Spectral Photon-counting CT: Initial Experience with Dual-Contrast Agent K-Edge Colonography.

Purpose To investigate the feasibility of using spectral photon-counting computed tomography (CT) to differentiate between gadolinium-based and nonionic iodine-based contrast material in a colon phantom by using the characteristic k edge of gadolinium. Materials and Methods A custom-made colon phantom was filled with nonionic iodine-based contrast material, and a gadolinium-filled capsule representing a contrast material-enhanced polyp was positioned on the colon wall. The colon phantom was scanned with a preclinical spectral photon-counting CT system to obtain spectral and conventional data. By fully using the multibin spectral information, material decomposition was performed to generate iodine and gadolinium maps. Quantitative measurements were performed within the lumen and polyp to quantitatively determine the absolute content of iodine and gadolinium. Results In a conventional CT section, absorption values of both contrast agents were similar at approximately 110 HU. Contrast material maps clearly differentiated the distributions, with gadolinium solely in the polyp and iodine in the lumen of the colon. Quantitative measurements of contrast material concentrations in the colon and polyp matched well with those of actual prepared mixtures. Conclusion Dual-contrast spectral photon-counting CT colonography with iodine-filled lumen and gadolinium-tagged polyps may enable ready differentiation between polyps and tagged fecal material. © RSNA, 2016.

A fast cardiac gamma camera with dynamic SPECT capabilities: design, system validation and future potential.

PURPOSE: The goal of this study is to present the Discovery NM 530c (DNM), a cardiac SPECT camera, interfacing multi-pinhole collimators with solid-state modules, aiming at slashing acquisition time without jeopardizing quality. DNM resembles PET since it enables 3-D SPECT without detector motion. We further envision how these novel capabilities may help with current and future challenges of cardiac imaging. METHODS: DNM sensitivity, spatial resolution (SR) and energy resolution (ER), count rate response, cardiac uniformity and cardiac defect contrast were measured and compared to a dedicated cardiac, dual-head standard SPECT (S-SPECT) camera. RESULTS: DNM sensitivity was more than threefold higher while SR was notably better. Significantly, SR was the same for (99m)Tc and (201)Tl. ER was improved on DNM and allowed good separation of (99m)Tc and (123)I spectral peaks. Count rate remained linear on DNM up to 612 kcps, while S-SPECT showed severe dead time limitations. Phantom studies revealed comparable uniformity and defect contrast, notwithstanding significantly shorter acquisition time for the DNM. First patient images, including dynamic SPECT, are also presented. CONCLUSION: DNM is raising the bar for expedition and upgrade of practice. It features high sensitivity as well as improved SR, temporal resolution and ER. It enables reduction of acquisition time and fast protocols. Importantly, it is potentially capable of dynamic 3-D acquisition. The new technology is potentially upgradeable and may become a milestone in the evolution of nuclear cardiology as it assumes its key role in molecular imaging of the heart.

Feasibility of improving vascular imaging in the presence of metallic stents using spectral photon counting CT and K-edge imaging.

Correct visualization of the vascular lumen is impaired in standard computed tomography (CT) because of blooming artifacts, increase of apparent size, induced by metallic stents and vascular calcifications. Recently, due to the introduction of photon-counting detectors in the X-ray imaging field, a new prototype spectral photon-counting CT (SPCCT) based on a modified clinical CT system has been tested in a feasibility study for improving vascular lumen delineation and visualization of coronary stent architecture. Coronary stents of different metal composition were deployed inside plastic tubes containing hydroxyapatite spheres to simulate vascular calcifications and in the abdominal aorta of one New Zealand White (NZW) rabbit. Imaging was performed with an SPCCT prototype, a dual-energy CT system, and a conventional 64-channel CT system (B64). We found the apparent widths of the stents significantly smaller on SPCCT than on the other two systems in vitro (p < 0.01), thus closer to the true size. Consequently, the intra-stent lumen was significantly larger on SPCCT (p < 0.01). In conclusion, owing to the increased spatial resolution of SPCCT, improved lumen visualization and delineation of stent metallic mesh is possible compared to dual-energy and conventional CT.

Assessment of candidate elements for development of spectral photon-counting CT specific contrast agents.

Spectral photon-counting computed tomography (SPCCT) is a rapidly emerging imaging modality that provides energy-dependent information on individual x-ray photons, leading to accurate material decomposition and simultaneous quantification of multiple contrast generating materials. Development of SPCCT-specific contrast agents is needed to overcome the issues with currently used iodinated contrast agents, such as difficulty in differentiation from calcified structures, and yield SPCCT's full promise. In this study, the contrast generation of different elements is investigated using a prototype SPCCT scanner based on a modified clinical CT system and suitable elements for novel contrast agent development for SPCCT imaging are identified. Furthermore, nanoparticles were synthesized from tantalum as a proof of concept spectral photon-counting CT agent and tested for their in vitro cytotoxicity and contrast generation to provide insight into the feasibility of nanoparticle contrast agent development from these elements. We found that gadolinium, ytterbium and tantalum generate high contrast in spectral photon-counting CT imaging and may be suitable elements for contrast agent development for this modality. Our proof of concept results with tantalum-based nanoparticles underscore this conclusion due to their detectability with spectral photon-counting CT, as well as their biocompatibility.

Sentinel node detection in an animal study: evaluation of a new portable gamma camera.

We tested the capacity of a newly developed portable gamma camera to precisely locate sentinel nodes by injecting a radiotracer. Two sets of experiments were performed on eight pigs under general anesthesia. 99mTc-Nanocolloid and dye complex was injected in the submuscular layer of the small bowel in the first set and subcutaneously in the knee region in the second set of experiments. Image acquisition of the sentinel nodes was performed with the Camera placed at various angles. A mosaic of images was obtained encompassing the injection sites, lymphatic pathways, and sentinel lymph nodes. Three-dimensional visualizations were obtained, allowing the precise location and complete excision of these nodes. The use of the portable gamma camera allowed the rapid visualization of the lymphatic pathways leading from the injection sites to the sentinel nodes and precise location of these nodes. The Camera was also useful to verify the complete removal of the labeled target tissues.

Evaluation of spectral photon counting computed tomography K-edge imaging for determination of gold nanoparticle biodistribution in vivo.

Spectral photon counting computed tomography (SPCCT) is an emerging medical imaging technology. SPCCT scanners record the energy of incident photons, which allows specific detection of contrast agents due to measurement of their characteristic X-ray attenuation profiles. This approach is known as K-edge imaging. Nanoparticles formed from elements such as gold, bismuth or ytterbium have been reported as potential contrast agents for SPCCT imaging. Furthermore, gold nanoparticles have many applications in medicine, such as adjuvants for radiotherapy and photothermal ablation. In particular, longitudinal imaging of the biodistribution of nanoparticles would be highly attractive for their clinical translation. We therefore studied the capabilities of a novel SPCCT scanner to quantify the biodistribution of gold nanoparticles in vivo. PEGylated gold nanoparticles were used. Phantom imaging showed that concentrations measured on gold images correlated well with known concentrations (slope = 0.94, intercept = 0.18, RMSE = 0.18, R2 = 0.99). The SPCCT system allowed repetitive and quick acquisitions in vivo, and follow-up of changes in the AuNP biodistribution over time. Measurements performed on gold images correlated with the inductively coupled plasma-optical emission spectrometry (ICP-OES) measurements in the organs of interest (slope = 0.77, intercept = 0.47, RMSE = 0.72, R2 = 0.93). TEM results were in agreement with the imaging and ICP-OES in that much higher concentrations of AuNPs were observed in the liver, spleen, bone marrow and lymph nodes (mainly in macrophages). In conclusion, we found that SPCCT can be used for repetitive and non-invasive determination of the biodistribution of gold nanoparticles in vivo.

Multicolor spectral photon-counting computed tomography: in vivo dual contrast imaging with a high count rate scanner.

A new prototype spectral photon-counting computed tomography (SPCCT) based on a modified clinical CT system has been developed. SPCCT analysis of the energy composition of the transmitted x-ray spectrum potentially allows simultaneous dual contrast agent imaging, however, this has not yet been demonstrated with such a system. We investigated the feasibility of using this system to distinguish gold nanoparticles (AuNP) and an iodinated contrast agent. The contrast agents and calcium phosphate were imaged in phantoms. Conventional CT, gold K-edge, iodine and water images were produced and demonstrated accurate discrimination and quantification of gold and iodine concentrations in a phantom containing mixtures of the contrast agents. In vivo experiments were performed using New Zealand White rabbits at several times points after injections of AuNP and iodinated contrast agents. We found that the contrast material maps clearly differentiated the distributions of gold and iodine in the tissues allowing quantification of the contrast agents' concentrations, which matched their expected pharmacokinetics. Furthermore, rapid, repetitive scanning was done, which allowed measurement of contrast agent kinetics with high temporal resolution. In conclusion, a clinical scale, high count rate SPCCT system is able to discriminate gold and iodine contrast media in different organs in vivo.

CZT gamma camera for scintimammography.

A high performance prototype gamma camera based on the semiconductor radiation detector Cd(Zn)Te is described. The camera features high spatial resolution, high-energy resolution, a reduced dead space on the edge of the field of view, and a compact format. The camera performance was first examined by comparison of small field of view examinations with those from an Elscint SP6HR standard clinical gamma camera. The new camera was found to give equal or improved image quality. The camera was then used for a systematic phantom study of small lesions in a background as would be found in breast cancer imaging. In this study the camera was able to systematically detect smaller, deeper, and fainter lesions. The camera is presently being used in a clinical trial aimed to assess its value in scintimammography where previous limitations of image quality and detector size have restricted the use of the functional imaging techniques. Preliminary results from 40 patients show high sensitivity and specificity with respect to X-ray mammography and surgery.

Fluence-Field Modulated X-ray CT using Multiple Aperture Devices.

We introduce a novel strategy for fluence field modulation (FFM) in x-ray CT using multiple aperture devices (MADs). MAD filters permit FFM by blocking or transmitting the x-ray beam on a fine (0.1-1 mm) scale. The filters have a number of potential advantages over other beam modulation strategies including the potential for a highly compact design, modest actuation speed and acceleration requirements, and spectrally neutral filtration due to their essentially binary action. In this work, we present the underlying MAD filtration concept including a design process to achieve a specific class of FFM patterns. A set of MAD filters is fabricated using a tungsten laser sintering process and integrated into an x-ray CT test bench. A characterization of the MAD filters is conducted and compared to traditional attenuating bowtie filters and the ability to flatten the fluence profile for a 32 cm acrylic phantom is demonstrated. MAD-filtered tomographic data was acquired on the CT test bench and reconstructed without artifacts associated with the MAD filter. These initial studies suggest that MAD-based FFM is appropriate for integration in clinical CT system to create patient-specific fluence field profile and reduce radiation exposures.

Evaluation of a small cadmium zinc telluride detector for scintimammography.

UNLABELLED: The purpose of this study was to evaluate a small semiconductor-based gamma camera that may have applications in scintimammography. METHODS: A small cadmium zinc telluride (CZT) detector was evaluated. The detector had a field of view of 20 x 20 cm with detector elements of 2.5 x 2.5 mm in size. Both short-bore (35 mm) and long-bore (50 mm) collimators, matched to the geometry of the detector elements, were evaluated. The imaging performance of the CZT detector was compared with that of a conventional gamma camera equipped with all-purpose and ultra-high-resolution collimators. The performance of both systems with respect to breast imaging was evaluated using a water tank containing small glass spheres, 1.8-9.8 mm in diameter. The effects of variations in breast thickness, tumor depth, and tumor-to-background ratio were all simulated in this phantom model. Total counts per image were adjusted to approximate the count density observed in clinical scintimammographic studies. RESULTS: Sensitivity of the CZT detector was 76% that of the equivalent NaI system. The system demonstrated excellent integral uniformity. The energy resolution of the CZT system was 6.5% for (99m)Tc. Spatial resolution with the long-bore collimator was superior to that of a conventional large field-of -view gamma camera equipped with an ultra-high- resolution collimator, over the range 0-6 cm from the collimator face. A blinded review of breast phantom images showed that small spheres (< or =7 mm in diameter) were better seen and had a better tumor-to-background ratio with the CZT system than with the conventional gamma camera. CONCLUSION: A small CZT detector offers superior performance to a conventional gamma camera and should permit reliable detection of breast tumors <1 cm in size.

A newly developed intra-operative gamma camera: performance characteristics in a laboratory phantom study.

PURPOSE: Radioguided surgery depends on the intra-operative detection of radiolabelled tissues. This is currently accomplished with hand tools capable of providing a tone signal, depending on the proximity and direction of a radioactive source in relation to the probe. The advantages of visual images of radiolabelled tissues are well recognised, but satisfactory means of acquiring such images intra-operatively are not yet available. The goal of this study was to examine the performance of a newly developed intra-operative gamma camera, compact enough to be a hand tool and capable of yielding a visual image of the source field. METHODS: The study was performed in the laboratory with a phantom consisting of a water bath and small hollow spheres (1-2 cm in internal diameter) filled with 99mTc (1-5 microCi/cc), placed in different configurations within the bath. For comparison, studies were also performed using a standard intra-operative gamma probe, and others using a standard single-head high-resolution gamma camera. RESULTS: Compared with the gamma probe, the intra-operative camera was found to possess a superior ability to distinguish small, deep and weakly localised radioactivity sources from background. By acquiring images from different angles, it allowed a 3D understanding of multiple radioactive sources. It detected "cold" defects within a "hot" radiolabelled sphere. It discriminated a weak source located near a much "hotter" radioactivity source, similar to discrimination with the standard gamma camera, and discerned localised sources against a background of radioactivity. CONCLUSION: It is anticipated that the high imaging potential of the camera tested in this study will offer clinical advantages.