Diminishing the impact of the partial volume effect in cardiac SPECT perfusion imaging.

The partial volume effect (PVE) significantly restricts the absolute quantification of regional myocardial uptake and thereby limits the accuracy of absolute measurement of blood flow and coronary flow reserve by SPECT. The template-projection-reconstruction method has been previously developed for PVE compensation. This method assumes the availability of coregistered high-spatial resolution anatomical information as is now becoming available with commercial dual-modality imaging systems such as SPECT/CTs. The objective of this investigation was to determine the extent to which the impact of the PVE on cardiac perfusion SPECT imaging can be diminished if coregistered high-spatial resolution anatomical information is available. For this investigation the authors introduced an additional parameter into the template-projection-reconstruction compensation equation called the voxel filling fraction (F). This parameter specifies the extent to which structure edge voxels in the emission reconstruction are filled by the structure in question as determined by the higher spatial-resolution imaging modality and the fractional presence of the structure at different states of physiological motion as in combining phases of cardiac motion. During correction the removal of spillover to the cardiac region from the surrounding structures is performed first by using reconstructed templates of neighboring structures (liver, blood pool, lungs) to calculate spillover fractions. This is followed by determining recovery coefficients for all voxels within the heart wall from the reconstruction of the template projections of the left and right ventricles (LV and RV). The emission data are subsequently divided by these recovery coefficients taking into account the filling fraction F. The mathematical cardiac torso phantom was used for investigation correction of PVE for a normal LV distribution, a defect in the inferior wall, and a defect in the anterior wall. PVE correction resulted in a dramatic visual reduction in the impact of extracardiac activity, improved the uniformity of the normally perfused heart wall, and enhanced defect visibility without undue noise amplification. No significant artifacts were seen with PVE correction in the presence of mild (one voxel) misregistration. A statistically significant improvement in the accuracy of the count levels within the normal heart wall was also noted. However, residual spillover of counts from within the myocardium creates a bias in regions of decreased wall counts (perfusion defects/abnormal wall motion) when the anatomical imaging modality does not allow definition of templates for defects present in the heart during emission imaging.