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エビデンスから考える骨シンチグラフィ

 エビデンスから考える骨シンチグラフィ

千葉核医学研究会 2022.5.20

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ICHIKAWA H.

May 20, 2022
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  1. 豊橋市⺠病院 放射線技術室 ⾦沢⼤学 医薬保健研究域 研究協⼒員 市川 肇 第108回 千葉核医学技術研究会 2022.5.20

  2. この講演内容に関する利益相反事項が ☑ あります 本講演内容の⼀部(⾻SPECTファントム⾃動解析ソフトウェア︓Hone Graph)は 富⼠フイルム富⼭化学社との共同研究によって開発し,資⾦提供を受けております Disclosure of conflict of

    interest
  3. Evidenceから考える骨シンチグラフィ • ⾻シンチの現状とevidences • SPECT/CTのポジショニングと短時間撮像 • ⾻SPECTの画質評価 Agenda

  4. 全⾝のみ 31% 29% 全⾝+SPECT 17% 14% 5% 4% 全⾝+プラナー+SPECT 230

    ճ౴ 全身+プラナー 全身+SPECT/CT ಄ᰍ෦  ڳ෦  ࠎ൫ʢΛؚΉʣ  େ଼෦  ܱ௣͔Βࠎ൫  ͦͷଞ  全身+プラナー+SPECT/CT ⾻シンチの実態: ルーチンプロトコル Ichikawa H. et al. Asia Ocean J Nucl Med Biol. 2020; 8(2):116-122. (⼀部改変)
  5. ⾻シンチの実態: ルーチンプロトコル 37% 28% 28% 25% 35% 22% 33% 4%

    22% 19% 75% 13% 16% 11% 0% 20% 40% 60% 80% 100% ⼤学病院 公的病院 ⺠間病院 その他 全⾝のみ 全⾝+プラナー 全⾝+SPECT 全⾝+SPECT/CT 全⾝+プラナー+SPECT 全⾝+プラナー+SPECT/CT n=68 n=86 n=72 n=4 Ichikawa H. et al. Asia Ocean J Nucl Med Biol. 2020; 8(2):116-122. (⼀部改変) n = 230
  6. 撮像の追加・省略の判断⽅法 追加:75% 省略:16% Ichikawa H. et al. Asia Ocean J

    Nucl Med Biol. 2020; 8(2):116-122. (⼀部改変)
  7. 追加撮像の判断基準 • ܽଛ૾ΛೝΊΔ • ҩࢣͷࢦࣔ • ᡺ᡦ಺ͷ೘Λഉᔔग़དྷͳ͍৔߹ • அ໘৘ใΛඞཁͱ൑அͨ͠৔߹ •

    ूੵͷॏͳΓΛೝΊΔ • ౰೔ʹCTݕࠪΛ͍ͯ͠ͳ͍৔߹ 23% 13% 35% 3% 89% 2% 20% 14% 15% 0% 20% 40% 60% 80% 100% 初 回 検 査 経 過 観 察 前 回 検 査 と 変 化 あ り 前 回 検 査 と 変 化 な し 異 常 集 積 を 認 め る 異 常 集 積 を 認 め な い 疼 痛 部 位 疾 患 毎 に 取 り 決 め が あ る そ の 他 n=172 (75%) Ichikawa H. et al. Asia Ocean J Nucl Med Biol. 2020; 8(2):116-122. (⼀部改変)
  8. 追加の根拠 0% 20% 40% 60% 文献など 経験則 根拠はない その他 7%

    42% 13% 13%
  9. 画像処理︓全⾝像 有 52% 無 48% BONENAVI 有 16% 無 84%

    ノイズ除去処理
  10. 画像処理︓SPECT 0% 5% 10% 15% 20% 定量画像 フュージョン画像 ソフトウェア フュージョン

    全体 59% 89% 18% 11% 16% 4% NC SC AC ACSC ACSCありとなし 2% 42 % 41 % 8% 7%
  11. 全⾝像 BSI (BONENAVI・VSBONE BSI) 前⽴腺癌患者 BSI of >1% • 病期の進⾏

    • ⽣存期間の短縮 • 癌死亡 Nakajima K. et al. International Journal of Urology (2017) 24, 668-73.(⼀部改変) 0.0 0.2 0.4 AUC EB: 0.94 BN1: 0.95 BN2: 0.96 AUC EB: 0.86 BN1: 0.91 BN2: 0.92 0.0 0.2 0.4 1-Specificity 0.6 0.8 1.0 0.0 0.2 0.4 1-Specificity 0.6 0.8 1.0 Sens 0.0 0.2 0.4 Sen with (a) prostate and (b) breast cancer. The artificial neural network of the software was trained using databases in Sweden (EXINI bone; EB), Japan (BONENAVI 1; BN1) and revised in Japan (BN2). The area under the receiver operating characteristic curve (AUC) is equally high in patients with prostate cancer, but improved with BN2 in patients with breast cancer.12 Table 1 Application of BSI in patients with prostate cancer Author and reference number Year No. patients Patients or study setting BSI cut-off and prognosis Sabbatini et al.13 1999 191 Androgen independent prostate cancer from a randomized trial BSI of <1.4%, 1.4–5.1% and >5.1% (median survivals of 18.3, 15.5 and 8.1 months, respectively) Meirelles et al.23 2010 43 Progressing prostate cancer with bone metastasis BSI >1.27 and <1.27 (median survival of 14.7 and 28.2 months, respectively) Dennis et al.17 2012 81 Metastatic CRPC in four clinical trials Doubling in BSI, 1.9-fold increase in risk of death; change in BSI, prognostic at 3 and 6 months on treatment Mitsui et al.18 2012 42 CRPC patients with taxane-based chemotherapy Reduction in BSI showing longer overall survival Ulmert et al.14 2012 384 Prostate cancer cases in two large population-based cohorts BSI groups of 0, 0.01–1.00 and >1.00 correlated prostate cancer death Kaboteh et al.19 2013 130 High-risk prostate cancer patients receiving primary hormonal therapy 5-year probability of survival: 55% for patients without metastases, 42% for BSI <1, 31% for BSI 1–5 and 0% for BSI >5 Kaboteh et al.24 2013 266 Prostate cancer patients with chemotherapy 2-year survival for patients with increasing and decreasing BSI from baseline to follow-up scans: 18% and 57%, respectively Reza et al.25 2014 146 Prostate cancer patients during androgen deprivation therapy BSI groups of 0, 0.01–1.00 and >1.00 correlated prostate cancer death (5-year survival rates of 80%, 60% and 25%, respectively) Armstrong et al.26 2014 201 Randomized double-blind trial of tasquinimod in men with metastatic CRPC BSI worsening at 12 weeks, prognostic for progression-free survival; patients with BSI >1.0 showing reduced survival Uemura et al.27 2016 41 Patients with metastatic CRPC treated with docetaxel Patients with BSI >1 showing shorter overall survival than patients with BSI ≤1 Miyoshi et al.28 2016 60 Hormone-naive prostate cancer patients with bone metastases Median OS: not reached in patients with BSI ≤1.9, 34.8 months in patients with BSI >1.9 Poulsen et al.29 2016 88 Patients with prostate cancer awaiting initiation of androgen-deprivation therapy Patients with BSI ≥1, significantly shorter overall survival than patients with BSI <1 52% 予後評価においては転移の数 よりもEODが重要 Armstrong AJ . et al. JAMA Oncol. 2018;4(7):944-51
  12. ノイズ除去処理によるANN・BSIへの影響 ݕग़ͨ͠ߴूੵ෦Ґͷ rANN ஋Λࢉग़ͨ͠ɽͳ͓ɼຊ ࿦จͰهड़͢Δϗοτεϙοτ ʢ਺ʣ ͸ BONENAVI Ͱݕ ग़͞ΕͨࠎసҠͷՄೳੑ͕ߴ͍ߴूੵ෦ҐͰ͋ΓɼҰ

    ൠతʹ༻͍ΒΕΔࢹ֮తʹೝΊΔߴूੵ෦Ґͱ͸ศٓ ɽ݁ɹՌ 2-1 શ਎ͰͷධՁ ɹݪը૾͓Αͼॲཧը૾ͷ BONENAVI ղੳ݁ ۉ஋Λ Table 1 ʹɼࢄ෍ਤΛ Fig. 1 ʹࣔ͢ɽࠎస Table 1 Comparison of ANN value, BSI, and number of hotspots for raw and processed images ANN BSI No. of hotspots Bone metastases (n=10) Raw image 0.72±0.30 3.201±4.015 10.2±7.7 Processed image 0.70±0.31 3.193±4.084 9.9±7.5 P value 0.161 0.859 0.317 No bone metastases (n=47) Raw image 0.14±0.19 0.083±0.288 1.5±3.8 Processed image 0.12±0.19 0.070±0.272 1.0±2.5 P value 0.024 0.031 0.006 mean±standard deviation 市川 肇 他. ⽇放技学誌 70(5);2014 461-6. Planar processing Original 投与量の適正化(低投与量化)に伴って有⽤性はさらに⾼まる!? 前⽴腺癌患者57例︓全例 740MBq投与 16%
  13. Clarity 2D processing (Swift scan) www.nature.com/scientificreports/ Figure 4. Quantitative evaluation

    of tumor bone with a reference part for di erent acquisition times in the Swi Scan planar image. (a) Contrat to noise ratio (CNR), (b) the percent of the coe cient of variance (% CV). LEHR low-energy high-resolution, LEHRS low-energy high-resolution and sensitivity. Shibutani T. et al. Scientific Reports 2021; 11:2644 25%収集時間の短縮が可能 m/scientificreports/ Figure 5. e phantom image of Swi Scan planar processing. Upper, middle and lower rows show the 100%, 75% and 50% acquisition time, respectively. e 100% acquisition corresponds to the clinical condition. LEHR
  14. WB SPECT/CT Whole-body SPECT/CTはtarget SPECT/CTよりも病変検出感度が⾼い Rager O. et al. Biomed

    Res Int. 2017; 2017:7039406. Threshold A: ⾻転移(+) Threshold B: ⾻転移(-) Metastatic Total Whole-body SPECT/CT ndings Final diagnosis Nonmetastatic Equivocal Metastatic Total A; nonmetastatic; B equivocal; C metastatic. T : Sensitivity and speci city % con dence intervals (CI) of planar with targeted SPECT/CT versus whole-body SPECT/CT. reshold A reshold B Sensitivity Speci city Sensitivity Speci city WB SPECT/CT ( . ; ) . ( . ; . ) . ( . ; . ) ( . ; ) Targeted SPECT/CT . ( . ; . ) . ( . ; . ) . ( . ; . ) . ( . ; . ) Di erence and exact % CI . [ . – . ] . [− . – . ] . [ . – . ] . [− . – . ] value . . . . T : Repartition of extra-axial scintigraphic ndings on targeted SPECT/CT and whole-body SPECT/CT in relation to nal diagnosis. A B C Total Targeted SPECT/CT ndings Final diagnosis Nonmetastatic
  15. Fusion SPECT/CT SPECT/CTのフュージョンは良悪性の鑑別に有⽤ d be de- dditional spatially s can

    be maps to ECT im- e the ex- the CT mage fu- rrection ons of e the re- ed near c lesion images. itfalls in lesions. tions on efully in- ntigrams d on CT ive fol- able image fusion in the thorax region in kere E, Bombardieri E. Bone scintigraphy Figure 6 Figure 6: Graphs show ROC curves representing findings of scintigraphic image (dashed line), separate datasetsofscintigraphicandCTimages(thinsolidline),andfusedimages(thicksolidline).(a)ROCcurve forreviewer1;(b)ROCcurveforreviewer2.FPFϭfalse-positivefraction,Sϭbonescintigraphicimages alone,andTPFϭtrue-positivefraction. spectedBoneMetastasis Utsunomiyaetal Utsunomiya D. et al. Radiology: 2006 238(1); 264-71. Figure 2 Figure 2: Diagnostic confidence scores of three reviews each for reviewers (a) 1 and (b) 2. (1 ϭ definitely not metastasis, 2 ϭ probably not metastasis, 3 ϭ indeter- minate,4ϭprobablymetastasis,5ϭdefinitelymetastasis.)FusedϭfusedbonescintigraphicandCTimages,Negativeϭactuallynegativecases,Non-fusedϭsepa- NUCLEARMEDICINE:SPECT/CTofSuspectedBoneMetastasis Utsunomiyaetal 89% (18%)
  16. WB SPECT (頭部から⼤腿中部) 2 additional patients scintigraphic studies were normal.

    equivocal reading was categorized as malignant (P , TABLE 3 Detection of Bone Metastases in 24 Study Patients Who Had Multi-FOV Axial-Body SPECT Final diagnosis Spread of metastases (n 5 13) No metastases (n 5 11) Interpretation* Modality M E B/N M E B/N Sensitivity (%) Specificity (%) PPV (%) NPV (%) Planar BS 6 3 4 0 4 7 69 (46) 64 (100) 69 (100) 64 (61) SPECTy 6 6 1 0 2 9 92 (46) 82 (100) 86 (100) 90 (61) 18F-Fluoride PET 6 7 0 0 2 9 100 (46) 82 (100) 87 (100) 100 (61) 18F-Fluoride PET/CT 11 2 0 0 0 11 100 (85) 100 (100) 100 (100) 100 (85) *Analysis considering equivocal results as positive for malignancy. In parentheses, analysis considering equivocal results as negative for malignancy. yMulti-FOV SPECT composed of 3 or 4 FOVs covering the axial skeleton. M 5 malignant; E 5 equivocal; B/N 5 benign or normal. by on November 13, 2018. For personal use only. jnm.snmjournals.org Downloaded from Even-Sapir E., et al. J Nucl Med 2006;47(2): 287−297. 前立腺癌患者において18F-NaF PET/CTには及ばないが, プラナー全身像と比較してSPECTの感度・特異度は高い
  17. SPECTの追加(頸椎から⾻盤) 肺がん患者における前向き試験 Schirrmeister H., et al. J Nucl Med 2001;42(12):

    1800-4. (一部改変) after intravenous eight gadolinium y typical contrast 18F PET, and 2 S complemented PECT by 2 other readers of BS, gs of each other. vailable to the 2 lts. ere classified as sed tracer uptake disk spaces was located at joints d endplates were interpreted as equivocal with SPECT, BS, and 18F PET. The results of planar BS, BS complemented with SPECT, and 18F PET are summarized in Table 1. TABLE 1 Results of Planar BS With and Without SPECT and 18F PET Finding BS BS ϩ SPECT 18F PET True-positive 5 9 11 False-positive 2 0 0 Equivocal 5 (2 BM, 3 benign) 2 (2 BM) 1 (BM) True-negative 35 41 41 False-negative 6 1 0 Total 53 53 53 NaF *撮像時間2〜2.5h
  18. SPECTの追加 不明瞭な集積が検出されるため特異度は低下する Palmedo H. et al. Eur J Nucl Med

    Mol Imaging (2014) 41:59–67 rate of 29.5 % (13/44 patients). No patient was upstaged. ROC analysis The changes in sensitivity and specificity in relation to the applied cut-off values are shown in Fig. 4. In the total patient CT was possible in 32.1 % of breast cancer patients, and in 29. (Table 7). Upstaging of prev Table 6 Sensitivity, specificity, and negative and positive predictive values of whole-body scintigraphy, SPECT and SPECT/CT analysed on a per-patient basis in patients with prostate cancer Modality Sensitivity Specificity Negative predictive value Positive predictive value Whole-body scintigraphy 96.4 % 75.3 % 98.1 % 61.4 % 27/28 52/69 52/53 27/44 SPECT 96.4 % 63.7 % 97.8 % 51.9 % 27/28 44/69 44/45 27/52 SPECT/CT 96.4 % 94.2 % 98.5 % 87.1 % 27/28 65/69 65/66 27/31 Fig. 4 ROC analysis for whole-bod SPECT/CT for different cut-off value static and nonmetastatic patients in th
  19. 定量SPECT画像(SUV) Kaneta T. et al. Am J Nucl Med Mol

    Imaging 2016;6(5):262-268 Kuji et al. European Journal of Hybrid Imaging (2017) 1:2 Table 2 Summary of SUV measurements in the DC and BM groups Total DC BM n mean sd n mean sd n mean sd p T 100 75 25 SUVmax 7.58 2.42 7.52 2.63 7.76 1.69 0.242 SUVpeak 6.51 2.12 6.49 2.30 6.59 1.48 0.399 SUVave 4.62 1.68 4.61 1.86 4.67 0.93 0.292 L 140 101 39 SUVmax 8.12 2.24 7.95 2.37 8.56 1.80 0.020* SUVpeak 6.68 1.93 6.57 2.01 6.97 1.72 0.083 SUVave 4.54 1.38 4.46 1.47 4.76 1.06 0.017* Lesions 240 114 126 SUVmax 29.42 27.45 16.73 6.74 40.90 33.46 <0.001*** SUVpeak 24.50 24.14 13.74 4.52 34.24 29.91 <0.001*** SUVave 17.41 17.30 9.47 3.94 24.59 21.19 <0.001*** MV 23.99 26.16 26.27 26.21 21.92 26.04 0.009** n number, sd standard deviation, T thoracic vertebral body, L lumbar vertebral body, BM bone metastases, DC degenerative changes, ***p < 0.001; **p < 0.01; *p < 0.05 Kuji et al. European Journal of Hybrid Imaging (2017) 1:2 SUV of bone using SPECT/CT Figure 2. Box-and-whisker plots of SUVmax (A), SUVpeak (B) and SUVmean (C), showing a quantitative distribution of 5 standard statistics: Smallest val- Data analysis From the vertebral bodies scanned, all vertebrae exhib- iting any focal SPECT or CT pathology, such as osteoph- yte, metastasis, and compre- ssion fracture, were exclud- ed from the analysis based RQ WKH GLDJQRVLV GHÀQHG E\ D ERDUGFHUWLÀHG UDGLRORJLVW Overall, SUVs of 189 verte- brae were calculated for anal- yses based on the criteria SUHYLRXVO\GHÀQHG The delineation of the vol- umes of interest (VOIs) was performed by a board-certi- ÀHGUDGLRORJLVWXVLQJDQHZO\ released software “G-I bone” provided by Nihon Medi-Ph- ysics Co., Ltd. (Tokyo, Japan), which reports the statistics for the various SUVs, such as max, peak, min, and mean SUV. Cylinder-shaped VOIs th- at covered the complete ver- 59% xSPECT Bone Flash3D
  20. SPECT/CT撮像の判断基準 Shafi A. et al. J Nucl Med Tech. 2014;42(1):28-32.(一部改変)

    トレーニング︓40例 テスト︓10例 current bone scan, a comparison with the previous scan, and pain or injury reported by the patient. The criteria are applied only to patients with known or suspected malignant disease who are undergoing routine bone scanning for screening or follow-up. For other indications, the nuclear medicine physician makes the decision regarding SPECT/CT (Table 1). between August and October 2011 at Ska ˚ne University Hospital, Malmo ¨, Sweden. Patients with known malignant disease who were undergoing routine bone scanning for screening or follow-up were included in the study. The mean age was 69 6 11 y. According to Swedish law, a study regarded as quality-improvement work does not need formal approval from a local research ethics committee. TABLE 1 Criteria for Performing SPECT/CT After Whole-Body Bone Scan Section Description A Indications for not performing SPECT/CT after bone scan Patient cannot participate in SPECT/CT examination Widespread metastatic disease is present A previous whole-body bone scan is available and no new lesions are present B Indications for performing SPECT/CT after bone scan Focal lesions in spine or pelvis are present Patient reports newly developed pain from spine or pelvis Prostate cancer patients have prostate-specific antigen that is increasing or . 20 ng/mL even though no metastatic lesions are present (SPECT/CT of lumbar spine and pelvis) Large urinary bladder is covering sacrum and patient has reported symptoms from this area C Indications for not performing SPECT/CT Whole-body bone scan has normal results and no criteria from section B to perform SPECT/CT are fulfilled D If technologist is unsure whether SPECT/CT should be performed, technologist calls physician These criteria apply to patients suspected of having metastatic disease. For other indications, nuclear medicine physician makes decision. TECHNOLOGISTS DECIDE ABOUT SPECT/CT • Shafi et al. 29 ・ ・ ・ ・
  21. Evidenceから考える骨シンチグラフィ • ⾻シンチの現状とevidences • SPECT/CTのポジショニングと短時間撮像 • ⾻SPECTの画質評価 Agenda

  22. SPECT/CTのポジショニング • アーチファクトの原因になるため,体幹の撮像では上肢を挙上 • 上肢を下垂させてもSPECT/CTでの画質・定量性は低下しない Procedure Guideline for SPECT/CT Imaging

    1.0* J Nucl Med 2006; 47:1227–34. Miyaji N. et al. Nucl Med Commun. 2021;42(3):267-75.
  23. 下垂 挙上 軽度 中度 重度 Miyaji N. et al. Nucl

    Med Commun. 2021;42(3):267-275.(⼀部改変) ポジショニングの違いによる画質への影響
  24. ポジショニングの違いによるカウントへの影響 30000 40000 50000 60000 70000 0 10 20 30

    40 50 60 30000 40000 50000 60000 70000 60 70 80 90 100 110 120 Detector 1 Detector 2 Counts Counts View View 14.4 % 15.0 % 手下げ 手下げ 挙上 挙上 Miyaji N. et al. Nucl Med Commun. 2021;42(3):267-275.(⼀部改変) • 収集距離が離れても取得カウントに⼤きな違いはない • ⼿下げは腕による減弱によって15%程度カウントが低下する
  25. SUVmax, mean, peak 0.00 2.00 4.00 6.00 8.00 5 15

    25 35 A B C D E Ref 0.00 2.00 4.00 6.00 5 15 25 35 A B C D E Ref SUVmax SUVmean 0.00 2.00 4.00 6.00 8.00 5 15 25 35 A B C D E Ref SUVpeak A B C D E Ref Width (cm) Height (cm) A:両手体側 22 5 B:挙上伸展 22 3 C:軽度下垂 26 6 D:中度下垂 18 12 E:補助台使用 26 10 Miyaji N. et al. Nucl Med Commun. 2021;42(3):267-275.(⼀部改変)
  26. Ultra-fast SPECT/CT撮像 A three-category scale of M1, M0, and Me

    was chosen diagnostic misclassification [17]; we encourage the inclu- Fig. 2 Illustrative examples of the M1 category (bone metastases); in this example, tracer uptake was increased in the os sacrum and proximal right femur corresponding to osteosclerotic lesions on low-dose CT. Additionally, tracer uptake was increased in the left side of L3 and L5 corresponding to benign changes seen on low-dose CT. a Posterior view of a maximum intensity projection (MIP) from ultra-fast acquisition SPECT. b Posterior view of a MIP from standard acquisition SPECT Zacho et al. EJNMMI Research (2017) 7:1 Page 5 of 7 3-min 11-min Zacho HD. et al. EJNMMI Research (2017) 7:1 全⾝プラナー像に3-min SPECT/CTを追加することで診断能はルーチン条件と同等
  27. Ultra-high-speed xSPECT Bone撮像 3-minでのxSPECT Bone撮像においても画質は損なわない Spherical VOIs of 1 cm

    were set as a reference to CT images of the bone window to measure SUVs and SDs from the first thoracic to the fifth lumbar vertebrae in clinical xB images using the Syngo Via software (Siemens Healthcare, Erlangen, Germany). Each of the 17 spherical VOIs was set at the center of the vertebral body as much as possible without abnormal accumulation and degenerative changes. The FWHM was also measured by drawing a profile curve on the spinous process of the fifth lumbar vertebra. time. The 13-mm sphere and intervertebral space were observable in xB but were undetectable in F3D. The noise and background of the spinous process were improved by increasing the acquisition time in F3D images. Radioactiv- ity concentrations of the cortical and spongious bones in the first vertebra were almost similar, whereas those of the cortical bone with high HU were decidedly higher than those of the spongious bone in xB images. In F3D image, the high- est value was observed at the center of the homogeneous Fig. 2 Sagittal image of the custom-designed xSPECT bone-specific (xSB) phantom. Flash3D images (top row) and xSPECT bone images (bot- tom row). The acquisition times are 3, 6, 9, 12, and 30 min from left to right 3 6 9 12 30 (min) xSPECT Bone Flash 3D Ichikawa H. et al. Ann Nucl Med. 2022;36(2):183-190.
  28. imilar to the true values, except for the he first

    vertebra covered by the cortical egion of the 13-mm sphere. The %CV wer values of xB than F3D, except that 13-mm sphere (Fig. 3c, d). No reduc- erved with prolonged acquisition time ion method. 12.6 ± 0.2 mm at 3-, 6-, 9-, 12-, and 30-min acquisition times, respectively. The FWHM of xB was lower than that of F3D at all acquisition times; moreover, the FWHM decreased with increasing acquisition time and exhibited almost the same value at 12 and 30 min for both recon- struction methods. centra- ent of econ- ous nificant n the 1 3 Fig. 4 Measured profiles of the first lumbar vertebra at various acquisition times for Flash3D (a) and xSPECT bone (b). The dashed line shows the actual radioactivity concentration Ichikawa H. et al. Ann Nucl Med. 2022;36(2):183-190. Ultra-high-speed xSPECT Bone撮像
  29. Ichikawa H. et al. Ann Nucl Med. 2022;36(2):183-190. scintigraphy, including

    whole-body planar images, general SPECT/CT images, and xB images, as increased accumu- lation due to bone metastases in the left iliac bone and left fifth rib, decreased accumulation in the right greater bar vertebrae for std-xB and UHS-xB were 0.90 ± 0.26 and 0.66 ± 0.21, respectively, which were significantly lower for UHS-xB than for std-xB. The FWHM of the fifth lumbar vertebra in the std-xB and UHS-xB images were 10.3 mm and 10.8 mm, respectively. Fig. 5 Clinical images are shown from left to right; maximum inten- sity projections (MIP) images of xSPECT bone (a, e), MIP images of Flash3D (b, f), anterior (c, g), and posterior (d, h) whole-body planar images. Upper row: standard acquisition time; lower row: ultra-high- speed acquisit images is equa standardized u 9 min/Bed xSPECT Bone Flash 3D 3 min/Bed (3m after) xSPECT Bone Flash 3D Ultra-high-speed xSPECT Bone撮像
  30. Short-time SPECT/CT using CZT camera Yamane T. et al. Scientific

    Reports. (2021) 11:24320. (⼀部改変) 10 min
  31. Evidenceから考える骨シンチグラフィ • ⾻シンチの現状とevidences • SPECT/CTのポジショニングと短時間撮像 • ⾻SPECTの画質評価 Agenda

  32. l コントラスト l Contrast-to-noise ratio l リカバリ係数 l Coefficient of

    variance l 定量値(Bq/mL, SUV) l Line profile (FWHMも含む) l 検出能 l etc. ファントムを用いた骨SPECTの画質評価 ROI(VOI)の設定 1) Zeintl J, et al. J Nucl Med. 2010; 51(6). 2) Nakahara T, et al. EJNMMI Res. 2017; 7(53). 3) Zhang R, et al. EJNMMI Phys. 2021;8(66). 4) 市川 肇 他. 日放技学誌. 2015;71(12). 5) 市川 肇 他. 核医学技術. 2017;37(3). 6) 三輪 建太 他.核医学技術. 2017;37(4). 7) 佐越 美香 他.日放技学誌. 2018;74(5). 8) Miyaji N, et al. EJNMMI Res. 2020;10(71). 9) Motegi K et al. Rad Phys Tech. 2020. 10) Ichikawa H, et al. Ann Nucl Med. 2021;35(8). 11) Ichikawa H, et al. Nucl Med comm. 2021;35(8). 12) Ito T, et al. Rad Phys Tech. 2021 13) Fukami M, et al. J Nucl Med Tech. 2021;49(2). 14) Shibutani T, et al. scientificreports. 2021; 11:2644 15) Ichikawa H, et al. Ann Nucl Med. 2022; 36(2).
  33. ⾻SPECT撮像の標準化に関するガイドライン1.0 核,00-1 図 1 NEMA IEC body ファントム 部分を占 フィの全

    像にかけ る1,6~8)。 れる病変 ・画像再 る技術的 要 が あ 限の画質 客観的な ガイドラインではボトムラインを用いた収集処理 条件の妥当性の判定法を基本に収集条件の考え方 標準化に関するガイドライン1.0(三輪,他) BG変動性 (NB,17mm ) %コントラスト (QH,17mm ) 三輪建太, 他.核医学技術. 2017; 37(4): 517-530 ボトムライン(最低基準)を評価するための指標を定義
  34. 検出能         

     4DPSF "DRVJTJUJPOUJNFNJO           4DPSF "DRVJTJUJPOUJNFNJO "1 3"0 '#1 04&. 04&. "$4$           "DRVJTJUJPOUJNFNJO           "DRVJTJUJPOUJNFNJO           "DRVJTJUJPOUJNFNJO           "DRVJTJUJPOUJNFNJO Sphere diameter (mm) 市川肇,他.⽇核技雑誌 2017:37(3);229 -238. Planar SPECT
  35. Rose criteria Contrast-to-noise ratio (CNR) > 5 CNR for detected

    (green) and non-detected (red) In general, the PET/CT showed slightly increased CRC and CNR for the OSEM+PSF(+TOF) reconstructions compared to PET/MRI. CRC and CNR in- creased when PSF was incorporated in the reconstruction, and a further increase was found when both PSF and TOF were included. Improvements by PSF and TOF have also been demonstrated previously [4, 13, 15–17, 19, 20], and this indi- cates that these algorithms should be used to increase the possibility of detecting small lesions. PSF is a geometry correction that provides higher and more uniform spatial resolution over the transaxial FOV and will therefore have the most impact at the outer edges of the FOV [32]. The inclusion of TOF increases the signal-to- Fig. 7 Histograms of contrast-to-noise ratio (CNR) for detected (green) and non-detected (red) spheres for a PET/MRI and b PET/CT for all the reconstructions with similar number of true counts for the two systems. The black line represents CNR = 5 (Rose criterion). There are twice as many reconstructions for the PET/CT than for the PET/MRI due to the TOF option Oen SK, et al. Fig. 2 Spherical VOIs placed over the hot spheres in OSEM with PSF and TOF with activity concentration of 8:1 (3 iterations, 2 mm voxel size) (purple: d = 20 mm, cyan: d = 12 mm, green: d = 8 mm, pink: d = 6 mm, orange: d = 5 mm, red: d = 4 mm) and seven spherical background VOIs (yellow: d = 20 mm) (a) (b) Øen et al. EJNMMI Physics (2019) 6:16 Page 7 of 16 Rose A. Vision. 1ed: Springer US; 1973. Oen SK, et al. EJNMMI Phys. 2019;6(1):16. 病変の検出
  36. ROI・VOIの設定 • Targetサイズの100%, 80% • Threshold 40% • 専⽤ソフトウェア •

    RC ¼ a A ð2Þ Volumes of interest (VOIs) for each sphere were determined with a region growing algorithm for which the cut-off threshold was calculated by [41]: VVthresh ¼ 0:5∙ VV max;sphere þ VVmean;bg À Á ð3Þ where VVthresh is the threshold voxel value, VVmax,sphere is the maximum voxel coefficients at 140 keV Scatter Correction DEW* (120 keV ± 10%) Kernel based DEW* (119 keV ± 7.5%) DEW* (119 keV ± 10%) Monte Carlo-based Monte Carlo-based Image voxel size 2.21 × 2.21 × 2.21 mm3† 4.7 × 4.7 × 4.7 mm3 2.54 × 2.54 × 2.54 mm3 4.8 × 4.8 × 4.8 mm3 4.8 × 4.8 × 4.8 mm3 4.8 × 4.8 × 4.8 mm3 * OSEM ordered subset expectation maximization, PSF point spread function, DEW dual energy window † Initial acquisition was performed with 128 × 128 matrix size and corresponding voxel size of 4.42 × 4.42 × 4.42 mm3. For quantification purposes this was interpolated to a 256 × 256 matrix size and corresponding voxel size of 2.21 × 2.21 × 2.21 mm3, as recommended by the vendor. Peters et al. EJNMMI Physics (2019) 6:29 三輪建太, 他.核医学技術. 2017; 37(4): 517-530 Miyaji N. et al. Nucl Med Commun. 2021;42(3):267-275. ü Bone GL tool ü Hone Graph 0 50000 100000 150000 200000 VVmax,sphere VVmean,bg VVthresh Ichikawa H. et al. Ann Nucl Med. 2021;35(8): 937–46.
  37. Scan Me SIM2 boneファントム

  38. L#RN- L#RN- L#RN- NN NN ϦϑΝϨϯε෦ ਖ਼ৗ௣ମ 13 mm 17

    mm 22 mm 28 mm ᑜಥى ٿঢ়໛ٖපม ௣ମ ԣಥى ഏʢλϑϥϯάϑΝϯτϜʣ όοΫάϥ΢ϯυ NN Target-to-normal bone ratio 6: i6 protocol Ichikawa H. et al. Ann Nucl Med. 2021;35(8): 937–46. (⼀部改変)
  39. 1 ߶ମม׵ (SPM2) ϦαϯϓϦϯά (1º1º1 mm3) 2 VOI template matching

    Χ΢ϯτଌఆɾ෺ཧධՁࢦඪͷܭࢉ 3 Detectability scoreͷࣗಈ෼ྨ 4 Report දࣔ Hone Graph: 解析手順 Ichikawa H. et al. Ann Nucl Med. 2021;35(8): 937–46.
  40. Fig.5 結果レポートの例 画像間の比較も可能 個々の画像の良し悪しが判断可能 Iteration 崽崉崌嵓1R 崽崉崌嵓੡ ⋇ , ⋈

    , ⋉ , ⋊ , ⋋ , ⋌ , ⋍ , ⋎ , ⋏ , ⋐ 崽崉崌嵓1R    ⋇    ⋈    ⋉    ⋊    ⋋    ⋌    ⋍    ⋎    ⋏    ਫ਼ল૨  PP PP PP PP                                     &15 PP PP PP PP                                     &9 %* %RQH                   ):+0 PP +RU 7DQ                   'HWHFWDELOLW\ PP PP PP PP PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     PP PP PP PP     &9 %* %RQH %* %RQH   %* %RQH   %* %RQH   %* %RQH   %* %RQH   %* %RQH   %* %RQH   %* %RQH   %* %RQH   12 84 18 24 30 36 72 60 48 Report
  41. 検者内再現性 検者間再現性 Hone Graph 1.7% (1.2–2.2) 0% 手動法 13.2% (5.4–24.6)

    39.6% (18.3–55.8) 位置情報のみが異なる7組のSPECT画像を4名の核医学専門技師がCNRを測定 再現性
  42. まとめ • 全身プラナー像 • BSI • ノイズ除去処理︓投与量の適正化 • 頸椎から骨盤SPECT/CT •

    短時間撮像(撮像時間の最適化)・再構成パラメータの最適化 → 適切な画質評価 • Uncorrected画像の出⼒(アーチファクトの確認) • 今後の課題︓Uptake timeの統⼀化・SUVの調和化 Evidenceをもとに撮像プロトコルの最適化