The influence of misregistration between CT and SPECT images on the accuracy of CT-based attenuation correction of cardiac SPECT/CT imaging: Phantom and clinical studies

Document Type: Original Article

Authors

1 Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran

3 Chronic Respiratory Dis‌eases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 PET/CT and Cyclotron Center of Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Cardiovascular Interventional Research Center, Department of Nuclear Medicine, Rajaei Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran

6 Department of Nuclear Medicine, Rajaei Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran

7 Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction: Integration of single photon emission computed tomography (SPECT) and computed tomography (CT) scanners into SPECT/CT hybrid systems permit detection of coronary artery disease in myocardial perfusion imaging (MPI). Misregistration between CT and emission data can produce some errors in uptake value of SPECT images. The aim of this study was evaluate the influence of attenuation correction (AC) versus non-attenuation correction (NC) images and the effect of misregistration on all segments of SPECT images for quantitative and qualitative analysis.
Methods: 99 patients (45 males, 54 females) underwent stress/rest myocardial perfusion imaging (MPI) using 99mTc-MIBI were used in this study. We also utilized cardiac insert and lung insert in cylinder phantom. Phantom studies were performed with and without defect. The misregistration of all patient data was measured and variation in misregistration of our population was recorded. The effect of attenuation correction (AC) and non-attenuation correction (NC) images were also evaluated in both phantom and patient data. The CT images were shifted by ±1, ±2, ±3 pixels along X-, Y- and Z-axis (Left/right, dorsal/ventral, cephalic/caudal) for both phantom and patient studies. Differences between misalignment data and misregistration correction images were also measured. Results displayed with 20 segments polar map analysis and illustration in standard orientations for cardiac tomographic images.
Results:In the patient population data, 1.5% were perfectly registered, 17% and 73% misaligned under 1 pixel and more than 1 pixel, respectively. AC of SPECT images showed increased uptake value in normal phantom and false positives findings were disappeared versus to NC images. In patient data, statistically significant variation were shown for the most segments before and after AC (P-value<=0.004) and also between AC of SPECT image and misregistration correction images (P-value<=0.048). Along X-axis, in 3 pixel shift in right direction, the percent of relative difference in lateral wall were 11.94% for mid anterolateral. Along Y-axis, the Ventral shift caused -15.9% changes in basal inferolateral and along Z-axis -8.59 % changes in apical anterolateral were also observed in caudal direction when 3 pixel shifts were used.
Conclusion: This study showed that CT-based attenuation correction of cardiac images in hybrid SPECT/CT is important to improve image quality. Misalignment in caudal, cephalad, ventral and right direction introduced significant variation even in 1 pixel shift. It is important to apply misregistration correction even in small misalignment routinely in clinical myocardial perfusion imaging.

Keywords

Main Subjects


  1. Hachamovitch R. Prognostic characterization of patients with mild coronary artery disease with myocardial perfusion single photon emission computed tomography: validation of an outcomes-based strategy. J Nucl Cardiol. 1998 Jan-Feb;5(1):90-5.
  2. Russell RR 3rd, Zaret BL. Nuclear cardiology: present and future. Curr Probl Cardiol. 2006 Sep;31(9):557-629.
  3. Zaidi H, Hasegawa BH. Attenuation correction strategies in emission tomography.  quantitative analysis in nuclear medicine imaging. Springer; 2006. p. 167-204.
  4. Bybel B, Brunken RC, DiFilippo FP, Neumann DR, Wu G, Cerqueira MD. SPECT/CT imaging: clinical utility of an emerging technology. Radiographics. 2008 Jul-Aug;28(4):1097-113.
  5. Goetze S, Brown TL, Lavely WC, Zhang Z, Bengel FM. Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration. J Nucl Med. 2007 Jul;48(7):1090-5.
  6. Geramifar P, Zafarghandi MS, Ghafarian P, Rahmim A, Ay MR. Respiratory-induced errors in tumor quantification and delineation in CT attenuation-corrected PET images: effects of tumor size, tumor location, and respiratory trace: a simulation study using the 4D XCAT phantom. Mol Imaging Biol. 2013 Dec;15(6):655-65.
  7. Ay M, Shahriari M, Sarkar S, Ghafarian P. Measurement of organ dose in abdomen-pelvis CT exam as a function of mA, KV and scanner type by Monte Carlo method. Int J Radiat Res. 2004;1(4):187-194
  8. Ay MR, Mehranian A, Maleki A, Ghadiri H, Ghafarian P, Zaidi H. Experimental assessment of the influence of beam hardening filters on image quality and patient dose in volumetric 64-slice X-ray CT scanners. Phys Med. 2013 May;29(3):249-60.
  9. Ghafarian P, Aghamiri SM, Ay MR, Fallahi B, Rahmim A, Schindler TH, Ratib O, Zaidi H. Coronary calcium score scan-based attenuation correction in cardiovascular PET imaging. Nucl Med Commun. 2010 Sep;31(9):780-7.
  10. Ay MR, Mehranian A, Abdoli M, Ghafarian P, Zaidi H. Qualitative and quantitative assessment of metal artifacts arising from implantable cardiac pacing devices in oncological PET/CT studies: a phantom study. Mol Imaging Biol. 2011 Dec;13(6):1077-87.
  11. Etemadi Z, Ghafarian P, Bitarafan-Rajabi A, Malek H, Rahmim A, Ay MR. Is correction for metallic artefacts mandatory in cardiac SPECT/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads? Iran J Nucl Med. 2018;26(1):35-46.
  12. Ghafarian P, Aghamiri SM, Ay MR, Rahmim A, Schindler TH, Ratib O, Zaidi H. Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads? Eur J Nucl Med Mol Imaging. 2011 Feb;38(2):252-62.
  13. Huang R, Li F, Zhao Z, Liu B, Ou X, Tian R, Li L. Hybrid SPECT/CT for attenuation correction of stress myocardial perfusion imaging. Clin Nucl Med. 2011 May;36(5):344-9.
  14. Gerdekoohi SK, Vosoughi N, Tanha K, Assadi M, Ghafarian P, Rahmim A, Ay MR. Implementation of absolute quantification in small-animal SPECT imaging: Phantom and animal studies. J Appl Clin Med Phys. 2017 Jul;18(4):215-223.
  15. Goetze S, Wahl RL. Prevalence of misregistration between SPECT and CT for attenuation-corrected myocardial perfusion SPECT. J Nucl Cardiol. 2007 Apr;14(2):200-6.
  16. Ghafarian P, Ay M. The influence of PET and CT misalignment due to respiratory motion on the cardiac PET/CT imaging: a simulation study. Front Biomed Technol. 2015;1(4).
  17. Ghafarian P, Ay MR, Fard-Esfahani A, Rahmim A, Zaidi H. Quantification of PET and CT misalignment errors due to bulk motion in cardiac PET/CT imaging: phantom and clinical and studies. Front Biomed Technol. 2014;1(3).
  18. Fricke E, Fricke H, Weise R, Kammeier A, Hagedorn R, Lotz N, Lindner O, Tschoepe D, Burchert W. Attenuation correction of myocardial SPECT perfusion images with low-dose CT: evaluation of the method by comparison with perfusion PET. J Nucl Med. 2005 May;46(5):736-44.
  19. Heller GV, Bateman TM, Johnson LL, Cullom SJ, Case JA, Galt JR, Garcia EV, Haddock K, Moutray KL, Poston C, Botvinick EH, Fish MB, Follansbee WP, Hayes S, Iskandrian AE, Mahmarian JJ, Vandecker W. Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging. J Nucl Cardiol. 2004 May-Jun;11(3):273-81.
  20. Patton JA, Turkington TG. SPECT/CT physical principles and attenuation correction. J Nucl Med Technol. 2008 Mar;36(1):1-10.
  21. Pazhenkottil AP, Ghadri JR, Nkoulou RN, Wolfrum M, Buechel RR, Küest SM, Husmann L, Herzog BA, Gaemperli O, Kaufmann PA. Improved outcome prediction by SPECT myocardial perfusion imaging after CT attenuation correction. J Nucl Med. 2011 Feb;52(2):196-200.
  22. Apostolopoulos DJ, Gąsowska M, Savvopoulos CA, Skouras T, Spyridonidis T, Andrejczuk A, Vassilakos PJ. The impact of transmission-emission misregistration on the interpretation of SPET/CT myocardial perfusion studies and the value of misregistration correction. Hell J Nucl Med. 2015 May-Aug;18(2):114-21.
  23. Huang JY, Yen RF, Lee WC, Huang CK, Hsu PY, Cheng MF, Lu CC, Lin YH, Chien KL, Wu YW. Improved diagnostic accuracy of thallium-201 myocardial perfusion single-photon emission computed tomography with CT attenuation correction. J Nucl Cardiol. 2018 Feb 26. doi: 10.1007/s12350-018-1230-y.
  24. Polycarpou I, Chrysanthou-Baustert I, Demetriadou O, Parpottas Y, Panagidis C, Marsden PK, Livieratos L. Impact of respiratory motion correction on SPECT myocardial perfusion imaging using a mechanically moving phantom assembly with variable cardiac defects. J Nucl Cardiol. 2017 Aug;24(4):1216-1225.
  25. Patchett ND, Pawar S, Miller EJ. Visual identification of coronary calcifications on attenuation correction CT improves diagnostic accuracy of SPECT/CT myocardial perfusion imaging. J Nucl Cardiol. 2017;24(2):711-20.
  26. Kennedy JA, Israel O, Frenkel A. Directions and magnitudes of misregistration of CT attenuation-corrected myocardial perfusion studies: incidence, impact on image quality, and guidance for reregistration. J Nucl Med. 2009 Sep;50(9):1471-8.