratios increased their effects after interpolation.ConclusionThese results indicate that effective improvement of image quality can be expected with interpolation. Thus, image quality and the ability to depict images can be improved while maintaining the present acquisition time and image quality. In addition, this can be achieved more effectively than at present even if the acquisition time is reduced.

A simple non-invasive I-123-IMP autoradiography method developed by modifying the simple non-invasive I-123-IMP microsphere method

Objective(s): We developed a simple non-invasive I-123-N-isopropyl-p-iodoamphetamine (123I-IMP) quantification method by analyzing chest RI-angiography and single photon emission computed tomography (SPECT) images based on the microsphere model (SIMS method). Theoretically, the SIMS method could be changed to the simple non-invasive ARG (SIARG) method by modifying the integrated washout ratio (WR) to one-point WR. If the regional cerebral blood flow (rCBF) values derived from the SIARG and ARG methods correlate well, the facilities employing the ARG method can easily switch to the SIARG method. The purpose of this study was to develop the SIARG method by modifying the SIMS method, and to confirm the feasibility of this method. Methods: The correlation between the input counts of the SIARG method and the blood counts was determined by linear regression analysis. The rCBF values determined by the SIARG method were compared with the values obtained with the ARG and SIMS methods. Results: There was a good linear correlation between the SIARG counts and the arterial blood counts obtained by the ARG method (r=0.85, P<0.001, n=29). The rCBF values obtained by the ARG and SIARG methods (n=29, 696 ROIs) correlated well (y=1.01x – 3.6, r=0.85, P<0.001). Similarly, the rCBF values obtained by the SIARG and SIMS methods (n=29, 696 ROIs) correlated well (y=0.98x – 15.2, r=0.90, P<0.001). rCBF values obtained by the SIARG method were almost the same as the values obtained by the ARG method, and values of the SIMS method were 15 ml/100g/min higher that of those obtained by the SIARG method. Conclusion: The rCBF values obtained by the ARG, SIARG, and SIMS methods correlated very well. Therefore, the SIARG method is potentially useful for examinations in routine clinical practice.

Development of an 123I-metaiodobenzylguanidine Myocardial Three-Dimensional Quantification Method for the Diagnosis of Lewy Body Disease

Objective(s): We recently developed a new uptake index method for 123I-metaiodobenzylguanidine (123I-MIBG) heart uptake measurements by using planar images (radioisotope angiography and planar image) for the diagnosis of Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). However, the diagnostic accuracy of the uptake index was approximately equal to that of the heart-to-mediastinum ratio (H/M) for the discrimination of the LBD and non-LBD patients. A simple and pain-free uptake index method using 123I-MIBG SPECT images by modifying the uptake index method may show better diagnostic accuracy than the planar uptake index method. We hypothesized that the development of a new uptake index method for the determination of 123I-MIBG using single-photon emission computed tomography (SPECT) imaging would provide a reliable and reproducible diagnostic tool for clinical application. Regarding this, the purpose of this study was to develop a new uptake index method with a simple protocol to determine 123I-MIBG uptake on SPECT. Methods: The 123I-MIBG input function was determined from the input counts of the pulmonary artery, assessed by analyzing the pulmonary artery time-activity curves. The 123I-MIBG output function was obtained from 123I-MIBG SPECT counts on the polar map. The uptake index was calculated through dividing the output function by the input function (SPECT uptake method). For the purpose of the study, 77 patients underwent 123I-MIBG SPECT, with an average of 31.5 min after clinical assessment and injection of the tracer. The H/M values, as well as planar and SPECT uptake indices were calculated, and then correlated with clinical features. Results: According to the results, values obtained for LBD were significantly lower than those for non-LBD in all analyses (P<0.01). The overlap of the H/M values between the LBD and non-LBD cases ranged from 2.06 to 2.50. Furthermore, the overlap in uptake index values between LBD and non-LBD cases in planar image analysis was 1.05-1.29. The SPECT uptake index method showed the least overlap of 1.23-1.25, with the highest value for LBD patients clearly distinguished from the lowest value for the non-LBD patients. Conclusion: The new 123I-MIBG SPECT quantification method, developed by the input counts of the pulmonary artery, clearly distinguished LBD from non-LBD. Therefore, this method may be appropriate for routine clinical study.

Uptake index of 123I-metaiodobenzylguanidine myocardial scintigraphy for diagnosing Lewy body disease

Objective(s): Iodine-123 metaiodobenzylguanidine (123I-MIBG) myocardial scintigraphy has been used to evaluate cardiac sympathetic denervation in Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). The heart-to-mediastinum ratio (H/M) in PD and DLB is significantly lower than that in Parkinson’s plus syndromes and Alzheimer’s disease. Although this ratio is useful for distinguishing LBD from non-LBD, it fluctuates depending on the system performance of the gamma cameras. Therefore, a new, simple quantification method using 123I-MIBG uptake analysis is required for clinical study. The purpose of this study was to develop a new uptake index with a simple protocol to determine 123I-MIBG uptake on planar images. Methods: The 123I-MIBG input function was obtained from the input counts of the pulmonary artery (PA), which were assessed by analyzing the PA time-activity curves. The heart region of interest used for determining the H/M was used for calculating the uptake index, which was obtained by dividing the heart count by the input count. Results: Forty-eight patients underwent 123I-MIBG chest angiography and planar imaging, after clinical feature assessment and tracer injection. The H/M and 123I-MIBG uptake index were calculated and correlated with clinical features. Values for LBD were significantly lower than those for non-LBD in all analyses (P<0.001). The overlapping ranges between non-LBD and LBD were 2.15 to 2.49 in the H/M method, and 1.04 to 1.22% in the uptake index method. The diagnostic accuracy of the uptake index (area under the curve (AUC), 0.98; sensitivity, 96%; specificity, 91%; positive predictive value (PPV), 90%; negative predictive value (NPV), 93%; and accuracy, 92%) was approximately equal to that of the H/M (AUC, 0.95; sensitivity, 93%; specificity, 91%; PPV, 90%; NPV, 93%; and accuracy, 92%) for discriminating patients with LBD and non-LBD. Conclusion: A simple uptake index method was developed using 123I-MIBG planar imaging and the input counts determined by analyzing chest radioisotope angiography images of the PA. The diagnostic accuracy of the uptake index was approximately equal to that of the H/M for discriminating patients with LBD and non-LBD.

Fully automatic input function determination program for simple noninvasive 123I-IMP microsphere cerebral blood flow quantification method

We recently developed a simple noninvasive (123)I-IMP microsphere (SIMS) method using chest dynamic planar images and brain single photon emission computed tomography. The SIMS method is an automatic analysis method, except for the process of setting the region of interest (ROI) of the input function. If a fully automatic ROI setting algorithm can be developed to determine the input function for the SIMS method, repeatability and reproducibility of the analysis of regional cerebral blood flow (rCBF) of the SIMS method can be guaranteed. The purpose of this study is to develop a fully automatic input function determination program for the SIMS method and to confirm the clinical usefulness of this program. The automatic input function determination program consists of two ROI setting programs for the PA and lung regions, and it is developed using the image phase analysis of a chest RI angiogram. To confirm the clinical usefulness of this program, the rCBF in 34 patients measured using the automatic method were compared with the values obtained through the manual setting method. Input functions by the automatic and manual methods were approximately equal. A good correlation was observed between the rCBF values obtained by the automatic method and those obtained by the manual setting method (r=0.96, p<0.01). Further, the total time taken for the automatic SIMS analysis is 1-2min as compared to 20-30min for the current analysis, and therefore, this technique contributes to the improvement of the throughput of nuclear medical examinations.

Evaluation of Entropy-based Image Co-registration Techniques for Brain Perfusion SPECT

We examined image co-registration techniques based on mutual information (MI) and normalized mutual information (NMI) to registrate two SPECT images with localized differences in brain activity. Simulations were performed by 100 trials with the random initial mismatch of ±20° and ±45 mm for a normal perfusion model (NRM) and a pathological perfusion model with a hemisphere defect (HSD) . In the HSD, activity in the defect region was reduced to be 75% (HSD75%), 50% (HSD50%), and 25% (HSD25%) of normal value. In the MI-based registration for the NRM and NRM dataset, no biases were observed (≤-0.06°, ≤0.06 mm) and the SDs were very small (≤0.07°, ≤0.04 mm) . In the registration for the NRM and HSD dataset, the biases were slightly larger (≤-0.18°, ≤0.34 mm for HSD75%, ≤-0.23°, ≤=0.45 mm for HSD50%, ≤-0.23°, ≤0.18 mm for HSD25%) in comparison with the results of registration for the NRM and NRM dataset. The accuracy of the NMI was almost identical to that of the MI. The entropy-based registration techniques are relatively unaffected by localized differences in brain activity.

Current abstracts of the articles published in The Japanese Journal of Nuclear Medicine

Sympathetic nerve system is activated as a compensatory mechanism in heart failure. However, excessive activation of sympathetic nerve system deteriorates disease state. Sympathetic nerve system can be suppressed with N-type Ca 2+ channel blocker. An antihypertensive drug, cilnidipine, is a dual L/N-type Ca 2+ channel blocker. We studies usefulness of cilnidipine in treating with chronic heart failure with 123I-MIBG myocardial scintigraphy. We enrolled 24 patients with stable chronic heart failure. Twelve patients were treated with ACE-inhibitors, diuretics and cardiotonics (control group), and the other 12 patients were treated with ACE-inhibitors, diuretics, cardiotonics and cilnidipine (cilnidipine group). We examined blood pressure, heart rate, norepinephrine level, brain natriuretic peptide (BNP) level, cardiothoracic ratio on chest X-ray, ejection fraction of left ventricle on two-dimensional echocardiography, count rate of heart to mediastinum (H/M) and washout rate (WOR) on 123I-MIBG myocardial scintigraphy before and six months after medication. Symptom was improved in 8 patients in the control group and 10 patients in the cilnidipine group after medication. And another parameters were also improved in the both groups after medication. However the degree of change in blood pressure (mmHg) was 21.2 _+ 8.0 in the cilnidipine group and 10.8 _+ 9.1 in the control group, that in heart rate (/min) was 24.1 +_ 6.8 and 16.2 _ 11.0, that in BNP level (pg/m/) was 65.2 _ 12.0 and 42.8 _ 11.1, that in H/M was 0.30 _ 0.08 and 0.19 _+ 0.09, that in WOR was 19.4 _ 5.6 and 12.2 _ 7.0, respectively. And the degree of these changes were larger in the cilnidipine group (p < 0.05). These findings suggested that cilnidipine, a dual L/N-type Ca 2+ channel blocker, might be useful in treating with chronic heart failure.