Indian Journal of Nuclear Medicine
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Year : 2010  |  Volume : 25  |  Issue : 3  |  Page : 127-128 Table of Contents   


Date of Web Publication25-Nov-2010

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How to cite this article:
. SPECT-CT. Indian J Nucl Med 2010;25:127-8

How to cite this URL:
. SPECT-CT. Indian J Nucl Med [serial online] 2010 [cited 2022 May 19];25:127-8. Available from:


Early experience of SPECT/ CT Co-registration in bone scans for characterization of skeletal lesions in metastatic workup: Additional confidence wherever required

Vandana KD, Manju Saini 1 , Shivaprasad G, Pankaj KD 1

Department Of Nuclear Medicine, Cancer Research Institute, Himalayan Institute Hospital Trust, Dehradun, Uttrakhand, India. 1 Department of Radiology, Himalayan Institute Hospital Trust, Dehradun, Uttrakhand, India

Background: Whenever SPECT/CT hybrid machines are available, the usefulness of combining functional data with anatomical data, the so called hybrid or fusion imaging is well established. However at centers working on plain gamma cameras this is not an option available. We intended to evaluate the practical usefulness of manual co- registration of bone SPECT images on a plain gamma camera and CT images of the same region in for lesion characterization mostly referred for detection of skeletal metastasis at our new centre. Materials and Methods: Of the total of 126 consecutive bone scans referred for metastatic workup at our new centre, 10 selected patients having 16 suspicious vertebral lesions were evaluated. Tc-99m MDP whole body planar bone scans with a regional SPECT study followed by a regional non contrast CT- scan was done separately using appropriate markers for landmark identification during fusion and images fused using software and evaluated to look for difference in outcome of SPECT images alone versus fused images. Results: Of the 16 lesions 10 lesions were characterized correctly on planar and SPECT images alone by pattern recognition and localization on vertebrae with confirmation of findings but no additional benefit offered by CT evaluation. In 6 lesions [37.5%] doubt was cleared by additional information provided by CT and thus actual correct characterization into benign or metastatic lesion. Conclusion: It may be possible in most cases to characterize the lesions on SPECT and planar bone scan images alone using usual pattern identification and regional uptake on vertebrae. However, addition of CT co registration was helpful in a significant number [35%] of doubtful lesions. We would thus recommend not all but selected doubtful lesions for CT co-registration, when using a plain gamma camera without integrated CT. This would be cost-effective and more practicable. However, this would be good for integrated systems as well if radiation exposure is considered.

Keywords: SPECT/CT, Bone scan, Co-registration, vertebral lesions


Detection of bile leak post hepatobiliary surgery: incremental value of SPECT/CT over planar hepatobiliary scintigraphy

Das KJ, Kumar R, Reddy RSM, Singla Suhas, Patnecha M, Singhal A, Sahoo MK, Dhull Varun, Malhotra A

Department of Nuclear medicine, All India Institute of Medical Science, New delhi, India

Objective: With increase in no. of laparoscopic cholecystectomy being done over open cholecystectomy, the incidence in bile duct injury has been more frequently reported. The incidence being 0.1% for open cholecystectomy to about 0.3 to 2% for laparoscopic cholecystectomy. Definitive treatment requires the specific localization of the site of bile leak. The present study was aimed to find out the added value of SPECT/CT, if any, over planar hepatobiliary scintigraphy in patients with suspected bile leak after surgery. Methods: A total of 17 patients suspected of bile leak clinically were referred for hepatobiliary scintigraphy (HIDA) for confirmation and site of bile leak after gall bladder/GI surgery. The study was undertaken from 2009 to 2010. All the patients who had clear bile leak on plannar scintigraphy were not included in this study. Only those doubtful cases where SPECT/CT was done in addition to planar imaging were reviewed. There were 11 male and 6 female. Result: Of 17 patients, 16 had bile leak and 1 had normal study based on scintigraphy and clinical follow-up. Of 16 patients who had bile leak, planar scintigraphy was positive for bile leak in 11 patients, while it has no leak in 5 patients. Hepatobiliary SPECT/CT was positive in all 16 patients, including 5 patients who had no leak on planar scintigraphy. Therefore, SPECT/CT was helpful in detecting bile leak in 5 cases. Conclusion: Hepatobiliary scintigraphy is a useful and accurate technique for the detection and localization of the site of bile leak, however, it can miss small bile leak. Hepatobiliary SPECT/CT found to have higher sensitivity in detection of bile leak than planar Hepatobiliary scintigraphy and can detect even small bile leak after surgery.

Keywords: Bile Leak, SPECT-CT, Hepatobiliary scintigraphy


Characterizing parathyroid adenoma as superior or inferior for Minimal Invasive Surgery: Incremental value of SPECT- Low dose CT over planar and SPECT alone

Jain Suruchi, Ora M, Madhusudanan P, Arya A, Barai S, Pradhan PK, Kumar U, Mukherjee DR, Gambhir S

Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow (U.P.)

Background: For minimally invasive parathyroid surgery, accurate pre-operative localization is mandatory. Superior parathyroid glands are more posterior than inferior glands and commonly found in the tracheo-esophageal groove. Surgery for an inferio-posterior gland (superior gland) is difficult because of its proximity to the recurrent laryngeal nerve. Preoperative knowledge of whether the parathyroid gland is superior or inferior facilitates exploration. Materials and Methods: Out of 31 patients who underwent MIBI parathyroid imaging, 26 had positive scans and underwent successful surgical resection. Standard parathyroid imaging protocol with early and delayed imaging was used with the addition of SPECT/CT at 15 minutes. Two experienced readers independently evaluated four image sets (early and delayed planar imaging, SPECT, and SPECT/CT) for adenoma detection and localization at 7 possible sites right/left superior, right/left inferior, right/left intra-thyroidal, and ectopic. Infero-posterior location was considered to be superior parathyroid adenoma. Results: SPECT and SPECT-CT detected all 26 positive cases where as dual phase imaging detected 24 cases and early planar imaging detected only 21 cases. Localization of adenoma (superior or inferior) was done correctly in 16 (62%) and 22 (84.61%) cases with SPECT and SPECT-CT respectively. Certainty of adenoma characterization as superior or inferior was significantly higher with SPECT-CT in comparison to SPECT alone or planar dual phase images. Large adenomas with increased uptake were difficult to call superior or inferior due to adhesion along whole length of posterior aspect of thyroid. Conclusion: SPECT/CT shows clear advantage over SPECT alone or dual phase imaging for localization and characterization of parathyroid adenoma as superior or inferior for minimal invasive surgery.

Keywords: Parathyroid adenoma, SPECT-CT, Minimally invasive surgery


Skull base osteomyelitis: Role of three phase & Hybrid SPECT/CT bone scintigraphy

Chakraborty D, Bhattacharaya A, Kamaleshwaran KK, Mittal BR, Aggarwal K, Singh B, Bhoil A

Department of Nuclear Medicine, PGIMER, Chandigarh-160 012, India

Background: Skull base osteomyelitis is the infection that has spread to the skull base, beyond the external auditory canal & seen in advanced stage of malignant otitis externa. Early diagnosis of this condition includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the skull base osteomyelitis from the severe type of otitis externa in which there is no extension to the adjacent bone. Objective: To determine the role of three phase bone scintigraphy & delayed SPECT/CT in detection of skull base osteomyelitis in patients with malignant otitis externa. Material and Methods: Clinical records of 20 patients (14 Male & 6 Female; mean age 72 yrs) of otitis externa with suspected skull base involvement referred for bone scintigraphies were analyzed retrospectively. Three phase bone scintigraphy was acquired under dual detector gamma camera after intravenous injection of 20 mCi (740 MBq) 99mTc-MDP followed by SPECT/CT of the skull. Scintigraphic findings were compared with clinical symptoms, signs & diagnostic CT scan findings. Results: All the patients except one were diabetic & having elevated ESR. 18 patients presented with bilateral symptoms & rest unilateral. Cranial nerves were involved in 8 patients (40%). Ear discharge culture sensitivity report was found in three patients; it was positive for  Pseudomonas aeruginosa Scientific Name Search r two patients & in Diptheroids for one. In 9 patients (45%) increased flow of tracer & 10 patients (50%) increased blood pool phase in the temporal region was found. Delayed phase images showed increased uptake in skull bone in 19 patients (95%). Hybrid SPECT/CT of the skull localized areas of increased tracer uptake to the mastoid part in 15 patients (75%), petrous part in 11 patients (55%), sphenoid in 3 patients (15%) & zygomatic bone in one patient (5%) with CT showing destructive changes in 5 patients (25%) which were corroborated with diagnostic CT findings. SPECT/CT along with three phase bone scan findings were suggestive of active inflammation in 10 patients (50%) which changed the management in 5 patients (25%). Conclusion: Three phase bone scintigraphy & Hybrid SPECT/CT is a sensitive modality in detection of skull base osteomyelitis in cases of malignant otitis externa.

Keywords: SPECT/CT, skull base osteomyelitis, malignant otitis externa


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