Medical & Biological Engineering & Computing

, Volume 57, Issue 7, pp 1581–1590 | Cite as

Absolute radiotracer concentration measurement using whole-body solid-state SPECT/CT technology: in vivo/in vitro validation

  • John A. KennedyEmail author
  • Ilya Reizberg
  • Rachel Lugassi
  • Shoham Himmelman
  • Zohar Keidar
Original Article


The accuracy of recently approved quantitative clinical software was determined by comparing in vivo/in vitro measurements for a solid-state cadmium-zinc-telluride SPECT/CT (single photon emission computed tomography/x-ray computed tomography) camera. Bone SPECT/CT, including the pelvic region in the field of view, was performed on 16 patients using technetium-99m methylene diphosphonic acid as a radiotracer. After imaging, urine samples from each patient provided for the measurement of in vitro radiopharmaceutical concentrations. From the SPECT/CT images, three users measured in vivo radiotracer concentration and standardized uptake value (SUV) for the bladder using quantitative software (Q.Metrix, GE Healthcare). Linear regression was used to validate any in vivo/in vitro identity relations (ideally slope = 1, intercept = 0), within a 95% confidence interval (CI). Thirteen in vivo/in vitro pairs were available for further analysis, after rejecting two as clinically irrelevant (SUVs > 100 g/mL) and one as an outlier (via Cook’s distance calculations). All linear regressions (R2 ≥ 0.85, P < 0.0001) provided identity in vivo/in vitro relations (95% CI), with SUV averages from all users giving a slope of 0.99 ± 0.25 and intercept of 0.14 ± 5.15 g/mL. The average in vivo/in vitro residual difference was < 20%. Solid-state SPECT/CT imaging can reliably provide in vivo urinary bladder radiotracer concentrations within approximately 20% accuracy. This practical, non-invasive, in vivo quantitation method can potentially improve diagnosis and assessment of response to treatment.

Graphical abstract


SPECT/CT Quantitation Cadmium-zinc-telluride CZT 


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Jaszczak RJ (2006) The early years of single photon emission computed tomography (SPECT): an anthology of selected reminiscences. Phys Med Biol 51(13):R99–R115CrossRefPubMedGoogle Scholar
  2. 2.
    Moses WW, Gayshan V, Gektin A (2006) The evolution of SPECT—from Anger to today and beyond. In: Tavernier S, Gektin A, Grinyov B, Moses WW (eds) Radiation detectors for medical applications. Springer, Dordrecht, pp 37–80CrossRefGoogle Scholar
  3. 3.
    Jaszczak RJ, Coleman RE, Lim CB (1980) SPECT: Single photon emission computed tomography. IEEE Trans Nucl Sci 27(3):1137–1153CrossRefGoogle Scholar
  4. 4.
    Camargo EE (2001) Brain SPECT in neurology and psychiatry. J Nucl Med 42(4):611–623PubMedGoogle Scholar
  5. 5.
    Madsen MT (2007) Recent advances in SPECT imaging. J Nucl Med 48(4):661–673CrossRefPubMedGoogle Scholar
  6. 6.
    Chowdhury FU, Scarsbrook AF (2008) The role of hybrid SPECT-CT in oncology: current and emerging clinical applications. Clin Radiol 63(3):241–251CrossRefPubMedGoogle Scholar
  7. 7.
    Germano G, Berman DS (2008) Clinical gated cardiac SPECT. Wiley, New YorkGoogle Scholar
  8. 8.
    Schillaci O (2005) Hybrid SPECT/CT: a new era for SPECT imaging? Eur J Nucl Med Mol Imaging 32(5):521–524CrossRefPubMedGoogle Scholar
  9. 9.
    Mariani G, Bruselli L, Kuwert T et al (2010) A review on the clinical uses of SPECT/CT. Eur J Nucl Med Mol Imaging 37(10):1959–1985CrossRefPubMedGoogle Scholar
  10. 10.
    Bockisch A, Freudenberg LS, Schmidt D, Kuwert T (2009) Hybrid imaging by SPECT/CT and PET/CT: proven outcomes in cancer imaging. Semin Nucl Med 39(4):276–289CrossRefPubMedGoogle Scholar
  11. 11.
    Na CJ, Kim J, Choi S et al (2015) The clinical value of hybrid sentinel lymphoscintigraphy to predict metastatic sentinel lymph nodes in breast cancer. Nucl Med Mol Imaging 49(1):26–32CrossRefPubMedGoogle Scholar
  12. 12.
    Seo HJ, Ryu YH, Lee I et al (2015) Usefulness of (131)I-SPECT/CT and (18)F-FDG PET/CT in evaluating successful (131)I and retinoic acid combined therapy in a patient with metastatic struma ovarii. Nucl Med Mol Imaging 49(1):52–56CrossRefPubMedGoogle Scholar
  13. 13.
    Suh M, Cheon GJ, Seo HJ, Kim HH, Lee DS (2015) Usefulness of additional SPECT/CT identifying lymphatico-renal shunt in a patient with chyluria. Nucl Med Mol Imaging 49(1):61–64CrossRefPubMedGoogle Scholar
  14. 14.
    Bailey DL, Willowson KP (2013) An evidence-based review of quantitative SPECT imaging and potential clinical applications. J Nucl Med 54:83–89CrossRefPubMedGoogle Scholar
  15. 15.
    King MA, Coleman M, Penney BC, Glick SJ (1991) Activity quantitation in SPECT: a study of prereconstruction Metz filtering and the use of the scatter degradation factor. Med Phys 18:184–189CrossRefPubMedGoogle Scholar
  16. 16.
    Walrand SHM, van Elmbt LR, Pauwels S (1994) Quantitation in SPECT using an effective model of the scattering. Phys Med Biol 39:719–734CrossRefPubMedGoogle Scholar
  17. 17.
    Blankespoor SC, Wu X, Kalki K et al (1996) Attenuation correction of SPECT using x-ray CT on an emission-transmission CT system: myocardial perfusion assessment. IEEE Trans Nucl Sci 43:2263–2274CrossRefGoogle Scholar
  18. 18.
    Da Silva AJ, Tang HR, Wong KH et al (2001) Absolute quantification of regional myocardial uptake of 99mTc-sestamibi with SPECT: experimental validation in a porcine model. J Nucl Med 42:772–779PubMedGoogle Scholar
  19. 19.
    Vandervoort E, Celler A, Harrop R (2007) Implementation of an iterative scatter correction, the influence of attenuation map quality and their effect on absolute quantitation in SPECT. Phys Med Biol 52:1527–1545CrossRefPubMedGoogle Scholar
  20. 20.
    Israel O, Front D, Hardoff R et al (1991) In vivo SPECT quantitation of bone metabolism in hyperparathyroidism and thyrotoxicosis. J Nucl Med 32:1157–1161PubMedGoogle Scholar
  21. 21.
    Israel O, Keidar Z, Rubinov R, Iosilevski G, Frenkel A, Kuten A, Betman L, Kolodny GM, Yarnitsky D, Front D (2000) Quantitative bone single-photon emission computed tomography for prediction of pain relief in metastatic bone disease treated with rhenium-186 etidronate. J Clin Oncol 18:2747–2754CrossRefPubMedGoogle Scholar
  22. 22.
    Kim J, Lee HH, Kang Y, Kim TK, Lee SW, So Y, Lee WW (2017) Maximum standardised uptake value of quantitative bone SPECT/CT in patients with medial compartment osteoarthritis of the knee. Clin Radiol 72(7):580–589CrossRefPubMedGoogle Scholar
  23. 23.
    National Electrical Manufacturers Association (2012) Performance measurements of gamma cameras: NEMA standards publication NU 1–2012. NEMA, RosslynGoogle Scholar
  24. 24.
    Bocher M, Blevis IM, Tsukerman L, Shrem Y, Kovalski G, Volokh L (2010) A fast cardiac gamma camera with dynamic SPECT capabilities: design, system validation and future potential. Eur J Nucl Med Mol Imaging 37:1887–1902CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hatt M, Le Rest CC, Albarghach N, Pradier O, Visvikis D (2011) PET functional volume delineation: a robustness and repeatability study. Eur J Nucl Med Mol Imaging 38(4):663–672CrossRefPubMedGoogle Scholar
  26. 26.
    Bollen KA, Jackman RW (1990) Regression diagnostics: an expository treatment of outliers and influential cases. In: Fox J, Long JS (eds) Modern methods of data analysis. Sage, Newbury Park, pp 257–291Google Scholar
  27. 27.
    MATLAB and Statistics Toolbox Release 2015b (2015) The MathWorks, Inc., Natick, Massachusetts, United StatesGoogle Scholar
  28. 28.
    Cherry SR, Sorenson JA, Phelps ME (2012) Physics in nuclear medicine, fourth edition. Elsevier, Philadelphia PAGoogle Scholar
  29. 29.
    Zeintl J, Vija AH, Yahil A, Hornegger J, Kuwert T (2010) Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximization with 3-dimensional resolution recovery, attenuation, and scatter correction. J Nucl Med 51:921–928CrossRefPubMedGoogle Scholar
  30. 30.
    Meikle S, Kyme AZ, Kench P, Boisson F, Parmar A (2017) Preclinical PET and SPECT. In: Dahlbom M (ed) Physics of PET and SPECT imaging. CRC press. Taylor & Francis Group, New York, pp 413–438CrossRefGoogle Scholar
  31. 31.
    Boellaard R (2009) Standards for PET image acquisition and quantitative data analysis. J Nucl Med 50:11S–20SCrossRefGoogle Scholar
  32. 32.
    Takahashi Y, Oriuchi N, Otake H et al (2008) Variability of lesion detectability and standardized uptake value according to the acquisition procedure and reconstruction among five PET scanners. Ann Nucl Med 22:543–548CrossRefPubMedGoogle Scholar
  33. 33.
    Boellaard R, Oyen WJG, Hoekstra CJ et al (2008) The Netherlands protocol for standardisation and quantification of FDG whole body PET studies in multi-centre trials. Eur J Nucl Med Mol Imaging 35:2320–2333CrossRefPubMedGoogle Scholar
  34. 34.
    Lodge MA, Chaudhry MA, Wahl RL (2012) Noise considerations for PET quantification using maximum and peak standardized uptake value. J Nucl Med 53:1041–1047CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2019

Authors and Affiliations

  1. 1.Department of Nuclear MedicineRambam Health Care CampusHaifaIsrael
  2. 2.The Ruth & Bruce Rappaport Faculty of MedicineTechnion–Israel Institute of TechnologyHaifaIsrael

Personalised recommendations