title: Simplifying volumes-of-interest (VOIs) definition in quantitative SPECT: Beyond manual definition of 3D whole-organ VOIs.
abstract: OBJECTIVE
  We investigated the feasibility of using simpler methods than manual whole-organ volume-of-interest (VOI) definition to estimate the organ activity concentration in single photon emission computed tomography (SPECT) in cases where the activity in the organ can be assumed to be uniformly distributed on the scale of the voxel size. In particular, we investigated an anatomic region-of-interest (ROI) defined in a single transaxial slice, and a single sphere placed inside the organ boundaries.
  
  
  METHODS
  The evaluation was carried out using Monte Carlo simulations based on patient indium111In pentetreotide SPECT and computed tomography (CT) images. We modeled constant activity concentrations in each organ, validating this assumption by comparing the distribution of voxel values inside the organ VOIs of the simulated data with the patient data. We simulated projection data corresponding to 100, 50, and 25% of the clinical count level to study the effects of noise level due to shortened acquisition time. Images were reconstructed using a previously validated quantitative SPECT reconstruction method. The evaluation was performed in terms of the accuracy and precision of the activity concentration estimates.
  
  
  RESULTS
  The results demonstrated that the non-uniform image intensity observed in the reconstructed images in the organs with normal uptake was consistent with uniform activity concentration in the organs on the scale of the voxel size; observed non-uniformities in image intensity were due to a combination of partial-volume effects at the boundaries of the organ, artifacts in the reconstructed image due to collimator-detector response compensation, and noise. Using an ROI defined in a single transaxial slice produced similar biases compared to the three-dimensional (3D) whole-organ VOIs, provided that the transaxial slice was near the central plane of the organ and that the pixels from the organ boundaries were not included in the ROI. Although this slice method was sensitive to noise, biases were less than 10% for all the noise levels studied. The use of spherical VOIs was more sensitive to noise. The method was more accurate for larger spheres and larger organs such as the liver in comparison to the kidneys. Biases lower than 7% were found in the liver when using large enough spheres (radius ≥ 28 mm), regardless of the position, of the VOI inside the organ even with shortened acquisition times. The biases were more position-dependent for smaller organs.
  
  
  CONCLUSIONS
  Both of the simpler methods provided suitable surrogates in terms of accuracy and precision. The results suggested that a spherical VOI was more appropriate for estimating the activity concentration in larger organs such as the liver, regardless of the position of the sphere inside the organ. Larger spheres resulted in better estimates. A single-slice ROI was more suitable for activity estimation in smaller organs such as the kidneys, providing that the transaxial slice selected was near the central plane of the organ and that voxels from the organ boundaries were excluded. Under those conditions, activity concentrations with biases lower than 5% were observed for all the studied count levels and coefficients of variation were less than 9% and 5% for the 25% and 100% count levels, respectively.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA.
authors.forename: Esther M
authors.initials: EM
authors.lastname: Vicente
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Lodge
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Rowe
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, 21287, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Frey
mesh_terms: D006801:Humans; D009010:Monte Carlo Method; D009929:Organ Size; D019047:Phantoms, Imaging; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
keywords: activity concentration estimation; quantitative SPECT; quantitative accuracy; volume-of-interest definition