Quantitative capabilities of four state-of-the-art SPECT-CT cameras

BACKGROUND Four state-of-the-art single-photon emission computed tomography-computed tomography (SPECT-CT) systems, namely Philips Brightview, General Electric Discovery NM/CT 670 and Infinia Hawkeye 4, and Siemens Symbia T6, were investigated in terms of accuracy of attenuation and scatter correction, contrast recovery for small hot and cold structures, and quantitative capabilities when using their dedicated three-dimensional iterative reconstruction with attenuation and scatter corrections and resolution recovery. METHODS The National Electrical Manufacturers Association (NEMA) NU-2 1994 phantom with cold air, water, and Teflon inserts, and a homemade contrast phantom with hot and cold rods were filled with 99mTc and scanned. The acquisition parameters were chosen to provide adequate linear and angular sampling and high count statistics. The data were reconstructed using Philips Astonish, General Electric Evolution for Bone, or Siemens Flash3D, eight subsets, and a varying number of iterations. A procedure similar to the one used in positron emission tomography (PET) allowed us to obtain the factor to convert counts per pixel into activity per unit volume. RESULTS Edge and oscillation artifacts were observed with all phantoms and all systems. At 30 iterations, the residual fraction in the inserts of the NEMA phantom fell below 3.5%. Contrast recovery increased with the number of iterations but became almost saturated at 24 iterations onwards. In the uniform part of the NEMA and contrast phantoms, a quantification error below 10% was achieved. CONCLUSIONS In objects whose dimensions exceeded the SPECT spatial resolution by several times, quantification seemed to be feasible within 10% error limits. A partial volume effect correction strategy remains necessary for the smallest structures. The reconstruction artifacts nevertheless remain a handicap on the road towards accurate quantification in SPECT and should be the focus of further works in reconstruction tomography.