Introduction: Single-Photon Emission Computed Tomography (SPECT) is used to measure and quantify radiopharmaceutical distribution within the body. The accuracy of quantification depends on acquisition parameters and reconstruction algorithms. Until recently, most SPECT images were constructed using Filtered Back Projection techniques with no attenuation or scatter corrections. The introduction of 3-D Iterative Reconstruction algorithms with the availability of both computed tomography (CT)-based attenuation correction and scatter correction may provide for more accurate measurement of radiotracer bio-distribution. The effect of attenuation and scatter corrections on accuracy of SPECT measurements is well researched. It has been suggested that the combination of CT-based attenuation correction and scatter correction can allow for more accurate quantification of radiopharmaceutical distribution in SPECT studies (Bushberg et al., 2012). However, The effect of respiratory induced cardiac motion on SPECT images acquired using higher resolution algorithms such 3-D iterative reconstruction with attenuation and scatter corrections has not been investigated.
Aims: To investigate the quantitative accuracy of 3D iterative reconstruction algorithms in comparison to filtered back projection (FBP) methods implemented on cardiac SPECT/CT imaging with and without CT-attenuation and scatter corrections. Also to investigate the effects of respiratory induced cardiac motion on myocardium perfusion quantification. Lastly, to present a comparison of spatial resolution for FBP and ordered subset expectation maximization (OSEM) Flash 3D together with and without respiratory induced motion, and with and without attenuation and scatter correction.
Methods: This study was performed on a Siemens Symbia T16 SPECT/CT system using clinical acquisition protocols. Respiratory induced cardiac motion was simulated by imaging a cardiac phantom insert whilst moving it using a respiratory motion motor inducing cyclical elliptical motion of the apex of the cardiac insert.
Results: Our analyses revealed that the use of the Flash 3-D reconstruction algorithm without scatter or attenuation correction has improved Spatial Resolution by 30% relative to FBP. Reduction in Spatial Resolution due to respiratory induced motion was 12% and 38% for FBP and Flash 3-D respectively. The implementation of scatter correction has resulted in a reduction in resolution by up to 6%. The application of CT-based attenuation correction has resulted in 13% and 26% reduction in spatial resolution for SPECT images reconstructed using FBP and Flash 3-D algorithms respectively.
Conclusion: We conclude that iterative reconstruction (Flash-3D) provides significant improvement in image spatial resolution, however as a result the effects of respiratory induced motion have become more evident and correction of this is required before the full potential of these algorithms can be realised for myocardial perfusion imaging. Attenuation and scatter correction can improve image contrast, but may have significant detrimental effect on spatial resolution.