Quantitative single-photon emission computed tomography: Basic and clinical considerations

Although quantitative single-photon emission computed tomography (SPECT) has been the goal of much research effort for a number of years, only recently has it received wide interest, especially for clinical applications. It has been increasingly recognized that the achievement of quantitative SPECT will increase the accuracy of measurements, such as dimensions of specific regions of interest, absolute amount of radioactivity, and dosimetry calculations, and substantially reduce reconstruction image artifacts and distortions, thus, greatly improving clinical diagnosis. This article provides a review of the definition of terms, major factors affecting SPECT quantitation and their degrading effects on SPECT image quality, and methods to compensate for these effects. Compensation methods include those that make certain approximations for ease of implementation and those that provide more accurate compensation by modeling the imaging process more exactly, usually at the cost of increased complexity and computational requirements. Different reconstruction and compensation methods may be compared through the use of phantom cardiac and brain SPECT studies. The clinical efficacy of the methods may be demonstrated by applying them to a clinical thallium-201 myocardial perfusion SPECT study. The results clearly demonstrate that, by modeling the imaging process and/or image degrading factors threedimensionally, quantitative reconstruction and compensation methods provide the best image quality and quantitative accuracy. Important research efforts and developmental work being conducted currently to bring quantitative SPECT into routine clinical use are also discussed.