title: Infection scintigraphy: added value of single-photon emission computed tomography/computed tomography fusion compared with traditional analysis.
abstract: OBJECTIVE
  Positron emission tomography (PET)/computed tomography (CT) imaging is a powerful dual-modality integrating physiology and anatomy. Analogously, fusing separate single-photon emission computed tomography (SPECT) and CT images can overcome interpretive challenges in characterizing and localizing abnormalities. This study explores the value of SPECT/CT image fusion compared with traditional "side-by-side" SPECT-CT image review for infectious /inflammatory processes.
  
  
  METHODS
  We identified 17 abnormal infection/inflammation SPECT scans in 16 patients (11 indium 111 WBC and 6 gallium citrate Ga 67) with a contemporary CT scan. The SPECT and CT images were uploaded onto "side-by-side" workstations, one with fusion software. Two nuclear radiologists reviewed "side-by-side" SPECT and CT images and fused SPECT/CT images. They scored 2 parameters (anatomical localization and diagnostic confidence) using a 4-point scale (1 "not helpful" to 4 "very helpful"). Score differences more than 1 indicated "added value" and less than 0, "no added value".
  
  
  RESULTS
  Compared with "side-by-side" SPECT-CT, fused SPECT/CT images yielded "added value" for anatomical localization in 65%, diagnostic confidence in 71%, and altered interpretations in 47% of cases. Greater confidence was achieved in 75% of cases with altered interpretations and 55% of unaltered cases.
  
  
  CONCLUSIONS
  The SPECT/CT image fusion outperformed "side-by-side" SPECT/CT review for anatomical localization and diagnostic confidence of infectious/inflammatory abnormalities. Therefore, SPECT/CT fusion potentially influences clinical decisions and treatment options.
authors.affiliation: Nuclear Radiology Section, Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA..
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Ingui
authors.forename: Nirav P
authors.initials: NP
authors.lastname: Shah
authors.forename: Mary E
authors.initials: ME
authors.lastname: Oates
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D002951:Citrates; D003287:Contrast Media; D005260:Female; D005708:Gallium; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007205:Indium Radioisotopes; D007239:Infections / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014283:Triiodobenzoic Acids
chemical_list: D002951:Citrates; D003287:Contrast Media; D007205:Indium Radioisotopes; D019275:Radiopharmaceuticals; D014283:Triiodobenzoic Acids; D005708:Gallium; C103850:gallium citrate; C054871:ioversol