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SPECT-CT- technology of the future

SPECT or single photon emission computed tomography is an integrated part of all latest gamma cameras and is done in most of the Nuclear Medicine Departments world wide.
Hybrid imaging techniques (SPECT/CT) enable the fusion of anatomic and functional data without any scope for misregistration.
With the availability of integrated SPECT/CT scanners, lesions visualized by functional imaging (gamma camera) can be superimposed on the corresponding anatomic structure to obtain valuable morphologic information as well.This increases the sensitivity and specificity of scintigraphic findings and makes the nuclear medicine reports truly complete.

CT data can also be used for attenuation correction, thus increasing the target to background ratio of lesions and enabling quantification of uptakes.

Applications of SPECT-CT in clinical practice:

  1. For sentinel lymph node (SLN) mapping
  2. A combination of lymphoscintigraphy before surgery and mapping with blue dye during surgery has been demonstrated to be a practicable approach for accurately localizing the sentinel lymph node. Inguinal and lower axillary lymph nodes can be reliably detected on planar scans, however, a CT co-registration would be a valuable tool for sentinel lymph node detection in the pelvis, mediastinum and head and neck region. This may improve the SLN identification and localization during surgery.

  3. In malignant skeletal diseases:
    • The lesions identified in planar bone scans can be differentiated in to benign and malignant lesions especially when the lesions are solitary or are cold spots.
    • The fused images can be used to guide bone biopsies.
    • Benign skeletal lesions can be further characterized by fusion imaging in a single examination.
    • Integrated SPECT/CT images were found to be superior to side by side reading of SPECT and CT images.

  4. In Iodine-131 whole body scans in differentiated cancer thyroid cases:
  5. It can help distinguish lymph node metastasis from residual thyroid tissue, lung metastasis from mediastinum metastasis. Additional information regarding spinal cord compression, pathological fracture etc. can be obtained in a single study.

  6. In parathyroid adenomas
  7. Precise anatomic localization of parathyroid adenomas detected on Tc-99m MIBI dual phase scans enables minimally invasive surgeries for excision of the adenoma.
    This is especially useful in patients with distorted neck anatomy or ectopic location of the gland.

  8. In adrenocortical tumours and neuroendocrine tumours.
  9. Scintigraphic studies offer high specificity in the diagnosis of above mentioned condition especially in differentiating residual tumour tissue from scar.However, the morphologic data obtained with CT/MRI is highly sensitive in diagnosing these conditions.
    Fusion imaging combines the best of both modalities for the diagnosis and characterisation of these lesions.

  10. Cardiac imaging
  11. No homogenous photon attenuation in the thorax is one of the most notable limitations of myocardial perfusions imaging.
    Breast attenuation and diaphragmatic attenuation produce artifacts in the anterior/ anteroseptal region and inferior wall leading to false positive findings. These limitations are overcome by the application of CT based attenuation correction.
    Apart from this, the myocardial perfusion SPECT images can be combined with CT based calcium scoring / CT based coronary angiography to give a complete report. This option is highly attractive, due to improved logistics, diagnosis and illustrative visualization.

The advent of SPECT-CT can be considered to mark the journey from “UNCLEAR” MEDICINE TO “NEW CLEAR” MEDICINE. For further information and appointment,

Dr.Shefali Gokhale
Dept. of Nuclear Medicine
Inlaks and Budhrani Hospital
M.N.Budhrani Cancer Institute

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