Scatter correction in planar imaging and SPECT by constrained factor analysis of dynamic structures (FADS).

The removal of Compton scattered photons included within the pulse height window is recognized as one of the most difficult noise problems in the restoration of nuclear medicine images. A new approach to Compton scatter correction based on factor analysis of dynamic structures (FADS) is presented in this study. The method requires all of the energy information. Acquisition of data can be performed either by list-mode or frame-mode. While the former presents some theoretical advantages, the latter is actually used in this work. Two factors are extracted by FADS, unfortunately no pure photopeak factor can be found by the algorithm. These rough factors lead to incorrect factor images. The innovation reported here is the use of a constrained photopeak factor. This novel algorithm is evaluated both on planar imaging and SPECT data using Monte Carlo simulations and real phantoms. A comparison with the modified method of Jaszczak is also presented. Different parameters are significantly improved with our recombination method in SPECT studies, particularly after attenuation compensation by the iterative method of Chang. Compared with the subtraction method the contrast is increased by 1.5 for planar Monte Carlo simulations and the scatter fraction is reduced four times with our recombination method.

Introducing simultaneous spatial resolution and attenuation correction after scatter removal in SPECT imaging.

A new approach to simultaneous spatial resolution and attenuation correction in SPECT imaging is presented. Before these corrections, scatter is removed on the projections. This removal is performed by spectral constrained factor analysis. The innovation reported here is the use of the different impulse responses of the system, according to the source-detector distance, and their integration in a generalized version of the Chang attenuation correction method. This novel algorithm is evaluated on computed and physical phantoms. In the computer-simulated phantom, the count rates after full-processing are very close to the initial values. In the physical phantom, the contrast is increased by 1.8 after full processing. The activity profiles drawn both on raw projections and reconstructed slices demonstrate the effectiveness of the algorithm for the restoration of spatial resolution. Furthermore, the method improves the quality of the images greatly. A clinical study is also presented. When the whole procedure is applied, the resulting slice matches the corresponding computed tomographic scan very well, which is not the case with the usual back-projected images. The process is fully automatic and the computing time performance allows its daily use for single photon emission tomographic examinations.

[Course of ejection fraction, regurgitation fraction and ventricular volumes during exertion in chronic aortic insufficiency. Study using technetium 99m gamma-cineangiography]. / Evolution au cours de l'effort de la fraction d'éjection, de la fraction de régurgitation et des volumes ventriculaires dans l'insuffisance aortique chronique. Etude par gamma-ciné-angiographie au technetium 99 m.

Previous studies have shown that variations of the ejection fraction (EF) during exercise were representative of the contractile state of the left ventricle: an increased EF on effort is considered to be physiological, whilst a decrease would indicate latent LV dysfunction unmasked during exercise. This hypothesis was tested by performing Technetium 99 gamma cineangiography at equilibrium under basal conditions and at maximal effort in 8 healthy subjects and 44 patients with pure, severe aortic regurgitation to measure the ejection and regurgitant fractions and the variations in end systolic and end diastolic LV volume. In the control group the EF increased and end systolic volume decreased significantly on effort whilst the regurgitant fraction and end diastolic volume were unchanged. In the 44 patients with aortic regurgitation no significant variations in EF, end systolic and end diastolic volumes were observed because the individual values were very dispersed. Variations of the EF and end systolic volume were inversely correlated. The regurgitant fraction decreased significantly on effort. Based on the variations of the EF and end systolic volume three different types of response to effort could be identified: in 7 patients, the EF increased on effort and end systolic volume decreased without any significant variation in the end diastolic volume, as in the group of normal control subjects; in 22 patients, a reduction in EF was observed on effort, associated with an increased end systolic volume. These changes indicated latent IV dysfunction inapparent at rest and unmasked by exercise; in a third group of 15 patients, the EF decreased on effort despite a physiological decrease in end systolic volume due to a greater decrease in end diastolic volume.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anomalies in left ventricular systolic function disclosed by exercise testing in chronic aortic insufficiency. Study by cavitary scintigraphy]. / Les anomalies de fonction systolique ventriculaire gauche dévoilées par l'effort dans l'insuffisance aortique chronique. Etude par scintigraphie cavitaire.

Fifty-two patients with a symptomatic chronic aortic insufficiency underwent radionuclide angiography. The following parameters were measured at rest and at peak exercise: ejection fraction, regurgitant fraction, ventricular volumes, stroke volume, cardiac output and an index of systemic arterial resistance. The ventricular dimensions, the thickness of the septal and posterior walls, left ventricular myocardial mass and endsystolic stress were determined by 2D echocardiography. The patients were divided into 3 groups based on left ventricular changes on exercise: the first group (18 patients) had physiological left ventricular adaptation to exercise (increased ejection fraction, reduced endsystolic volume); a second group of 18 patients had moderate left ventricular dysfunction (absence of increase in ejection fraction and a reduction of less than 20% of endsystolic volume with respect to basal values); a third group of 17 patients had what was considered to be severe left ventricular dysfunction (decreased ejection fraction of over 5% and increased endsystolic volume of over 20% with respect to basal values). There was no significant difference between the three groups with respect to basal values of ejection fraction, ventricular volumes and systemic arterial resistance. On exercise, the heart rate, blood pressure and systemic arterial resistances varied in a comparable manner in each of the three groups. The left ventricular dimensions and myocardial mass were identical in the three groups. Only left ventricular endsystolic strain tended to be higher in the third group of patients compared with the other two, but the difference was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

[Method of isotopic determination of aortic valve regurgitation]. / Méthode de détermination isotopique des régurgitations valvulaires aortiques.

The index of valvular regurgitation was measured by two techniques after technetium 99 m gamma-cineangiography: the classical technique of comparing left and right ventricular stroke volumes, and the same technique after subtracting the radioactivity arising from the right atrium from the zone of right atrioventricular superposition. The index of valvular regurgitation was calculated in 41 patients with chronic coronary artery disease without valvular regurgitation and also undergoing coronary angiography with 30 degrees right anterior oblique ventriculography, in 8 healthy volunteer subjects, at rest and on exercise; and in 15 patients with chronic aortic regurgitation also undergoing cardiac catheterization and 30 degrees right anterior oblique left ventriculography and aortography. The regurgitant index by the classical technique was 1,25 +/- 0,18; when the index was calculated again after subtracting right atrial radioactivity, a value of 1,05 +/- 0,12 (p less than 0,01) was obtained. The regurgitant index is not affected by left ventricular contractility or by the degree of left ventricular dilatation. On the other hand, this index is affected by the degree of right ventricular dilatation. The valvular regurgitant index did not vary significantly on exercise (1,01 +/- 0,11 to 1,17 +/- 0,16 NS). The isotopic regurgitant fraction deduced from the valvular regurgitant index correlated well with the angiographic regurgitant fraction (R = 0,74; p less than 0,001). The index of valvular regurgitation gives an exact, reliable and reproducible quantification of left sided regurgitant lesions. It is only valid when there is no intracardiac shunt or regurgitant right heart lesion.

[Simultaneous study of the placental, myometrial and cervical circulations (indium 113 and anemometric thermometry). 2. Effect of xanthinol nicotinate]. / Etude simultanée des circulations placentaire, myométriale et cervicale (indium 113 et thermométrie anémométrique). 2. Effet du nicotinate de xantinol

The authors have studied the action of nicotinate of xantinol on the placental, myometrial and cervical circulations using an isotope technique (Indium 113) and anemometric thermometry. They show that this product in every case increases the flow through the cervix and has little action on the flow through the placenta, except that in rare cases it lessens it. The action on the myometrial circulation varies from woman to woman. There is a significant negative statistical correlation between variation in the circulation through the cervix and the placenta.

[Scintigraphic analysis, with the help of functional images]. / Analyse des données scintigraphiques à l'aide d'images fonctionnelles.

Functional images are a new technique for analysis and visualization biological values. Each point of the organ is substitute by a functional value, representative of local uptake. This type of processing is interesting as the dynamic information gained is stored in a concentrated form, which can be easily reproduced and filed.

A fully automated contour detection algorithm the preliminary step for scatter and attenuation compensation in SPECT.

Contour detection is an important step in information extraction from nuclear medicine images. In order to perform accurate quantitative studies in single photon emission computed tomography (SPECT) a new procedure is described which can rapidly derive the best fit contour of an attenuated medium. Some authors evaluate the influence of the detected contour on the reconstructed images with various attenuation correction techniques. Most of the methods are strongly affected by inaccurately detected contours. This approach uses the Compton window to redetermine the convex contour: it seems to be simpler and more practical in clinical SPECT studies. The main advantages of this procedure are the high speed of computation, the accuracy of the contour found and the programme's automation. Results obtained using computer simulated and real phantoms or clinical studies demonstrate the reliability of the present algorithm.

Improvement of quantification in SPECT studies by scatter and attenuation compensation.

The filtered backprojection images obtained from classical SPECT studies are not adequate for evaluation of volumes or parameters of clinical interest. Noise, scattering, boundary accuracy and attenuation are the main problems of SPECT quantification. It is the aim of the following study to overcome these difficulties. The first step of all correction algorithm is the contour detection of the attenuation medium. A new procedure, previously described by the authors, accurately and automatically found the boundaries of the surrounding body. The Compton scattering elimination is carried out by a modified version of Jaszczak's method. This alteration is essential to implement the iterative attenuation correction algorithm derived from Chang's method. Results obtained using computer simulation and real phantoms or clinical studies demonstrate the high improvement of contrast and count levels in the corrected slices. The process is fully automatic and the efficiency of the procedures allow fast processing of the daily SPECT examination.

Morphological study of the liver using local rate of uptake analysis.

Four types of liver functional images were obtained by calculating for each point on an image matrix the local uptake rate, the local uptake transit time, the point's own maximum and the time necessary to attain the maximum. The study was based on 52 cases: 21 controls and 31 cases of hepatic disease. The controls showed a homogeneous spread of colloidal substance on the images of local uptake rate and local transit time, despite variations in liver tissue thickness. In the cases of parenchymal lesions revealed by deficient uptake on standard images, local variations of uptake rate were almost always shown even in instances where the standard images showed minimal variation. This technique therefore would seem to bring additional diagnostic assistance by permitting a better appreciation of liver morphology and function and the processing time required (approx. 1.5 min.) does not necessitate an increase in overall examination time.

Diagnosis of splenosis: the advantages of splenic scintiscanning with Tc 99m heat-damaged red blood cells.

We present one case of peritoneal splenosis, which was not confirmed by the splenic scintiscan with 99mTc-sulphur colloid, but whose diagnosis, carried out during a second scintiscan with 99mTc-heat-damaged RBC, was confirmed by laparotomy and histology. This case confirms that, for the diagnosis of splenosis, heat-damaged RBC scintigraphy must be used rather than either sulphur colloid scintigraphy or computed-tomography.

[Study of skin microcirculation by epicutaneous diffusion of 133 xenon]. / Etude de la microcirculation cutanée par diffusion épicutanée de xénon 133.

The diffusion of radioactive inert gas xenon 133 through the epidermis in man was studied by compartimental model with a constant speed injection. From this we deduce the cutaneous and subcutaneous flow.

[Comparison of 2 methods of determining the kinetics of a bicompartmental system. Application to the measurement of cutaneous blood flow]. / Comparaison de deux méthodes de détermination de la cinétique d'un système bicompartimental. Application à la mesure des débits sanguins cutanés.

Peeling method and a non linear regressions method (Newton's method) have been tested on experimental and simulated data. Newton's method is the most accurate and precise when running on simulated data. Experimental curves artefacts make Newton's algorithm automatically running less efficient than classical peeling algorithm working in interactive mode.

Scintigraphic image contrast-enhancement techniques: global and local area histogram equalization.

This article develops two contrast-modification techniques for the display of scintigraphic images. Based on histogram-modification techniques, histogram equalization, where each level of gray is used to the same extent, gives maximum entropy. The first technique uses the application of histogram equalization in the whole image. To eliminate contrast attenuation small but important portion of the gray scale histogram, local area histogram equalization has been applied to images with differences in intensity. Both techniques were tested using a phantom with known characteristics. The global equalization technique is more suitable to bone scintigraphies, and some well-chosen boundaries improved the difference between two comparable areas. For liver scintigraphies, where intensity is quite equal in every pixel, a local area equalization was chosen that allowed detection of heterogeneous structures. The images resulting from histogram-equalization techniques improve the readability of data, but are often far from usual images and necessitate an apprenticeship for the physician.

Intraoperative radioactive localization of osteoid osteomas: four case reports.

We have excised four osteoid osteomas in four children, aided by intraoperative radioactive localization. Here we report these cases and describe the equipment used. Exact detection and elective excision are the two advantages of this technique.

Factors influencing the variations of ejection fraction during exercise in chronic aortic regurgitation.

The influence of left ventricular volume variations and regurgitant fraction variations upon left ventricular ejection fraction during exercise was examined using equilibrium radionuclide angiography in patients suffering from aortic regurgitation. Ejection fraction (EF), regurgitant fraction (RF), end diastolic volume (EDV) and end systolic volume (ESV) variations from rest to peak exercise were determined in 44 patients suffering from chronic aortic regurgitation (AR) and in 8 healthy volunteers (C). In C, EF increased (+0.10 +/- 0.03, P less than 0.01) and ESV decreased significantly (-23% +/- 12%, P less than 0.01), RF and EDV did not vary significantly. In AR patients, EF, EDV and ESV did not vary significantly because of important scattering of individual values. Changes in EF and ESV were inversely correlated (r = -0.79, P less than 0.01) and RF decreased significantly (-0.12 +/- 0.10, P less than 0.01). Volumes and EF changes during exercise occurred in three different ways. In a 1st subgroup of 7 patients, EF increased (+0.09 +/- 0.03, P less than 0.05) in conjunction with a reduction of ESV (-24% +/- 12%, P less than 0.05) without a significant change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04 +/- 0.07, P less than 0.01) in association with an increase in ESV (+17% +/- 16%, P less than 0.01) and no change in EDV. In a 2nd group of 22 patients, EF decreased (-0.04 +/- 0.07, P less than 0.01) in association with an increase in ESV (+17% +/- 16%, P less than 0.01) and no change in EDV. In a 3rd subgroup of 15 patients, EF decreased (-0.02 +/- 0.06, P less than 0.01) despite a reduction in ESV (-7% +/- 6%, P less than 0.01) because of a dramatic EDV decrease (-10% +/- 6%, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between vertical parallel hole collimator and 30 degrees rotating slant hole collimator for assessing global and regional left ventricular function by radionuclide angiography.

Left ventricular ejection fraction (LVEF) and regional wall motion abnormalities were determined in 40 patients (30 with coronary artery disease and 10 with valvular heart disease) using equilibrium radionuclide angiography. Scintigraphic acquisitions were collected in random order with 2 different collimators as follows: in anterior face (AF), left anterior oblique (25 degrees-45 degrees LAO) and 70 degrees LAO, with a vertical parallel hole collimator (VTC), and in 25 degrees-45 degrees LAO and 65 degrees-80 degrees LAO with a 30 degrees rotating slant hole collimator (RSHC), with the slant of the collimator directed towards the cardiac apex in both projections. Results were compared to contrast ventriculography (CV) performed in the 30 degrees right anterior view (3 segments: anterior, apical, inferior) and in a 60 degrees left anterior oblique view (3 segments: septal, apical and lateral). Radionuclide LVEF in both series was closely correlated with contrast ventriculographic LVEF (r = 0.89, VTC vs CV and r = 0.87, RSHC vs CV, respectively). Regional wall motion analysis was only performed among the 30 patients suffering from coronary heart disease. Eight contrast angiographic studies were normal and 22 abnormal. Global sensitivity and specificity were 100% and 63% with the VTC (3 false positives) and 91% and 87% with the 30 degrees RSHC (2 false negatives and 1 false positive, P = ns). Agreement for the localisation of the regional wall motion abnormalities between CV and radionuclide angiography was 70.6% with the VTC and 71.2% with the RSHC (P = ns).(ABSTRACT TRUNCATED AT 250 WORDS)