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Automated Breath-Hold Perfusion SPECT/CT Fusion Images of the Lungs

Kazuyoshi Suga1, Yasuhiko Kawakami1, Hideyuki Iwanaga2, Osamu Tokuda2 and Naofumi Matsunaga2

1 Department of Radiology, St. Hill Hospital, 1462-3 Nishikiwa, Ube, Yamaguchi 755-0151, Japan.
2 Department of Radiology, Yamaguchi University School of Medicine, Yamaguchi 755-8505, Japan.


Figure 1
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  		Fig. 1A —Chest phantom study. As CT of phantom shows, inside of phantom contains two round water-filled nodules of 24 and 8 mm (arrows, a). With increases in number of continuous rotating repeated acquisition (CRRA) mode projection data sets for reconstructing SPECT of standing phantom, perfusion defects of these nodules becomes more distinct (arrows, b). SPECT reconstructed from eight continuous rotating repeated acquisition mode projection data (b; n = 8) has good image quality, as does SPECT (arrow, c) obtained with step-and-shoot mode and total acquisition time of 8 minutes. Perfusion defect of small 8-mm nodule on this SPECT is clearer compared with that on SPECT (arrow, d) of moving phantom (moving in head-to-caudal direction with range of 12 mm at frequency of 15 times/min) obtained using step-and-shoot mode and with total acquisition time of 8 minutes (d). R = right.

 

Figure 2
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  		Fig. 1B —Chest phantom study. Coefficient of variation (SD/mean count value of pixel counts) of lung parenchyma measured at five different slices on SPECT of standing phantom is gradually decreased and steady as number of continuous rotating repeated acquisition mode projection data sets increases. Value of 0.27 ± 0.06 on SPECT reconstructed from eight CRRA-mode projection data was almost equal to that of 0.26 ± 0.03 on SPECT of standing phantom obtained with step-and-shoot mode and total acquisition time of 8 minutes.

 

Figure 3
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  		Fig. 2A —71-year-old man with pulmonary emphysema. R=right. CT shows bullous changes in both peripheral lungs and organized consolidation in left lung (left image, arrows). Deep-inspiratory breath-hold (DIBrH) SPECT shows more heterogeneous defects compared with non-breath-hold SPECT, with expansion of several defects (center image, arrows). Image set of transaxial DIBrH SPECT, SPECT/CT fusion, and CT confirms perfusion defects associated with bullous changes or consolidation on CT (right image, arrows). Heterogeneous defects are also seen in normal right ventral lung on CT.

 

Figure 4
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  		Fig. 2B —71-year-old man with pulmonary emphysema. R=right. As seen in image sets of coronal and sagittal SPECT, SPECT/CT fusion, and CT, DIBrH SPECT improves SPECT/CT matching of lung base and diaphragmatic contours compared with non-breath-hold SPECT (arrows). Image sets of DIBrH SPECT also show excellent matching of perfusion defects and peripheral bullous changes on CT. Although extensive peripheral defects are not well recognized on DIBrH SPECT alone, fusion images confirm these defects by delineating outer boundary of lungs on coregistered CT.

 

Figure 5
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  		Fig. 3A —Deep-inspiratory breath-hold (DIBrH) SPECT/CT fusion images. 44-year-old man with obstructive bronchiolitis.

 

Figure 6
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  		Fig. 3B —Deep-inspiratory breath-hold (DIBrH) SPECT/CT fusion images. 45-year-old man with diffuse panbronchiolitis.

 

Figure 7
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  		Fig. 3C —Deep-inspiratory breath-hold (DIBrH) SPECT/CT fusion images. 58-year-old woman with bronchomalacia. R = right.

 

Figure 8
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  		Fig. 4A —52-year-old woman with acute pulmonary thromboembolism (PTE). R = right. CT scan (left) shows wedge-shaped area of low attenuation in right lung base (left image, arrow). Deep-inspiratory breath-hold (DIBrH) SPECT enhances perfusion defects compared with non-breath-hold SPECT, with expansion of several defects (center image, arrows). Image set of transaxial DIBrH SPECT, SPECT/CT fusion, and CT (right images) shows excellent matching between perfusion defects and low CT attenuation.

 

Figure 9
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  		Fig. 4B —52-year-old woman with acute pulmonary thromboembolism (PTE). R = right. As seen in image sets of coronal and sagittal perfusion SPECT, SPECT/CT fusion, and CT, DIBrH SPECT improves SPECT/CT matching of lung base and diaphragmatic contours compared with non-breath-hold SPECT. Image sets of DIBrH SPECT also show excellent matching between wedge-shaped defect and lung base low CT attenuation.

 

Figure 10
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  		Fig. 5A —59-year-old man with interstitial pneumonia. R =right. CT image shows peripheral areas of high attenuation in both lungs (left image, arrows). Deep-inspiratory breath-hold (DIBrH) SPECT shows more heterogeneous perfusion defects compared with non-breath-hold SPECT, with expansion of defects (center image, arrows). Image set of transaxial DIBrH SPECT, SPECT/CT fusion, and CT (right images) shows excellent matching between perfusion defects and high CT attenuation areas (arrows). Defects are also seen in normal lung areas on CT.

 

Figure 11
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  		Fig. 5B —59-year-old man with interstitial pneumonia. R =right. As seen in image sets of coronal and sagittal perfusion SPECT, SPECT/CT fusion, and CT, DIBrH SPECT improves SPECT/CT matching of lung base and diaphragmatic contours (arrows).

 

Figure 12
Figure 12
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  		Fig. 6 —Comparison of correlation of coefficient of variation (CV) values and diffusing capacity of lungs for carbon monoxide/alveolar volume ratios (DLCO/VA) between deepinspiratory breath-hold (DIBrH) and non-breath-hold SPECT in patients with chronic obstructive pulmonary disease.

 

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