[Three Dimensional Display in Nuclear Medicine].

Imaging techniques to obtain a tomographic image in nuclear medicine such as PET and SPECT are widely used. It is necessary to interpreting all of the tomographic images obtained in order to accurately evaluate the individual lesion, whereas three dimensional display is often useful in order to overview and evaluate the feature of the entire lesion or disease such as the position, size and abnormal pattern. In Japan, the use of three dimensional image analysis workstation with an application of the co-registration and image fusion between the functional images such as PET or SPECT and anatomical images such as CT or MRI has been generalized. In addition, multimodality imaging system such as a PET/CT and SPECT/CT has been widespread. Therefore, it is expected to improve the diagnostic accuracy using three dimensionally image fusion to functional images with poor anatomical information. In this commentary, as an example of a three dimensional display that are commonly used in nuclear medicine examination in Japan, brain regions, cardiac region and bone and tumor region will be introduced separately.

[Determination of the optimal ROI setting position of the input function for the 99mTc-ethyl cysteinate dimmer brain uptake ratio method].

Determination of the input function for the (99m)Tc-ethyl cysteinate dimmer brain uptake ratio ((99m)Tc-ECD BUR) method as a non-invasive quantitative measurement of cerebral blood flow measurement is of critical importance in order to improve the accuracy of this method. The input functions were experimentally obtained by setting the regions of interest (ROIs) in the ascending aorta, aortic arch, and descending aorta on the 49 chest RI-angio images. rCBFs by the BUR method with 3 input functions of the 6 cases were compared with those by the (123)I-iodoamphetamine (IMP) continuous arterial blood sampling method in order to determine the best location for the ROI of the input function. The input function of the ascending aorta was higher than those of the aortic arch and the descending aorta. The input functions of the aortic arch and the descending aorta decreased due to the origin of the three branches of the right brachiocephalic artery, left subclavian artery, and left common carotid artery. A good correlation was found in the regional cerebral blood flow (rCBF) values between the (123)I-IMP continuous arterial blood sampling method and the (99m)Tc-ECD BUR method with the input function of the ascending aorta. Therefore, the ascending aorta is the best location for the ROI of the input function for the (99m)Tc-ECD BUR method.

Multimodal image registration using IECC as the similarity measure.

PURPOSE: The registration of images from positron emission tomography (PET) to those from magnetic resonance imaging (MRI) using mutual information is usually effective, but fails occasionally because of small region of overlap, low-activity defects in the PET image, difference in spatial resolution, etc. In this article, the authors propose the pixel-based individual entropy correlation coefficient (IECC) as a new, more accurate and more robust registration criterion. METHODS: The authors compare it to the current criteria: Mutual information (MI), normalized mutual information (NMI), and the entropy correlation coefficient (ECC). The anatomical region to be registered was the head. A rigid-body registration was used; no deformation was employed. The authors established the effectiveness of IECC by both simulated data and clinical studies using brain fluorodeoxyglucose (FDG) PET and MRI. Both a normal-activity FDG model and a FDG model with a perfusion defect were used for the PET image. Reconstruction by both filtered backprojection and by ordered subset-expectation maximization was investigated. RESULTS: The mean errors and SDs of IECC were 1.17 +/- 0.85 mm for translation and 1.04 +/- 1.28 degrees for rotation in clinical PET. Those of MI, NMI, and ECC were 1.86 +/- 1.22, 1.86 +/- 0.96, and 1.68 +/- 4 1.05 mm for translations and 1.52 +/- 1.84 degrees, 1.74 +/- 1.68 degrees, and 1.70 +/- 1.90 degrees for rotations. The mean errors and SDs of IECC were 1.56 +/- 0.58 mm for translation and 1.46 +/- 1.66 degrees for rotation in clinical PET model with a 30% perfusion defect. Those of MI, NMI, and ECC were 2.81 +/- 1.41, 2.98 +/- 1.80, and 3.29 +/- 2.08 mm for translations and 3.34 +/- 3.800, 2.87 +/- 3.25 degrees, and 3.04 +/- 3.44 degrees for rotations. The mean errors and SDs of IECC were 1.79 +/- 1.04 mm for translation and 1.64 +/- 1.62 degrees for rotation in clinical PET model with a 50% perfusion defect. Those of MI, NMI, and ECC were 3.49 +/- 1.92, 3.57 +/- 2.22, and 3.49 +/- 1.89 mm for translations and 4.12 +/- 4.24 degrees, 3.62 +/- 4.87 degrees, and 3.44 +/- 3.80 degrees for rotations. The significant differences between IECC and each of the other three criteria were found for displacement misregistration in almost all parameters (p < 0.01). CONCLUSIONS: Accuracy of the IECC criterion was higher than that of the other criteria, usually in a statistically significant way.

[Development and assessment of an automatic quantitative cerebral vascular reserve estimation tool for use with triple-injection 99mTc-ECD SPECT].

In nuclear medicine, cerebral vascular reserve(CVR) is evaluated using technetium-99m ethyl cysteinate dimer [99mTc-ECD] and acetazolamide(ACZ). We developed a protocol involving the intravenous injection of 99mTc-ECD in three divided doses(TIE method), and have found that the cerebrovascular response to ACZ depended on time after ACZ administration. However, it was difficult to obtain high-precision quantitative SPECT images by the conventional method because of complicated image processing and image degradation accompanying image subtraction. We recently developed software known as the Automatic Quantitative CVR Estimation Tool(hereinafter referred to as Triple AQCEL), which, after the input of simple parameters, enables us to carry out automatic reconstruction of quantitative SPECT images without image degradation due to subtraction. Triple AQCEL was determined to reduce image degradation caused by subtraction and to provide valid quantitative data. Because Triple AQCEL does not require manual determination of ROI or image selection for the reconstruction of quantitative SPECT images, reproducibility of regional cerebral blood flow by 3DSRT is ensured. Since all analyses in evaluation by the TIE method are automated and the operator plays no part in them, with the resulting increase of throughput, this software will contribute to improved reproducibility of regional cerebral blood flow data, and will be useful in clinical pathophysiological assessment both preoperatively and during postoperative follow-up.

[Development of an automatic analytical tool for quantitative cerebral blood flow measurement using 99mTc-ECD, and verification of clinical examples].

The following process conventionally has been followed to develop quantitative images of cerebral blood flow: (1) mean cerebral blood flow (mCBF) is calculated by the Patlak plot method; (2) a SPECT slice that includes the basal ganglia is selected; and (3) based on the value of mCBF calculated by the Patlak plot method, the SPECT slice is corrected by the Lassen method and developed into a SPECT image of quantitative regional cerebral blood flow. However, this process is complicated, and the values of rCBF have been reported to fluctuate because selection of the SPECT slice and the ROI setting are in the hands of the operator. We have developed new software that automates this analysis. This software enables automatic processing simply by inputting the value of mCBF in the normal hemisphere. Since there is no need for manual operations such as setting the ROI, reproducibility is improved as well. Regional cerebral blood flow as determined by this software is quite similar to that calculated by the conventional method, so the existing clinical evaluation does not need to be changed. This software is considered to be useful.

[Improvement in accuracy of quantitative assessment of the regional cerebral blood flow with 99mTc-ECD].

Mean cerebral blood flow (mCBF) in the slice including the basal ganglia (reference slice) is necessary for the quantification of regional CBF using Patlak plot and BUR methods on 99mTc-ECD cerebral perfusion SPECT. The mCBF was calculated from the mean counts of this slice. A region of interest (ROI) has been manually set on the reference slice to obtain the mean counts (manual ROI method). However, there was large variability observed in the value of rCBF in this method. We developed a 3DSRT method for improving the accuracy of the mean counts in the reference slice and evaluated the difference between the value of rCBF on manual ROI method and that on 3DSRT method in consecutive 11 patients with cerebral vascular disease. Difference in the value of mean counts of the reference slice was distributed within the 2 standard deviations (SD) with Blant-Altman analysis in 9 of 11 patients. Significant difference in the value of mean counts between two methods was observed in 2 of 11 patients. 3DSRT method is superior accuracy to the manual ROI method in the evaluation of the counts in the ROI. Lower accuracy in manual ROI method, therefore, results in the difference of the value of mean counts. 3DSRT method provides high accuracy with the various quantitative methods for the evaluation of rCBF using 99mTc-ECD.