Fusion imaging of computed tomographic pulmonary angiography and SPECT ventilation/perfusion scintigraphy: initial experience and potential benefit

  • Benjamin HarrisEmail author
  • Dale Bailey
  • Paul Roach
  • Elizabeth Bailey
  • Gregory King
Original article



The objective of this study was to examine the feasibility of fusing ventilation and perfusion data from single-photon emission computed tomography (SPECT) ventilation perfusion (V/Q) scintigraphy together with computed tomographic pulmonary angiography (CTPA) data. We sought to determine the accuracy of this fusion process. In addition, we correlated the findings of this technique with the final clinical diagnosis.


Thirty consecutive patients (17 female, 13 male) who had undergone both CTPA and SPECT V/Q scintigraphy during their admission for investigation of potential pulmonary embolism were identified retrospectively. Image datasets from these two modalities were co-registered and fused using commercial software. Accuracy of the fusion process was determined subjectively by correlation between modalities of the anatomical boundaries and co-existent pleuro-parenchymal abnormalities.


In all 30 cases, SPECT V/Q images were accurately fused with CTPA images. An automated registration algorithm was sufficient alone in 23 cases (77%). Additional linear z-axis scaling was applied in seven cases. There was accurate topographical co-localisation of vascular, parenchymal and pleural disease on the fused images. Nine patients who had positive CTPA performed as an initial investigation had co-localised perfusion defects on the subsequent fused CTPA/SPECT images. Three of the 11 V/Q scans initially reported as intermediate could be reinterpreted as low probability owing to co-localisation of defects with parenchymal or pleural pathology.


Accurate fusion of SPECT V/Q scintigraphy to CTPA images is possible. This technique may be clinically useful in patients who have non-diagnostic initial investigations or in whom corroborative imaging is sought.


CT V/Q Pulmonary embolism SPECT Fusion 



This work was supported by the Northern Sydney Health Staff Specialist Scholarship 2005.


  1. 1.
    Dalen JE, Alpert JS. Natural history of pulmonary embolism. Prog Cardiovasc Dis 1975;17:259–70PubMedCrossRefGoogle Scholar
  2. 2.
    British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development G. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism. Thorax 2003;58:470–83CrossRefGoogle Scholar
  3. 3.
    Wagner HN, Sabiston DC, McAfee JG, Tow D, Stern HS. Diagnosis of massive pulmonary embolism in man by radioisotope scanning. N Engl J Med 1964;71:377–84PubMedCrossRefGoogle Scholar
  4. 4.
    The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990;2639:2753–9CrossRefGoogle Scholar
  5. 5.
    Safriel Y, Zinn H. CT pulmonary angiography in the detection of pulmonary emboli: a meta-analysis of sensitivities and specificities. Clin Imaging 2002;26:101–5PubMedCrossRefGoogle Scholar
  6. 6.
    Van Strijen MJL, De Monye W, Kieft GJ, Pattynama PMT, Prins MH, Huisman MV. Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy. J Thromb Haemost 2005;3:17–25PubMedCrossRefGoogle Scholar
  7. 7.
    Studholme C, Hill D, Hawkes D. Automated three-dimensional registration of magnetic resonance and positron emission tomography brain images by multiresolution optimization of voxel similarity measures. Med Phys 1997;24:25–35PubMedCrossRefGoogle Scholar
  8. 8.
    Gottschalk A, Sostman HD, Coleman RE, Juni JE, Thrall J, McKusick KA, et al. Ventilation-perfusion scintigraphy in the PIOPED study. Part II. Evaluation of the scintigraphic criteria and interpretations. J Nucl Med 1993;34:1119–26PubMedGoogle Scholar
  9. 9.
    Maki DD, Gefter WB, Alavi A Recent advances in pulmonary imaging. Chest 1999;116:1388–402PubMedCrossRefGoogle Scholar
  10. 10.
    Jones DK, Horsfield MA, Simmons A. Optimal strategies for measuring diffusion in anisotropic systems by magnetic resonance imaging. Magn Reson Med 1999;42:515–25PubMedCrossRefGoogle Scholar
  11. 11.
    Meyer JH, Kapur S, Eisfeld B, Brown GM, Houle S, DaSilva J, et al. The effect of paroxetine on 5-HT2A receptors in depression: an [18F]setoperone PET imaging study. Am J Psychiatry 2001;158:78–85PubMedCrossRefGoogle Scholar
  12. 12.
    Thurfjell L, Lau YH, Andersson JLR, Hutton BF. Improved efficiency for MRI-SPET registration based on mutual information. Eur J Nucl Med Mol Imaging 2000;27:847–56CrossRefGoogle Scholar
  13. 13.
    Shekhar R, Zagrodsky V. Mutual information-based rigid and nonrigid registration of ultrasound volumes. IEEE Trans Med Imaging 2002;21:9–22PubMedCrossRefGoogle Scholar
  14. 14.
    Suga K, Kawakami Y, Zaki M, Yamashita T, Seto A, Matsumoto T, et al. Assessment of regional lung functional impairment with co-registered respiratory-gated ventilation/perfusion SPET-CT images: initial experiences. Eur J Nucl Med Mol Imaging 2004;31:240–9PubMedCrossRefGoogle Scholar
  15. 15.
    Zaki M, Suga K, Kawakami Y, Yamashita T, Shimizu K, Seto A, et al. Preferential location of acute pulmonary thromboembolism induced consolidative opacities: assessment with respiratory gated perfusion SPECT-CT fusion images. Nucl Med Commun 2005;26:465–74PubMedCrossRefGoogle Scholar
  16. 16.
    Suga K, Kawakami Y, Zaki M, Yamashita T, Shimizu K, Matsunaga N. Clinical utility of co-registered respiratory-gated 99mTc-Technegas/MAA SPECT-CT images in the assessment of regional lung functional impairment in patients with lung cancer. Eur J Nucl Med Mol Imaging 2004;31:1280–90.PubMedCrossRefGoogle Scholar
  17. 17.
    Woods R, Maziotta J, Cherry S. MRI-PET registration with automated algorithm. J Comput Assist Tomogr 1993;17:536–46PubMedCrossRefGoogle Scholar
  18. 18.
    Hutton BF, Braun M, Thurfjell L, Lau DY. Image registration: an essential tool for nuclear medicine. Eur J Nucl Med Mol Imaging 2002;29:559–77PubMedCrossRefGoogle Scholar
  19. 19.
    Gutman F, Hangard G, Gardin I, Varmenot N, Pattyn J, Clement J. Evaluation of a rigid registration method of lung perfusion SPECT and thoracic CT. Am J Roentgenol 2005;185:1516–24CrossRefGoogle Scholar
  20. 20.
    Goerres GW, Kamel E, Heidelberg TH, Schwitter MR, Burger C, von Schulthess GK. PET-CT image co-registration in the thorax: influence of respiration. Eur J Nucl Med Mol Imaging 2002;29:351–60PubMedCrossRefGoogle Scholar
  21. 21.
    Musset D, Parent F, Meyer G, Maitre S, Girard P, Leroyer C, et al. Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet 2002;360:1914–20PubMedCrossRefGoogle Scholar
  22. 22.
    Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 2004;230:329–37PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Benjamin Harris
    • 1
    • 2
    Email author
  • Dale Bailey
    • 3
    • 5
  • Paul Roach
    • 3
  • Elizabeth Bailey
    • 3
  • Gregory King
    • 1
    • 2
    • 4
  1. 1.Department of Respiratory MedicineRoyal North Shore HospitalSt LeonardsAustralia
  2. 2.Northern Clinical School, Faculty of MedicineUniversity of SydneySydneyAustralia
  3. 3.Department of Nuclear MedicineRoyal North Shore HospitalSt LeonardsAustralia
  4. 4.The Woolcock Institute of Medical ResearchCamperdownAustralia
  5. 5.Schools of Physics and Medical Radiation ScienceUniversity of SydneySydneyAustralia

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