UNLABELLED:The goal of this study was to assess the effect of diaphragmatic respiratory motion on inferior wall cold artifact in myocardial SPECT and to assess the ability of attenuation correction (AC) to correct for this artifact in the presence of diaphragmatic motion.METHODS:We used an anthropomorphic phantom with ventricular wall activity, variable ventricular caudal tilt, attenuating liver and spleen cold inserts, and variable vertical (diaphragmatic) motion amplitude and pattern. Cardiac SPECT images were acquired on a gamma camera with dual scanning transmission line sources and commercially available AC software (with scatter correction and iterative reconstruction). The acquired data were processed either using filtered backprojection or with the AC software. The resulting myocardial activity maps were processed with polar plots and with standardized inferior-to-anterior and anterior-to-lateral wall ratios.RESULTS:Subdiaphragmatic attenuation reduces inferior wall counts and this component of inferior wall artifact is fully corrected by AC relative to anterior wall counts both with and without diaphragmatic respiratory motion. In the phantom, diaphragmatic motion artifact manifests as reduction in relative count density in both the anterior wall and the inferior wall relative to the lateral wall, which is not corrected by AC. This artifact becomes more marked with increasing respiratory amplitude and its symmetry depends on the pattern of diaphragmatic motion.CONCLUSION:Images with AC acquired at small respiratory amplitudes (approximately 2 cm) in the phantom resemble images with AC found in published normal patient databases. These results support a clinical need for respiratory gating of myocardial SPECT images.

A 56-year-old man underwent bilateral lung transplantation 17 months earlier for idiopathic pulmonary fibrosis. He had a large high right retroperitoneal hemorrhage related to anticoagulation treatment for recurrent pulmonary embolism. Two months after surgical evacuation, the drainage tube stopped draining, and intractable hemoptysis developed. Bronchoscopy showed intact lung anastomoses but blood originating from the right middle lobe. Tc-99m stannous fluoride colloid was injected into the caudal part of the retroperitoneal hematoma. Dynamic scintigraphy showed radioactivity rapidly outlining both main bronchi and the trachea. Imaging of fresh hemoptysis further confirmed the presence of a retroperitoneo-bronchial fistula.

s of the 31st Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine - Hobart, Tasmania, Australia, 18-22 May 2001

s of the 31st Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine - Hobart, Tasmania, Australia, 18-22 May 2001