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Annals of Nuclear Medicine

, Volume 27, Issue 10, pp 942–950 | Cite as

Radio-guided sentinel lymph node identification by lymphoscintigraphy fused with an anatomical vector profile: clinical applications

  • A. Niccoli AsabellaEmail author
  • F. Antonica
  • M. A. Renna
  • D. Rubini
  • A. Notaristefano
  • A. Nicoletti
  • G. Rubini
Technical note

Abstract

Objective

To develop a method to fuse lymphoscintigraphic images with an adaptable anatomical vector profile and to evaluate its role in the clinical practice.

Methods

We used Adobe Illustrator CS6 to create different vector profiles, we fused those profiles, using Adobe Photoshop CS6, with lymphoscintigraphic images of the patient. We processed 197 lymphoscintigraphies performed in patients with cutaneous melanomas, breast cancer or delayed lymph drainage.

Results

Our models can be adapted to every patient attitude or position and contain different levels of anatomical details ranging from external body profiles to the internal anatomical structures like bones, muscles, vessels, and lymph nodes. If needed, more new anatomical details can be added and embedded in the profile without redrawing them, saving a lot of time. Details can also be easily hidden, allowing the physician to view only relevant information and structures. Fusion times are about 85 s. The diagnostic confidence of the observers increased significantly. The validation process showed a slight shift (mean 4.9 mm).

Conclusions

We have created a new, practical, inexpensive digital technique based on commercial software for fusing lymphoscintigraphic images with built-in anatomical reference profiles. It is easily reproducible and does not alter the original scintigraphic image. Our method allows a more meaningful interpretation of lymphoscintigraphies, an easier recognition of the anatomical site and better lymph node dissection planning.

Keywords

Fusion Vector Planar Scintigraphy Clinical Adaptable Profile 

Notes

Acknowledgments

I certify that neither I nor any member of my immediate family has a material personal or financial relationship with any offeror, or to a direct competitor of any offeror under consideration by this proposal evaluation committee. I further certify that no other relationship, bias or ethical conflict exists which will prevent me from evaluating any proposal solely on its merits and in accordance with the Request for Proposal’s evaluation criteria. Furthermore, I agree to notify the Procurement Officer if my personal or financial relationship with one of the offerors is altered at any time during the evaluation process. If I am serving as the Procurement Officer of record I agree to advise my supervisor of any changes that could appear to represent a conflict of interest.

References

  1. 1.
    Niccoli Asabella A, Gatti P, Notaristefano A, Iuele F, Altini C, Rubini G. F-18 PET/CT in the diagnosis of a rare case of neurosarcoidosis in a patients with diabetes insipidus. Clin Nucl Med. 2011;36(9):795–7.CrossRefGoogle Scholar
  2. 2.
    Niccoli Asabella A, Cimmino A, Altini C, Notaristefano A, Rubini G. 18F-FDG positron emission tomography/computed tomography and 99mTc-MDP skeletal scintigraphy in a case of Erdheim-Chester disease. Hell J Nucl Med. 2011;14(3):311–2.Google Scholar
  3. 3.
    Roselli F, Pisciotta NM, Perneczky R, Pennelli M, Aniello MS, De Caro MF, et al. Severity of neuropsychiatric symptoms and dopamine transporter levels in dementia with Lewy bodies: a 123I-FP-CIT SPECT study. Mov Disord. 2009;24(14):2097–103.PubMedCrossRefGoogle Scholar
  4. 4.
    Niccoli Asabella A, Altini C, Notaristefano A, Iuele F, Rubini G. Contrast enhancement computed tomography and 18-Fluorine-Labelled 2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography correlation in the management of a patient with primary mediastinal seminoma and candidate to liver transplant. Gazz Med Ital. 2011;174:6.Google Scholar
  5. 5.
    Delbeke D, Sandler MP. The role of hybrid cameras in oncology. Semin Nucl Med. 2000;30:268–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Israel O, Keidar Z, Iosilevsky G, Bettman L, Sachs J, Frenkel A. The fusion of anatomic and physiologic imaging in the management of patients with cancer. Semin Nucl Med. 2001;31:191–205.PubMedCrossRefGoogle Scholar
  7. 7.
    Townsend DW, Cherry SR. Combining anatomy and function: the path to true image fusion. Eur Radiol. 2001;11(1):968–1974.Google Scholar
  8. 8.
    Patton JA, Townsend DW, Hutton BF. Hybrid imaging technology: from dreams and vision to clinical devices. Semin Nucl Med. 2009;39:247–63.PubMedCrossRefGoogle Scholar
  9. 9.
    Levin DN, Pelizzari CA, Chen GT, Chen CT, Cooper MD. Retrospective geometric correlation of MR, CT, and PET images. Radiology. 1988;169:817–23.PubMedGoogle Scholar
  10. 10.
    Hill DL, Hawkes DJ, Crossman JE, Gleeson MJ, Cox TC, Bracey EE, et al. Registration of MR and CT images for skull base surgery using point-like anatomical features. Brit J Radiol. 1991;64:1030–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Juengling FD, Kassubek J, Högerle S, Nitzsche EU, Moser E. SMART-PET: multimodality white matter imaging and display without loss of quantitative information. J Magn Reson Imaging. 2002;15:456–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Pelizzari CA, Chen GT, Spelbring DR, Weichselbaum RR, Chen CT. Accurate three-dimensional registration of CT, PET, and/or MR images of the brain. J Comput Assist Tomogr. 1989;13:20–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Viergever MA, Maintz JBA, Stokking R. Integration of functional and anatomical brain images. Biophys Chem. 1997;68:207–19.PubMedCrossRefGoogle Scholar
  14. 14.
    Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41:1369–79.PubMedGoogle Scholar
  15. 15.
    Zuckier LS. Hybrid imaging in planar scintigraphy: new implementations and historical precedents. Semin Nucl Med. 2012;42(1):62–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Currie GM, Wheat JM, Pearce RD. Planar image fusion. Internet J Nucl Med 2007, 4.Google Scholar
  17. 17.
    Dickinson RL, Erwin WD, Stevens DM, Bidaut LM, Mar MV, Macapinlac HA, et al. Hybrid modality fusion of planar scintigrams and CT topograms to localize sentinel lymph nodes in breast lymphoscintigraphy: Technical description and phantom studies. Int J Mol Imaging 2011. doi: 10.1155/2011/298102.
  18. 18.
    Hawkes DJ, Robinson L, Crossman JE, et al. Registration and display of the combined bone scan and radiograph in the diagnosis and management of wrist injuries. Eur J Nucl Med. 1991;18:752–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Hutton BF, Braun M. Software for image registration: algorithms, accuracy, efficacy. Semin Nucl Med. 2003;33:180–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Adobe Systems Inc. About brushes. In: Adobe help and tutorials—illustrator. http://help.adobe.com/en_US/illustrator/cs/using/WS714a382cdf7d304e7e07d0100196cbc5f-64faa.html. Accessed 27 Mar 2013.
  21. 21.
    Adobe Systems Inc. Layers panel overview. In: Adobe help and tutorials—illustrator. http://help.adobe.com/en_US/illustrator/cs/using/WS714a382cdf7d304e7e07d0100196cbc5f-62d8a.html. Accessed 27 Mar 2013.
  22. 22.
    Adobe Systems Inc. Drawing with the pencil tool. In: Adobe help and tutorials—illustrator. http://help.adobe.com/en_US/illustrator/cs/using/WS3f28b00cc50711d9-2cf89fa2133b344d448-8000.html#WS4CCAA516-C476-4cd9-B36A-DB88AD124DBA. Accessed 27 Mar 2013.
  23. 23.
    Adobe Systems Inc. About adjustment and fill layers. In: Adobe help and tutorials—photoshop. http://help.adobe.com/en_US/photoshop/cs/using/WSfd1234e1c4b69f30ea53e41001031ab64-787ba.html. Accessed 27 Mar 2013.
  24. 24.
    Adobe Systems Inc. Layer style dialog box overview. In: Adobe help and tutorials—photoshop. http://help.adobe.com/en_US/photoshop/cs/using/WSfd1234e1c4b69f30ea53e41001031ab64-789ba.html#WS76DA9F39-FFFA-4f3c-AC89-89FD52A84C02a. Accessed 27 Mar 2013.
  25. 25.
    Adobe Systems Inc. Puppet warp. In: Adobe help and tutorials—photoshop. http://help.adobe.com/en_US/photoshop/cs/using/WS36B5BBD7-ACCE-4608-AF31-9DACE770576A.html#WS2b33cd566cc765715d0271451243bc8da1d-7ffe. Accessed 27 Mar 2013.
  26. 26.
    Imielinska C, Downes MS, Yuan W. Semi-automated color segmentation of anatomical tissue. Comput Med Imaging Graph. 2000;24(3):173–80.CrossRefGoogle Scholar
  27. 27.
    Kirchgeorg MA, Prokop M. Increasing spiral CT benefits with postprocessing applications. Eur J Radiol. 1998;28(1):39–54.PubMedCrossRefGoogle Scholar
  28. 28.
    Mettler FA Jr, Thomadsen BR, Bhargavan M, Gilley DB, Gray JE, Lipoti JA, et al. Medical radiation exposure in the US in 2006: preliminary results. Health Phys. 2008;95:502–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Lee CI, Enzmann DR. Measuring radiology’s value in time saved. J Am Coll Radiol. 2012;9(10):713–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Takanami K, Ichikawa H, Fukuda H, Takahashi S. Three-dimensional lymphoscintigraphy using SPECT/CT and 123I-BMIPP for the preoperative detection of anatomical anomalies of the thoracic duct. Clin Nucl Med. 2012;37(11):1047–51.PubMedCrossRefGoogle Scholar
  31. 31.
    Wendler T, Hartl A, Lasser T, Traub J, Daghighian F, Ziegler SI, Navab N. Towards intra-operative 3D nuclear imaging: reconstruction of 3D radioactive distributions using tracked gamma probes. Med Image Comput Comput Assist Interv. 2007;10(Pt 2):909–17.PubMedGoogle Scholar
  32. 32.
    Park JS, Chung MS, Hwang SB, Lee YS, Har D. Technical report on semiautomatic segmentation using the adobe photoshop. J Digit Imaging. 2005;18(4):333–43.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Akcay I, Ilhan B, Dundar N. Comparison of conventional and digital radiography systems with regard to radiopacity of root canal filling materials. Int Endod J. 2012;45(8):730–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Gross JA, Thapa MM. Software aids for radiologists: Part 1, Useful photoshop skills. AJR Am J Roentgenol. 2012;199(6):W704–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Adobe Systems Inc. About DICOM files (Photoshop Extended). In: adobe help and tutorials—photoshop. http://help.adobe.com/en_US/photoshop/cs/using/WS2748158C-26B7-42cd-A660-F899C3516BA9a.html. Accessed 27 Mar 2013.
  36. 36.
    Adobe Systems Inc. About Smart objects. In: Adobe help and tutorials—photoshop. http://help.adobe.com/en_US/photoshop/cs/using/WS41A5B796-6846-4e95-8459-95243441E126.html#WSCCBCA4AB-7821-4986-BC03-4D1045EF2A57a. Accessed 27 Mar 2013.
  37. 37.
    D’Eredità G, Troilo VL, Fischietti F, Rubini G, Berardi T. Comparison of two models for predicting non-sentinel lymph node metastases in sentinel lymph node metastases in sentinel lymph node-positive breast cancer patients. Updat Surg. 2011;63(3):163–70.CrossRefGoogle Scholar
  38. 38.
    Camilleri G, Borg Grima K, Zarb F. Correlation of number and identification of sentinel nodes during radiographer led lymphoscintigraphy prior to sentinel lymph node biopsy in breast cancer patients. Radiography. 2012;18(1):9–14.CrossRefGoogle Scholar
  39. 39.
    Puthiamadathil J, Zuckier L, Dhawan A. Planar visual fusion scintigraphy. Conf Proc IEEE Eng Med Biol Soc. 2004;3:1726–9.PubMedGoogle Scholar
  40. 40.
    Zuckier LS, Koncicki HM. New applications of planar image fusion in clinical nuclear medicine and radiology. Conf Proc IEEE Eng Med Biol Soc. 2006;1:1576–9.PubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2013

Authors and Affiliations

  • A. Niccoli Asabella
    • 1
    Email author
  • F. Antonica
    • 1
  • M. A. Renna
    • 1
  • D. Rubini
    • 1
  • A. Notaristefano
    • 1
  • A. Nicoletti
    • 1
  • G. Rubini
    • 1
  1. 1.DIM, Unità di Medicina Nucleare-RadiodiagnosticaUniversità degli studi di BariBariItaly

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