Improved visualization of perfusion defects by respiratory-gated SPECT: a phantom simulation study.

OBJECTIVES

Single-photon emission computed tomography ventilation/perfusion (SPECT V/Q) imaging is recommended both by the Society of Nuclear Medicine and by the European Association of Nuclear Medicine for the diagnosis of pulmonary embolism. However, respiratory motion produces image blurring and degradation of detail in the lungs. We have investigated respiratory gating of SPECT images, correcting for motion to reduce blur and improve image definition.

MATERIALS AND METHODS

Wedge-shaped defects of different sizes ranging from 15 to 4 mm were fixed in the lung cavities of an anthropomorphic lung phantom to simulate perfusion defects. Gated and nongated SPECT images were obtained using a double-headed SPECT system. Three-dimensional movement was introduced using a purpose-built moving platform with two motion frequencies of 10 and 20 cycles/min. Motion was tracked with a respiratory-gating system. Gated SPECT data were acquired in 16 discrete data bins in synchronization with the breathing cycle. The images were reconstructed using ordered-subset expectation maximization algorithms and corrected for rigid motion. Contrast and contrast-to-noise ratios (CNRs) were measured to quantify any improvement in the gated motion-corrected images. Visualization of defects in the reconstructed images was performed by seven observers and analyzed using alternative free-response receiver operating characteristic analysis.

RESULTS

Assessment of gated and nongated SPECT phantom images demonstrated that motion adversely affected the detectability of defects. Quantification of data demonstrated that, in the controlled simulation, image quality, defect definition, observer confidence, contrast, and CNR were increased after applying motion correction. Improvement in CNRs was found to be significant using alternative free-response receiver operating characteristic analysis (P=0.0002).

CONCLUSION

Respiratory-gated motion-corrected SPECT images enhanced the visualization of defects compared with matched moving/nongated images in a realistic moving phantom. This approach may be particularly valuable for SPECT V/Q imaging and may improve the diagnosis of pulmonary embolism.