title: Quantitative lung SPECT applied on simulated early COPD and humans with advanced COPD.
abstract: BACKGROUND
  Reduced ventilation in lung regions affected by chronic obstructive pulmonary disease (COPD), reflected as inhomogeneities in the single-photon emission computed tomography (SPECT) lung image, is correlated to disease advancement. An analysis method for measuring these inhomogeneities is proposed in this work. The first aim was to develop a quantitative analysis method that could discriminate between Monte Carlo simulated normal and COPD lung SPECT images. A second aim was to evaluate the ability of the present method to discriminate between human subjects with advanced COPD and healthy volunteers.
  
  
  METHODS
  In the simulated COPD study, different activity distributions in the lungs were created to mimic the healthy lung (normal) and different levels of COPD. Gamma camera projections were Monte Carlo simulated, representing clinically acquired projections of a patient who had inhaled 125 MBq 99mTc-Technegas followed by a 10-min SPECT examination. Reconstructions were made with iterative ordered subset expectation maximisation. The coefficient of variance (CV) was calculated for small overlapping volumes covering the 3D reconstructed activity distribution. A CV threshold value (CVT) was calculated as the modal value of the CV distribution of the simulated normal. The area under the distribution curve (AUC), for CV values greater than CVT, AUC(CVT), was then calculated. Moreover, five patients with advanced emphysema and five healthy volunteers inhaled approximately 75 MBq 99mTc-Technegas immediately before the 20-min SPECT acquisition. In the human study, CVT was based on the mean CV distribution of the five healthy volunteers.
  
  
  RESULTS
  A significant difference (p < 0.001) was found between the Monte-Carlo simulated normal and COPD lung SPECT examinations. The present method identified a total reduction of ventilation of approximately 5%, not visible to the human eye in the reconstructed image. In humans the same method clearly discriminated between the five healthy volunteers and five patients with advanced COPD (p < 0.05).
  
  
  CONCLUSIONS
  While our results are promising, the potential of the AUC(CVT) method to detect less advanced COPD in patients needs further clinical studies.
authors.affiliation: Department of Medical and Health Sciences, Linköping University, and Center for Medical Image Science and Visualization, and Medical Radiation Physics, County Council of Östergötland, Linköping, SE-581 85, Sweden. Pernilla.Norberg@lio.se.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Norberg
authors.forename: Hans Lennart
authors.initials: HL
authors.lastname: Persson
authors.forename: Gudrun Alm
authors.initials: GA
authors.lastname: Carlsson
authors.forename: Björn
authors.initials: B
authors.lastname: Bake
authors.forename: Magnus
authors.initials: M
authors.lastname: Kentson
authors.forename: Michael
authors.initials: M
authors.lastname: Sandborg
authors.forename: Agnetha
authors.initials: A
authors.lastname: Gustafsson