Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
Integrated Personalized and Precision Oncology Network, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
J Nucl Med. 2020 Sep;61(9):1284-1291. doi: 10.2967/jnumed.119.236943. Epub 2020 Jul 3.
Twenty years ago, SPECT/CT became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid-state digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/CT systems, replacing low-end x-ray tubes with high-end multislice CT scanners equipped with iterative reconstruction, metal artifact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics offer exciting opportunities. Although it is true that the SPECT/CT ecosystem has seen several challenges during its development over the past 2 decades, it is now a feature-rich and mature tool ready for clinical prime time.
二十年前，SPECT/CT 开始商业化，结合了这两种技术的优势：SPECT 的诊断灵敏度和 CT 的解剖细节。最初的其他好处包括 SPECT 重建的衰减校正，最终发展为能够进行绝对示踪剂摄取定量的校正技术。SPECT 硬件的最新发展包括具有更高灵敏度和分辨率的固态数字系统，使用基于钨的新型准直器设计。在混合 SPECT/CT 系统中也引入了类似的 CT 技术进步，用配备迭代重建、金属伪影减少算法和双能能力的高端多排 CT 扫描仪代替低端 X 射线管。最近，全身 SPECT/CT 系统的设计又取得了重大飞跃，引入了一个配备多个可移动探测器的环形龙门架，环绕着患者。这些令人兴奋的发展激发了开发新型 SPECT 放射性药物的努力，为放射性标记创造了新的螯合剂和假体基团。创新的 SPECT 放射性核素对现在可用于放射性标记，有可能用作治疗诊断剂。精准医学的发展以及对准确放射性核素治疗剂量测定的相关需求，可能会在不久的将来推动 SPECT/CT 的使用。此外，SPECT/CT 在骨科等其他领域的临床应用的扩展也提供了令人兴奋的机会。尽管在过去的 20 年中，SPECT/CT 生态系统在发展过程中遇到了一些挑战，但它现在是一种功能丰富且成熟的工具，已经准备好进入临床黄金时代。
