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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
Online ISSN 1827-1936
Knešaurek K. 1, Kolker D. 2, Vatti S. 3, Heiba S. 1
1 Division of Nuclear Medicine, Department of Radiology, The Mount Sinai Medical Center, New York, NY, USA;
2 Department of Orthopedics, The Mount Sinai Medical Center, New York, NY, USA;
3 Department of Radiology/Musculature skeleton Division, The Mount Sinai Medical Center, New York, NY, USA
AIM: The purpose of our study was to correctly fuse MRI and SPECT 111In WBC and 99m Tc HDP images using companion CT images. The fused images could be used to assess proper surgical approach in treatment of the diabetic foot.
METHODS: Nine patients who had dual energy 111In WBC/ 99m Tc HDP SPECT/CT and MRI studies within a week were investigated in an ongoing project. A GE Infinia SPECT/CT camera and Siemens MAGNETOM 1.5T MR system were used in this study. First, the MRI and corresponding CT images were coregistrated using a transformation based on normalized mutual information. The transformation was saved and used for MRI and 111In WBC/ 99m Tc HDP SPECT fusion. A Jaszczak phantom study was also performed in order to estimate accuracy of MRI/ SPECT fusion.
RESULTS: The Jaszczak phantom study with 3.7 MBq 111In hot sphere showed that MRI/SPECT alignment using the approach described above produced registration with 0.7±0.4 mm accuracy in all three dimensions (3D). The nine clinical cases were visually evaluated and showed 1-2 mm 3D fusion accuracy. MRI provides almost perfect anatomy of soft tissue and bony structures but it may exaggerate the extent of infection. 111In WBC/99m Tc HDP SPECT imaging is more accurate for infection detection but lacks anatomical reference. Combination of these images proved an essential adjunct to diagnosis. A clinical utility of the approach is illustrated in two clinical examples.
CONCLUSION: The CT in dual energy 111In WBC/99m Tc HDP SPECT/CT studies can be used to accurately fuse and compare 111In WBC/99m Tc HDP SPECT and MRI images of the diabetic foot. This can significantly help in conservative treatment planning and limb salvage procedures in treatment of diabetic foot infections.