Improvements in Cardiac Spect/CT for the Purpose of Tracking Transplanted Cells

Regenerative therapy via stem cell transplantation has received increased attention to help treat the myocardial injury associated with heart disease. Currently, the hybridisation of SPECT with X-ray CT is expanding the utility of SPECT. This thesis compared two SPECT/CT systems for attenuation correction using slow or fast-CT attenuation maps (mu-maps). We then developed a method to localize transplanted cells in relation to compromised blood flow in the myocardium following a myocardial infarction using SPECT/CT. Finally, a method to correct for image truncation was studied for a new SPECT/CT design that incorporated small field-of-view (FOV) detectors. Computer simulations compared gated-SPECT reconstructions using slow-CT and fast-CT mu-maps with gated-CT mu-maps. Using fast-CT mu-maps improved the Root Mean Squared (RMS) error from 4.2% to 4.0%. Three canine experiments were performed comparing SPECT/CT reconstruction using the Infinia/Hawkeye-4 (slow-CT) and Symbia T6 (fast-CT). Canines were euthanized prior to imaging, and then ventilated. The results showed improvements in both RMS errors and correlation coefficients for all canines. A first-pass contrast CT imaging technique can identify regions of myocardial infarction and can be fused with SPECT. Ten canines underwent surgical ligation of the left-anterior-descending artery. Cells were labeled with 111In-tropolone and transplanted into the myocardium. SPECT/CT was performed on day of transplantation, 4, and 10 days post-transplantation. For each imaging session first-pass perfusion CT was performed and successfully delineated the infarct zone. Delayed-enhanced MRI was performed and correlated well with first-pass CT. Contrast-to-noise ratios were calculated for 111In-SPECT and suggested that cells can be followed for 11 effective half-lives. We evaluated a modified SPECT/CT acquisition and reconstruction method for truncated SPECT. Cardiac SPECT/CT scans were acquired in 14 patients. The original projections were truncated to simulate a small FOV acquisition. Data was reconstructed in three ways: non-truncated and standard reconstruction (NTOSEM), which was our gold-standard; truncated and standard reconstruction (TOSEM); and truncated and a modified reconstruction (TMOSEM). Compared with NTOSEM, small FOV imaging incurred an average cardiac count ratio error greater than 100% using TOSEM and 8.9% using TMOSEM. When we plotted NTOSEM against TOSEM and TMOSEM the correlation coefficient was 0.734 and 0.996 respectively

Adaptive Bayesian Iterative Transmission Reconstruction for Attenuation Correction in Myocardial Perfusion Imaging with SPECT/Slow-Rotation Low-Output CT Systems

Objectives. SPECT/slow-rotation low-output CT systems can produce streak artifacts in filtered backprojection (FBP) attenuation maps, impacting attenuation correction (AC) in myocardial perfusion imaging. This paper presents an adaptive Bayesian iterative transmission reconstruction (ABITR) algorithm for more accurate AC. Methods. In each iteration, ABITR calculated a three-dimensional prior containing the pixels with attenuation coefficients similar to water, then used it to encourage these pixels to the water value. ABITR was tested with a cardiac phantom and 4 normal patients acquired by a GE Millennium VG/Hawkeye system. Results. FBP AC and ABITR AC produced similar phantom results. For the patients, streak artifacts were observed in the FBP and ordered-subsets expectation-maximization (OSEM) maps but not in the ABITR maps, and ABITR AC produced more uniform images than FBP AC and OSEM AC. Conclusion. ABITR can improve the quality of the attenuation map, producing more uniform images for normal studies

Characterization and Compensation of Hysteretic Cardiac Respiratory Motion in Myocardial Perfusion Studies Through MRI Investigations

Respiratory motion causes artifacts and blurring of cardiac structures in reconstructed images of SPECT and PET cardiac studies. Hysteresis in respiratory motion causes the organs to move in distinct paths during inspiration and expiration. Current respiratory motion correction methods use a signal generated by tracking the motion of the abdomen during respiration to bin list- mode data as a function of the magnitude of this respiratory signal. They thereby fail to account for hysteretic motion. The goal of this research was to demonstrate the effects of hysteretic respiratory motion and the importance of its correction for different medical imaging techniques particularly SPECT and PET. This study describes a novel approach for detecting and correcting hysteresis in clinical SPECT and PET studies. From the combined use of MRI and a synchronized Visual Tracking System (VTS) in volunteers we developed hysteretic modeling using the Bouc-Wen model with inputs from measurements of both chest and abdomen respiratory motion. With the MRI determined heart motion as the truth in the volunteer studies we determined the Bouc Wen model could match the behavior over a range of hysteretic cycles. The proposed approach was validated through phantom simulations and applied to clinical SPECT studies

Development of whole-heart myocardial perfusion magnetic resonance imaging

Myocardial perfusion imaging is of huge importance for the detection of coronary artery disease (CAD), one of the leading causes of morbidity and mortality worldwide, as it can provide non-invasive detection at the early stages of the disease. Magnetic resonance imaging (MRI) can assess myocardial perfusion by capturing the rst-pass perfusion (FPP) of a gadolinium-based contrast agent (GBCA), which is now a well-established technique and compares well with other modalities. However, current MRI methods are restricted by their limited coverage of the left ventricle. Interest has therefore grown in 3D volumetric \whole-heart" FPP by MRI, although many challenges currently limit this. For this thesis, myocardial perfusion assessment in general, and 3D whole-heart FPP in particular, were reviewed in depth, alongside MRI techniques important for achieving 3D FPP. From this, a 3D `stack-of-stars' (SOS) FPP sequence was developed with the aim of addressing some current limitations. These included the breath-hold requirement during GBCA rst-pass, long 3D shot durations corrupted by cardiac motion, and a propensity for artefacts in FPP. Parallel imaging and compressed sensing were investigated for accelerating whole-heart FPP, with modi cations presented to potentially improve robustness to free-breathing. Novel sequences were developed that were capable of individually improving some current sequence limits, including spatial resolution and signal-to-noise ratio, although with some sacri ces. A nal 3D SOS FPP technique was developed and tested at stress during free-breathing examinations of CAD patients and healthy volunteers. This enabled the rst known detection of an inducible perfusion defect with a free-breathing, compressed sensing, 3D FPP sequence; however, further investigation into the diagnostic performance is required. Simulations were performed to analyse potential artefacts in 3D FPP, as well as to examine ways towards further optimisation of 3D SOS FPP. The nal chapter discusses some limitations of the work and proposes opportunities for further investigation.Open Acces

Cardiovascular Magnetic Resonance Imaging for the Investigation of Patients with Coronary Heart Disease

Objectives To evaluate the role of stress perfusion cardiovascular magnetic resonance (CMR) in the investigation of stable coronary artery disease (CAD). Background Coronary artery disease remains the biggest cause of morbidity and mortality. The multi-parametric CMR examination is established as an investigative strategy for the investigation of CAD. Methods Study 1 & 2: Patients with stable coronary artery disease underwent a multi-parametric CMR protocol assessing 4 components: i) left ventricular function; ii) myocardial perfusion; iii) viability (late gadolinium enhancement (LGE)) and iv) coronary magnetic resonance angiography (MRA). The diagnostic accuracy of the individual components were assessed. The ischaemic burden of stress CMR Vs. Single Photon Emission Computed Tomography (SPECT) was determined. Study 3: Volunteers and patients were scanned with perfusion sequence which adapts the spatial resolution to the available scanning time and field-of-view. Study 4: A multi-centre pragmatic randomised controlled trial of patients with stable angina comparing CMR guided-care Vs. SPECT guided-care Vs. National Institute of Health and Care Excellence guided-care. Results Study 1 demonstrated the stress perfusion component of the multi-parametric CMR exam was the single most important component for overall diagnostic accuracy. However, the full combined multi-parametric protocol was the optimal approach for disease rule-out, and the LGE component best for rule-in. Study 2 showed that there was reasonable agreement of the summed stress scores between CMR and SPECT (a well established investigation with significant amounts of prognostic data). In study 3, a perfusion pulse sequence which automatically adapts the acquisition sequence to the available scanning time results in spatial resolution improvement and reduction in dark rim artefact. Finally in study 4 in patients with suspected angina using CMR as an initial investigative strategy produced a significantly lower probability of unnecessary angiography compared to NICE guidance. There were similar rates of CAD detection were comparable suggesting no penalty for using functional imaging as a gatekeeper for angiography. Conclusion CMR has high diagnostic accuracy for the detection of coronary artery disease; with similar detection of ischaemic burden to established tests and can be used safely and effectively as a gate keeper to invasive coronary angiography

Specifics of cardiac magnetic resonance imaging in children

SummaryThis review points out three specific features of cardiac magnetic resonance imaging (MRI) in children: the small size of the heart modifies the usual balance between signal-to-noise ratio and spatial resolution; the higher and more variable heart rate limits tissue characterization and temporal resolution; and motion artefacts (notably respiratory motions) must be dealt with. In the second part of this review, we present the current and future practices of cardiac magnetic resonance (CMR) in children, based on the experience of all French paediatric cardiac MRI centres

Perspectives on Nuclear Medicine for Molecular Diagnosis and Integrated Therapy

nuclear medicine; diagnostic radiolog

Small-animal SPECT and SPECT/CT: application in cardiovascular research

Preclinical cardiovascular research using noninvasive radionuclide and hybrid imaging systems has been extensively developed in recent years. Single photon emission computed tomography (SPECT) is based on the molecular tracer principle and is an established tool in noninvasive imaging. SPECT uses gamma cameras and collimators to form projection data that are used to estimate (dynamic) 3-D tracer distributions in vivo. Recent developments in multipinhole collimation and advanced image reconstruction have led to sub-millimetre and sub-half-millimetre resolution SPECT in rats and mice, respectively. In this article we review applications of microSPECT in cardiovascular research in which information about the function and pathology of the myocardium, vessels and neurons is obtained. We give examples on how diagnostic tracers, new therapeutic interventions, pre- and postcardiovascular event prognosis, and functional and pathophysiological heart conditions can be explored by microSPECT, using small-animal models of cardiovascular disease