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Annals of Nuclear Medicine (v.23, #5)

Intraoperative gamma probe guidance with ^99mTc-pertechnetate in the completion thyroidectomy by Gülseren Aras; Salih Sinan Gültekin; Nuriye Özlem Küçük; Seher Demirer; Tuğbay Tuğ (pp. 421-426).

Intraoperative gamma probe (GP) guidance with ^99mTc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study.The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 ± 12.0 years, age range 29–73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of ^99mTc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination.Preoperative TSH was less than 30 mIU/mL (mean 21 ± 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum–maximum) values were 220.90% (56.00–411.11%) in LTL, 80.43% (11.54–471.05%) in RTL and 66.60% (−3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (−20.55 to 47.62%) in LTL, 17.59% (−15.07 to 38.46%) in RTL and 17.59% (−1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 ± 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues.Gamma probe guidance with ^99mTc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.

Keywords: Completion thyroidectomy; Gamma probe; ^99mTc-pertechnetate; Differentiated thyroid cancer; Recurrent goiter

Dual-time point ¹⁸F-FDG PET/CT scan for differentiation between ¹⁸F-FDG-avid non-small cell lung cancer and benign lesions by Kazuyoshi Suga; Yasuhiko Kawakami; Atsuto Hiyama; Kazurou Sugi; Kazutomo Okabe; Tsuneo Matsumoto; Kazuhiro Ueda; Nobuyuki Tanaka; Naofumi Matsunaga (pp. 427-435).

The aim of this study is to clarify the difference of F-18 FDG uptake kinetics between FDG-avid non-small-cell lung cancer (NSCLC) and benign lesions associated with various etiologies on dual-time point PET/CT scan, and to determine the optimal parameter for differentiation.The materials were 76 FDG-avid solitary NSCLC in 76 patients and 57 FDG-avid solitary benign lesions associated with various etiologies in 61 patients. FDG PET/CT scan was performed at 60 and 120 min after intravenous injection of 4.4 MBq/kg F-18 FDG. The maximum standardized uptake value (SUVmax) on early and delayed scans and the percent change of SUVmax (%ΔSUVmax) between the two time points were measured. The optimal differential parameter was determined by receiver-operating characteristic curve analysis and evaluation of diagnostic accuracy.The mean ± SD of early SUV max, delayed SUVmax and %ΔSUVmax were 8.3 ± 5.2, and 10.2 ± 6.5, and 21.9% ± 18.9 in FDG-avid NSCLC, and 3.8 ± 3.2, 4.0 ± 3.7, and 11.3% ± 26.0 in FDG-avid benign lesions, respectively. Delayed SUVmax in NSCLC was significantly higher than early SUVmax (P < 0.0001); while not different in benign lesions. Percent change of SUVmax in NSCLC was also significantly higher than that in benign lesions (P < 0.01). The optimal parameter for the differentiation was delayed SUVmax > 5.5 and yielded sensitivity of 77.6%, specificity of 80.7% and accuracy of 78.9%, which provided better differentiation than the use of %ΔSUVmax or the traditional parameter of early SUVmax > 2.5. However, 11 (19.2%) benign lesions were indistinguishable from NSCLC.Although delayed PET/CT scan enhances the difference of FDG uptake between FDG-avid NSCLC and benign lesions, and the use of delayed SUVmax > 5.5 appears to improve the differentiation of these hypermetabolic lesions compared with an early scan, careful interpretation and management for correct differentiation are still required.

Keywords: PET; ¹⁸F-FDG; Non-small cell lung cancer (NSCLC); Pulmonary benign lesions; Dual-time point PET scan; Differential diagnosis

Parathyroid changes after high dose radioactive iodine in patients with thyroid cancer by Aytekin Guven; Serpil Salman; Harika Boztepe; Sema Yarman; Refik Tanakol; Halil Azizlerli; Faruk Alagol (pp. 437-441).

The study aimed to investigate the effect of high dose radioactive iodine (RAI) on parathyroid function in patients with differentiated thyroid cancer.Nineteen patients (8 men/11 women, age 46.5 ± 13.2 years) undergoing RAI for thyroid remnant ablation were enrolled in the study. The biochemical parameters related to parathyroid function [serum calcium (Ca), phosphate (P), creatinine (Cr), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), urinary Ca, cAMP concentrations and the maximum tubular capacity for phosphate per unit volume of glomerular filtrate (TmP/GFR)] were evaluated at baseline and at the 1st, 3rd, 6th and 12th months of RAI administration. SPSS 15.0 was used for statistical analysis.For all patients, thyroid-stimulating hormone levels were >30 U/ml at baseline and <0.1 U/ml at the following visits. Serum iPTH levels were decreased significantly at the 6th month and reached basal levels at the 12th month (baseline vs. 6th p = 0.027, 1st vs. 6th p = 0.011, 3rd vs. 6th p = 0.047, 3rd vs. 12th p = 0.014, 6th vs. 12th p = 0.001). At the 6th month, P and TmP/GFR levels were higher (p = 0.036, 0.017, respectively), and urinary cAMP measurements were lower (p = 0.020) compared to those of the 1st month. No difference was detected concerning the other parameters. Serum Ca levels decreased below 2.1 mmol/l in several patients (n = 5 at 1st month, n = 4 at 3rd month, n = 8 at 6th month and n = 3 at 12th month) without clinical symptoms.The study indicated a transient decline in PTH levels at the 6th month following RAI therapy. Although this decrease did not cause symptoms in any of the present cases, this pattern might be important especially in individuals with diminished parathyroid background.

Keywords: Thyroid cancer; RAI; Parathyroid; PTH

Metallic artifacts caused by dental metal prostheses on PET images: a PET/CT phantom study using different PET/CT scanners by Hiroaki Shimamoto; Naoya Kakimoto; Kouichi Fujino; Seiki Hamada; Eku Shimosegawa; Shumei Murakami; Souhei Furukawa; Jun Hatazawa (pp. 443-449).

The objective of this study was to investigate the effects of computed tomography (CT) artifacts caused by dental metal prostheses on positron emission tomography (PET) images.A dental arch cast was fixed in a cylindrical water-bath phantom. A spherical phantom positioned in the vicinity of the dental arch cast was used to simulate a tumor. To simulate the tumor imaging, the ratio of the ¹⁸F-fluoro-deoxy-glucose radioactivity concentration of the spherical phantom to that of the water-bath phantom was set at 2.5. A dental bridge composed of a gold–silver–palladium alloy on the right mandibular side was prepared. A spherical phantom was set in the white artifact area on the CT images (site A), in a slightly remote area from the white artifact (site B), and in a black artifact area (site C). A PET/CT scan was performed with and without the metal bridge at each simulated tumor site, and the artifactual influence was evaluated on the axial attenuation-corrected (AC) PET images, in which the simulated tumor produced the strongest accumulation. Measurements were performed using three types of PET/CT scanners (scanners 1 and 2 with CT-based attenuation correction, and 3 with Cesium-137 (¹³⁷Cs)-based attenuation correction). The influence of the metal bridge was evaluated using the change rate of the SUVmean with and without the metal bridge.At site A, an overestimation was shown (scanner 1: +5.0% and scanner 2: +2.5%), while scanner 3 showed an underestimation of −31.8%. At site B, an overestimation was shown (scanner 1: +2.1% and scanner 2: +2.0%), while scanner 3 showed an underestimation of −2.6%. However, at site C, an underestimation was shown (scanner 1: −25.0%, scanner 2: −32.4%, and scanner 3: −8.4%).When CT is used for attenuation correction in patients with dental metal prostheses, an underestimation of radioactivity of accumulated tracer is anticipated in the dark streak artifact area on the CT images. In this study, the dark streak artifacts of the CT caused by metallic dental prostheses may cause false negative finding of PET/CT in detecting small and/or low uptake tumor in the oral cavity.

Keywords: PET/CT; Metallic artifact; Dental metal prostheses; FDG

Comparison of exercise-rest-reinjection Tl-201 imaging and rest sublingual isosorbide dinitrate Tc-99m MIBI imaging for the assessment of myocardial viability by Seval Erhamamcı Günel; Ayşegul Akgun (pp. 451-457).

Nitrate administration has been proposed to enhance the detection of myocardial viability when performing myocardial perfusion imaging. In this study, we aimed to compare Tl-201 exercise-rest-reinjection protocol with rest isosorbide dinitrate (ISDN)-Tc99m MIBI study in the same population examined for the myocardial viability.Twenty-six patients with coronary artery disease who had fixed segmental defects on exercise-rest-Tl-201 imaging were studied. All of them underwent Tl-201 reinjection study. Within 1 week of Tl-201 imaging, rest-Tc99m MIBI imaging was performed after sublingual 5 mg ISDN administration (2-day protocol). For each study, tomograms were divided into 20 segments based on three short-axis slices, one vertical long-axis representing the totality of the left ventricle and regional tracer uptake was quantitatively analyzed. Regional tracer uptake was evaluated in 20 myocardial segments for all patients. Viability was defined as presence of tracer uptake ≥50% of peak activity on each study. A total 520 myocardial segments were assessed by semi quantitative analysis.On the baseline rest Tl-201 studies, 211 segments of the 520 segments that were analyzed had <50% of peak activity. Of these segments, 42 (20%) showed reversibility after reinjection Tl-201 imaging and 55 segments (27%) described as viable on the rest ISDN-Tc99m MIBI imaging. There was 89% concordance between the ISDN-Tc99m MIBI study and Tl-201 reinjection study regarding viable myocardial segments. Of the 23 segments with discordant results, 18 were irreversible on Tl-201 reinjection study, but showed ≥50% uptake on ISDN-Tc99m MIBI.Observation of good agreement between Tl-201 reinjection and ISDN-Tc99m MIBI study studies led us to suggest the use of ISDN enhanced imaging in the evaluation of myocardial viability.

Keywords: Myocardial viability; Isosorbide dinitrate; Tc99m MIBI; Tl-201

Clinical significance of performing ¹⁸F-FDG PET on patients with gastrointestinal stromal tumors: a summary of a Japanese multicenter study by Tomohiro Kaneta; Shoki Takahashi; Hiroshi Fukuda; Yukiko Arisaka; Noboru Oriuchi; Takayuki Hayashi; Hirofumi Fujii; Takashi Terauchi; Ukihide Tateishi; Kazuo Kubota; Tadashi Hara; Yuji Nakamoto; Kazuhiro Kitajima; Koji Murakami (pp. 459-464).

The aim of this study is to evaluate the clinical significance of performing ¹⁸F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) on patients with gastrointestinal stromal tumors (GISTs).The patient samples for this study were provided by seven PET institutions in Japan. Forty-one patients with pathologically proved GISTs, 24 men and 17 women (mean age 60.3 years, range 26–81 years) were enrolled in this study. Final diagnosis was based on the follow-up imaging at least 3 months after the PET scan or histopathological examinations.There were eight preoperative cases and 33 follow-up cases in our series. Preoperative cases showed that the sites of primary tumor were the stomach (5 cases, 62.5%), and small intestine (3 cases, 37.5%). One stomach lesion and one small intestine lesion showed negative findings. In follow-up cases, there were 18 PET-negative cases. Among them, two cases were considered as false negative by follow-up imaging. On the other hand, 15 cases showed positive findings at 23 lesions. Most PET-positive cases were considered as true positive except for one false-positive case, who later received surgery and was diagnosed as leiomyoma histopathologically. In 14 cases, PET findings were considered to provide additional information to conventional imaging. In eight cases among them, PET findings were considered to have influenced the decision-making of therapeutic plans.Our data suggest that FDG PET has an incremental value over conventional imaging for the diagnostic and therapeutic management of patients with GISTs in Japan as reported worldwide, and supports its introduction as a routine diagnostic tool for patients with GISTs.

Keywords: ¹⁸F-Fluorodeoxyglucose (FDG); Positron-emission tomography (PET); Gastrointestinal stromal tumor (GIST)

Comparison of subareolar injection lymphoscintigraphy with the 1-day and the 2-day protocols for the detection of sentinel lymph nodes in patients with breast cancer by Ju Won Seok; In Ju Kim; Young-Jun Heo; You Jung Yang; Yoo Shin Choi; Beom Gyu Kim; Seong Jun Park (pp. 465-469).

Lymphoscintigraphy and sentinel node biopsy are used for the detection of axillary lymph node metastasis in breast cancer patients. However, currently there is no standardized technique. For the detection of axillary lymph node metastasis by lymphoscintigraphy and sentinel node biopsy, in patients with breast cancer, we compared the results of subareolar injections administered on the day of surgery (1-day protocol) with injections administered on the day before surgery (2-day protocol).This study included 412 breast cancer patients who underwent surgery between 2001 and 2004. For the 1-day protocol (1 h before surgery) 0.8 ml of Tc-99m Tin-Colloid (37 MBq) was injected in 203 in the subareolar region on the morning of the surgery. For the 2-day protocol (16 h before surgery) 0.8 ml of Tc-99m Tin-Colloid (185 MBq) was injected in 209 patients on the afternoon before surgery. Lymphoscintigraphy was performed in the supine position and sentinel node identification was performed by hand-held gamma probe during surgery.Among 203 patients with the 1-day protocol, 185 cases (91.1%) were identified by sentinel node lymphoscintigraphy, and 182 cases (89.7%) were identified by gamma probe. Among the 209 patients, in the 2-day protocol, 189 cases (90.4%) had the sentinel node identified by lymphoscintigraphy, and 182 cases (87.1%) by the gamma probe. There was no significant difference in the identification rate of the sentinel node between the 1-day and 2-day protocols by lymphoscintigraphy and the gamma probe (p > 0.05, p > 0.05).The results of the identification of the sentinel node by subareolar injection according to 1-day or 2-day protocol, in breast cancer patients, showed no significant differences. Because the 2-day protocol allows for an adequate amount of time to perform the lymphoscintigraphy, it is a more useful protocol for the identification of sentinel nodes in patients with breast cancer.

Keywords: Sentinel node; Breast cancer; Lymphoscintigraphy; Subareolar injection

Influence of N-butylscopolamine on SUV in FDG PET of the bowel by Bal Sanghera; Jennifer Emmott; David Wellsted; Jane Chambers; Wai-Lup Wong (pp. 471-478).

Peristalsis can lead to confusing FDG PET bowel uptake artefacts and potential for recording inaccurate mean standardised uptake value (SUV) measurements in PET-CT scans. Accordingly, we investigate the influence of different SUV normalisations on FDG PET uptake of the bowel and assess which one(s) have least dependence on body size factors in patients with and without the introduction of the anti-peristalsis agent N-butylscopolamine (Buscopan).This study consisted of 92 prospective oncology patients, each having a whole body ¹⁸F-FDG PET scan. Correlations were investigated between height, weight, glucose, body mass index (bmi), lean body mass (lbm) and body surface area (bsa) with maximum and mean SUV recorded for bowel normalised to weight (SUV_w), lbm (SUV_lbm), bsa (SUV_bsa) and blood glucose corrected versions (SUV_wg, SUV_lbmg, SUV_bsag).Standardised uptake value normalisations were significantly different between control and Buscopan groups with less variability experienced within individual SUV normalisations by the administration of Buscopan. Mean SUV normalisations accounted for 80% of correlations in the control group and 100% in the Buscopan group. Further, >86% of all correlations across both groups were dominated by mean SUV normalisations of which, about 69% were accounted for by SUV_bsa and SUV_bsag.We recommend avoiding mean SUV_bsa and individual glucose normalisations especially, mean SUV_bsag as these dominated albeit relatively weak correlations with body size factors in control and Buscopan groups. Mean and maximum SUV_w and SUV_lbm were shown to be independent of any body size parameters investigated in both groups and therefore considered suitable for monitoring FDG PET uptake in the normal bowel for our patient cohort.

Keywords: SUV; Artefact; PET-CT; Correlation; Buscopan; Correction

Radioimmunotherapy of solid tumors targeting a cell-surface protein, FZD10: therapeutic efficacy largely depends on radiosensitivity by Hirofumi Hanaoka; Toyomasa Katagiri; Chikako Fukukawa; Hiroki Yoshioka; Shinji Yamamoto; Yasuhiko Iida; Tetsuya Higuchi; Noboru Oriuchi; Bishnuhari Paudyal; Pramila Paudyal; Yusuke Nakamura; Keigo Endo (pp. 479-485).

Frizzled homolog 10 (FZD10) is expressed at high levels on the cell surface of almost all synovial sarcoma tissues, but is absent in most normal organs. In a previous study, yttrium-90 (⁹⁰Y)-labeled anti-FZD10 antibody (MAb 92-13) showed considerable therapeutic efficacy in synovial sarcoma cell-bearing mice. The purpose of the present study was to elucidate the factors associated with this therapeutic efficacy of ⁹⁰Y-MAb 92-13.FZD10 expression levels of SYO-1 (FZD10-overexpressing synovial sarcoma cell line) and DLD-1/FZD10 (FZD10-transfected DLD-1 cell) were determined by the cell binding assay, and their radiosensitivity was evaluated by incubation with ⁹⁰Y-MAb 92-13 in vitro. Biodistribution study of indium-111 (¹¹¹In)-MAb 92-13 was performed in SYO-1 and DLD-1/FZD10 tumor-bearing mice. For therapeutic studies, SYO-1 and DLD-1/FZD10 tumor-bearing mice were treated with ⁹⁰Y-MAb 92-13 (100, 150, and 200 μCi), after which the change in tumor volume was measured. Immunohistochemical staining was performed on the excised tumor.Expression level of FZD10 on DLD-1/FZD10 was much greater than that on SYO-1. The accumulation of ¹¹¹In-MAb 92-13 was much higher in DLD-1/FZD10 tumor-bearing mice than in SYO-1 tumor-bearing mice (49.0 ± 4.2 and 22.0 ± 4.5% ID/g, respectively, at 48 h after administration). In SYO-1 tumor, substantial tumor size reduction was observed in all mice treated with ⁹⁰Y-MAb 92-13 (tumor volume decreased to less than 0.1 cm³ at 11 days after treatment) and tumor regrowth was not observed in most of them. In contrast, only slow progression was observed in DLD-1/FZD10 tumor. When incubated with ⁹⁰Y-MAb 92-13, high radioactivity was needed to damage DLD-1/FZD10. Immunohistochemical study indicated apoptosis of SYO-1 tumor.The therapeutic efficacy of RIT seems to largely depend on the tumor radiosensitivity.

Keywords: Radioimmunotherapy (RIT); FZD10; Radiosensitivity; Apoptosis

Diagnostic performance of Tc-99m HMPAO SPECT for early and late onset Alzheimer’s disease: a clinical evaluation of linearization correction by Tatsuya Mitsumoto; Nobuyoshi Ohya; Atsushi Ichimiya; Yuichi Sakaguchi; Aya Kiyota; Koichiro Abe; Junji Morishita; Masayuki Sasaki (pp. 487-495).

This study examined the influence of linearization correction (LC) on brain perfusion single-photon emission computed tomography (SPECT) for the diagnosis of Alzheimer’s disease (AD).The early onset group (<65 years old) consisted of 10 patients with AD, and the late onset group (≥65 years old) of 13 patients with AD. Age-matched controls included seven younger and seven older normal volunteers. Tc-99m hexamethyl propyleneamine oxine (HMPAO) SPECT images were reconstructed with or without LC [LC (+) or LC (−)] and a statistical analysis was performed using a three-dimensional stereotactic surface projection (3D-SSP). In addition, a fully automatic diagnostic system was developed, which calculated the proportion of the number of abnormal pixels in the superior and inferior parietal lobule, as well as in the precuneus and posterior cingulate gyrus.The areas under the receiver-operating characteristic curve (AUCs) of the early onset group for conventional axial SPECT images, SPECT + 3D-SSP images and the fully automatic diagnostic system were 0.71, 0.88, and 0.92 in LC (−) and 0.67, 0.85, and 0.91 in LC (+), respectively. The AUCs of the late onset group were 0.50, 0.61, and 0.79 in LC (−) and 0.49, 0.67, and 0.85 in LC (+), respectively.LC on Tc-99m HMPAO SPECT did not significantly influence the diagnostic performance for differentiating between AD and normal controls in either early or late onset AD. Further examination with individuals suffering from very mild dementia is, therefore, expected to elucidate the effect of LC on minimally hypoperfused areas.

Keywords: Alzheimer’s disease; Linearization correction; Cerebral blood flow; Tc-99m HMPAO SPECT; Three-dimensional stereotactic surface projection

Nesidioblastosis as a cause of focal pancreatic ¹¹¹In-pentetreotide uptake in a patient with putative VIPoma: another differential diagnosis by Alessandra Bastian Francesconi; Marco Matos; Joseph C. Lee; David K. Wyld; Andrew D. Clouston; David Macfarlane (pp. 497-499).

In adults, nesidioblastosis is a very infrequent condition and a rare cause of symptomatic presentations. The diagnosis of nesidioblastosis may be difficult with functional and anatomical imaging modalities. “Slight focal” pancreatic abnormalities using ¹¹¹In-pentetreotide imaging has been reported in patients with hyperinsulinaemic hypoglycaemia, confirmed histologically as nesidioblastosis. We describe a 60-year-old man who presented with a 1-year history of intermittent faecal urgency and refractory diarrhoea, non-specific laboratory results, negative imaging results (CT, MRI and EUS), a FNA biopsy that was inconclusive, but suggested an endocrine cell neoplasm, and a ¹¹¹In-pentetreotide scan that showed a moderately intense focal uptake clearly localised to the pancreatic head on a low-dose fusion CT. The histopathology of the specimen confirmed the diagnosis of nesidioblastosis.

Keywords: Nesidioblastosis; ¹¹¹In-pentetreotide uptake; Somatostatin receptor scintigraphy (SRS); Octreoscan^® ; Neuroendocrine tumours

Attenuation correction of myocardial SPECT by scatter-photopeak window method in normal subjects by Koichi Okuda; Kenichi Nakajima; Nobutoku Motomura; Masahiro Kubota; Noriyasu Yamaki; Hisato Maeda; Shinro Matsuo; Seigo Kinuya (pp. 501-506).

Segmentation with scatter and photopeak window data using attenuation correction (SSPAC) method can provide a patient-specific non-uniform attenuation coefficient map only by using photopeak and scatter images without X-ray computed tomography (CT). The purpose of this study is to evaluate the performance of attenuation correction (AC) by the SSPAC method on normal myocardial perfusion database.A total of 32 sets of exercise–rest myocardial images with Tc-99 m-sestamibi were acquired in both photopeak (140 keV ± 10%) and scatter (7% of lower side of the photopeak window) energy windows. Myocardial perfusion databases by the SSPAC method and non-AC (NC) were created from 15 female and 17 male subjects with low likelihood of cardiac disease using quantitative perfusion SPECT software. Segmental myocardial counts of a 17-segment model from these databases were compared on the basis of paired t test.AC average myocardial perfusion count was significantly higher than that in NC in the septal and inferior regions (P < 0.02). On the contrary, AC average count was significantly lower in the anterolateral and apical regions (P < 0.01). Coefficient variation of the AC count in the mid, apical and apex regions was lower than that of NC.The SSPAC method can improve average myocardial perfusion uptake in the septal and inferior regions and provide uniform distribution of myocardial perfusion. The SSPAC method could be a practical method of attenuation correction without X-ray CT.

Keywords: Myocardial perfusion imaging; SPECT; Non-X-ray based attenuation correction

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Annals of Nuclear Medicine (v.23, #5)