On the dark rim artifact in dynamic contrast-enhanced MRI myocardial perfusion studies.

A dark band or rim along parts of the subendocardial border of the left ventricle (LV) and the myocardium has been noticed in some dynamic contrast-enhanced MR perfusion studies. The artifact is thought to be due to susceptibility effects from the gadolinium bolus, motion, or resolution, or a combination of these. Here motionless ex vivo hearts in which the cavity was filled with gadolinium are used to show that dark rim artifacts can be consistent with resolution effects alone.

Comparison of temporal filtering methods for dynamic contrast MRI myocardial perfusion studies.

Dynamic contrast myocardial perfusion studies may benefit from methods that speed up the acquisition. Unaliasing by Fourier encoding the overlaps using the temporal dimension (UNFOLD), and a similar linear interpolation method have been shown to be effective at reducing the number of phase encodes needed for cardiac wall motion studies by using interleaved sampling and temporal filtering. Here such methods are evaluated in cardiac dynamic contrast studies, with particular regard to the effects of the choice of filter and the interframe motion. Four different filters were evaluated using a motion-free canine study. Full k-space was acquired and then downsampled to allow for a measure of truth. The different filters gave nearly equivalent images and quantitative flow estimates compared to full k-space. The effect of respiratory motion on these schemes was graphically depicted, and the performance of the four temporal filters was evaluated in seven human subjects with respiratory motion present. The four filters provided images of similar quality. However, none of the filters were effective at eliminating motion artifacts. Motion registration methods or motion-free acquisitions may be necessary to make these reduced FOV approaches clinically useful.

Reconstruction of dynamic renal tomographic data acquired by slow rotation.

UNLABELLED: Nuclear medicine renal studies can be performed using slow-rotation SPECT, but reconstruction of such data is largely underdetermined. METHODS: A new method of reconstruction of data acquired using slow camera rotations was developed. In this method we used a factor model of the data in which the factors and factor coefficients were determined by modeling their relationship directly with the projection measurements. This was done by solving a least-squares problem that fits the projections of factors and factor coefficients to the projection data with nonnegativity constraints imposed on the solution. The method was tested on computer simulations and applied to experimental renal (99m)Tc-mercaptoacetyltriglycine canine and patient studies. RESULTS: Computer simulations showed that the extracted time-activity curves of kidneys agreed well with the simulated curves for data with noise levels similar to those in the experimental studies. In the canine study, the method showed that >2 factors were necessary to adequately reproduce the kinetics of the kidney. In the patient study, the method was able to extract separate factors that correspond to the kidney cortex and the kidney pelvis. CONCLUSION: The computer simulation, the canine study, and the patient study all show that reconstructions of the data obtained with 1 detector displayed artifacts, whereas reconstructions of the data obtained with 2 and 3 detectors were free of artifacts. Computer simulations showed that the method gives accurate results that allow quantitation.

Feasibility of dual-isotope coincidence/single-photon imaging of the myocardium.

UNLABELLED: Hybrid PET scanners offer the possibility of obtaining myocardial viability information from coincidence imaging of the positron emitter (18)F-FDG and perfusion measurements from a single-photon tracer-potentially simultaneously. This new approach is less costly and more readily available than dedicated PET and offers potential for improved FDG resolution and sensitivity compared with SPECT with 511-keV collimators. Simultaneous imaging of the coincidence and single-photon events offers the further advantages of automatic image registration and reduced imaging time. However, the feasibility of simultaneous coincidence/single-photon imaging or even immediately sequential imaging is unknown. In this study, the potential of using standard low-energy high-resolution (LEHR) collimators with hybrid PET to obtain coincidence and SPECT data was assessed. METHODS: Phantom and human studies were performed to investigate the effect of LEHR collimators on FDG coincidence imaging with a hybrid PET system, the effect of the presence of (99m)Tc during FDG coincidence imaging with LEHR collimators, and the effect of the presence of FDG during (99m)Tc SPECT imaging. RESULTS: FDG images were somewhat degraded (a measure of myocardial nonuniformity increased 10%) with LEHR collimators. With 148 MBq (4 mCi) (99m)Tc present during FDG imaging of a phantom, image quality was maintained and the number of detected coincidences changed by <5%. With (99m)Tc/(18)F whole-body ratios of 7:1, crosstalk from (18)F photons accounted for the majority of counts in the (99m)Tc SPECT images and resulted in severe artifacts. The artifacts were decreased with a simple crosstalk correction scheme but remained problematic. CONCLUSION: (99m)Tc/(18)F ratios of at least 9:1 and state-of-the-art reconstruction and crosstalk correction are likely to be required to perform immediately sequential coincidence/single-photon imaging of the myocardium with clinically useful results. Additional challenges remain before simultaneous imaging of coincidence events and single photons can be realized in practice.

Compartmental modeling of technetium-99m-labeled teboroxime with dynamic single-photon emission computed tomography: comparison with static thallium-201 in a canine model.

UNLABELLED: Di Bella EVR, Ross SG, Kadrmas DJ, et al. Compartmental modeling of technetium-99m-labeled teboroxime with dynamic single-photon emission computed tomography: Comparison with static thallium-201 in a canine model. Invest Radiol 2001;36:178-185. RATIONALE AND OBJECTIVES: A compartmental modeling approach to deriving kinetic parameters from a time series of single-photon emission computed tomography (SPECT) images of technetium-99m-labeled (99mTc-) teboroxime may have value for semiquantitative assessment of myocardial perfusion. This study investigated the value of the kinetic parameters derived from a two-compartment model of 99mTc-teboroxime for measuring myocardial perfusion and compared it with static thallium-201 (201Tl) uptake and microsphere-measured blood flow in dogs. METHODS: Experiments were successfully conducted in 9 of 11 open-chest dogs. During adenosine stress, a single complete set of projections of 201Tl uptake was acquired. 99mTc-teboroxime was then injected during adenosine stress, and a complete set of projections was acquired every 5.7 seconds for 17 minutes. Resting studies were performed on 4 of the animals. All of the projection sets were reconstructed with an iterative algorithm and incorporated corrections for attenuation and the geometric response of the collimators. Regional kinetic parameters (washin and washout) were determined semiautomatically from the time series of reconstructed 99mTc-teboroxime images and registered with microsphere data. Regional washin estimates were compared with 201Tl intensities and myocardial blood flows determined from microspheres. RESULTS: Optimally scaled 99mTc-teboroxime washin parameters and 201Tl uptakes were correlated with microsphere-determined blood flows (r = 0.91, y = 0. 99x + 0.01, and r = 0.92, y = 0.88x + 0.28, respectively). In six of the studies, the left anterior descending coronary artery was occluded, and stress occluded-to-normal (O/N) ratios were calculated. The O/N ratios were 0.32 +/- 0.17 as determined from microspheres injected with 201Tl and 0.38 +/- 0.29 from microspheres injected with 99mTc-teboroxime (P = NS). The O/N ratios were 0.48 +/- 0.16 for static 201Tl uptake and 0.27 +/- 0.21 for 99mTc-teboroxime washin (P < 0.05). CONCLUSIONS: Both 201Tl uptake and 99mTc-teboroxime kinetic parameters were well correlated with flow. The 99mTc-teboroxime washin parameters offer semiquantitative flow values and provide greater defect contrast than can be obtained with 201Tl uptake values.

Factor analysis with a priori knowledge--application in dynamic cardiac SPECT.

Two factor analysis of dynamic structures (FADS) methods for the extraction of time-activity curves (TACs) from cardiac dynamic SPECT data sequences were investigated. One method was based on a least squares (LS) approach which was subject to positivity constraints. The other method was the well known apex-seeking (AS) method. A post-processing step utilizing a priori information was employed to correct for the non-uniqueness of the FADS solution. These methods were used to extract 99mTc-teboroxime TACs from computer simulations and from experimental canine and patient studies. In computer simulations, the LS and AS methods, which are completely different algorithms, yielded very similar and accurate results after application of the correction for non-uniqueness. FADS-obtained blood curves correlated well with curves derived from region of interest (ROI) measurements in the experimental studies. The results indicate that the factor analysis techniques can be used for semi-automatic estimation of activity curves derived from cardiac dynamic SPECT images, and that they can be used for separation of physiologically different regions in dynamic cardiac SPECT studies.

Static Versus Dynamic Teboroxime Myocardial Perfusion SPECT in Canines.

Tc-99m-teboroxime is a perfusion tracer with high myocardial extraction, fast washin and washout kinetics, and excellent imaging properties. The fast kinetics pose some problems for static imaging, but they also allow for back-to-back stress / rest studies to be performed very quickly. Furthermore, such fast kinetics are ideally suited for dynamic imaging. We have compared static versus dynamic myocardial perfusion SPECT with teboroxime in canines using microsphere-derived flow values as the gold standard. Dynamic data were successfully acquired at rest and under adenosine stress in seven dogs using a fast serial scanning protocol. The data were analyzed in two ways: summing timeframes to create a single, static dataset with consistent projections; and 4D reconstruction and kinetic parameter estimation for a two compartment model. In both cases imaging data (voxel intensity or washin rate parameter) were correlated with flow values measured by microspheres. The static summing procedure that produced the best correlation with flow consisted of summing the projection data acquired from 60 to 180 seconds post-injection. The washin rate parameter was found to provide better correlation with flow than static image intensity in six of seven animals. When the data were pooled over all studies, washin provided significantly better correlation with flow than static imaging (p<0.01). We conclude that dynamic imaging of teboroxime with compartmental modeling provides a better measure of flow than can be obtained from static imaging techniques.

SPECT Imaging of Teboroxime during Myocardial Blood Flow Changes.

Kinetic parameters and static images from dynamic SPECT imaging of (99m)Tc-teboroxime have been shown to reflect blood flow in dogs and in humans at rest and during adenosine stress. When compartment modeling is used, steady-state physiological conditions are assumed. With standard adenosine stress protocols, imaging of teboroxime would likely involve significant changes in flow, even if performed only for five minutes. These flow changes may significantly bias the kinetic parameter estimates. On the other hand, when static imaging is performed, large flow changes during acquisition may improve contrast between normal and occluded regions. Computer simulations were performed to determine the effect of changing flows on kinetic parameter estimation and on static (average tissue uptake) images. Two canine studies were also performed in which adenosine was given with a standard protocol, and then imaging was repeated with adenosine infusion held constant. The simulations predicted biases on the order of 7% for kinetic washin parameter estimation and 18% for the washout parameter. Contrast for static studies was found to depend critically on the time-activity behavior of the distribution as well as on the stress protocol. The differences in washin contrast from the standard and continous adenosine dog studies was slightly larger than predicted from the simulations. Optimal imaging of teboroxime with adenosine using compartment modeling will require non-standard adenosine stress protocols, although sub-optimal imaging may still be useful clinically.

Blind estimation of compartmental model parameters.

Computation of physiologically relevant kinetic parameters from dynamic PET or SPECT imaging requires knowledge of the blood input function. This work is concerned with developing methods to accurately estimate these kinetic parameters blindly; that is, without use of a directly measured blood input function. Instead, only measurements of the output functions--the tissue time-activity curves--are used. The blind estimation method employed here minimizes a set of cross-relation equations, from which the blood term has been factored out, to determine compartmental model parameters. The method was tested with simulated data appropriate for dynamic SPECT cardiac perfusion imaging with 99mTc-teboroxime and for dynamic PET cerebral blood flow imaging with 15O water. The simulations did not model the tomographic process. Noise levels typical of the respective modalities were employed. From three to eight different regions were simulated, each with different time-activity curves. The time-activity curve (24 or 70 time points) for each region was simulated with a compartment model. The simulation used a biexponential blood input function and washin rates between 0.2 and 1.3 min(-1) and washout rates between 0.2 and 1.0 min(-1). The system of equations was solved numerically and included constraints to bound the range of possible solutions. From the cardiac simulations, washin was determined to within a scale factor of the true washin parameters with less than 6% bias and 12% variability. 99mTc-teboroxime washout results had less than 5% bias, but variability ranged from 14% to 43%. The cerebral blood flow washin parameters were determined with less than 5% bias and 4% variability. The washout parameters were determined with less than 4% bias, but had 15-30% variability. Since washin is often the parameter of most use in clinical studies, the blind estimation approach may eliminate the current necessity of measuring the input function when performing certain dynamic studies.

Iterative reconstruction of fluorine-18 SPECT using geometric point response correction.

UNLABELLED: This article demonstrates resolution recovery in 18F SPECT image reconstruction by using an iterative algorithm that corrects for the system geometric response. METHODS: Patient and phantom studies were performed using a Picker PRISM 3000 three-detector SPECT system (Picker International, Inc., Cleveland, OH) to image 18F with 511 keV collimators. A measured point response function of the imaging system was used in an iterative reconstruction algorithm in which the projector and backprojector modeled the system point response function by using an efficient layer-by-layer blurring technique. The blurring function was a five-element kernel in the shape of a cross. The iterative reconstruction algorithm was an ordered-subset maximum-likelihood expectation maximization algorithm. RESULTS: The iterative reconstruction algorithm with geometric response correction showed an improvement in resolution over the filtered backprojection reconstruction and the iterative reconstruction without correction. CONCLUSION: The proposed iterative reconstruction algorithm with geometric response correction is efficient and effective with significant resolution recovery.

Attenuation artifacts in SPECT: effect of wrap-around lung in 180 degrees cardiac studies.

UNLABELLED: We estimated that in 75%-90% of PET 82Rb patients the left lung appeared to wrap around the anterior aspect of the left ventricle. We used clinical PET 82Rb myocardial perfusion studies as the input to a SPECT computer simulation model to determine if patients with left lung wrap-around displayed consistent artifacts in reconstructed SPECT images. In particular, we sought an explanation for the hot lateral wall seen in SPECT images from normal female and male patients. METHODS: Attenuated SPECT 201Tl emission data were simulated from a mid-ventricular slice in 10 randomly selected clinical PET 82Rb studies with left lung wrap-around. In these same cases, the influence of left lung wrap-around was removed by assigning the left lung an attenuation coefficient which matched that of the heart. Five randomly selected clinical PET 82Rb studies without left lung wrap-around were also processed with our model. RESULTS: In all 10 cases with left lung wrap-around, reconstructed SPECT images showed the hot lateral wall artifact with a mean septal-to-lateral wall count ratio of 0.86. With left lung wrap-around removed in the same 10 patients, reconstructed images did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.07). The 5 cases without left lung wrap-around did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.04) and the ratios changed little with the filling of the left lung (mean septal-to-lateral wall count ratio = 1.05). CONCLUSION: Results of our PET-to-SPECT computer simulation model showed that the hot lateral wall artifact found in SPECT myocardial perfusion images was related to the orientation and positions of the left ventricle and the left lung.