Real-time ultrasound and freehand-SPECT

M. Freesmeyer; T. Winkens; T. Opfermann; P. Elsner; I. Runnebaum; A. Darr

doi:10.3413/Nukmed-0680-14-06

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2014; 53(06): 259-264
DOI: 10.3413/Nukmed-0680-14-06

Original article

Schattauer GmbH

Real-time ultrasound and freehand-SPECT

Experiences with sentinel lymph node mappingUltraschall und Freihand-SPECT/UltraschallErfahrungen mit dem Lymphknoten-Mapping

M. Freesmeyer

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

T. Winkens

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

T. Opfermann

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

,

P. Elsner

²Department of Dermatology, Jena University Hospital Jena, Germany

,

I. Runnebaum

³Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany

,

A. Darr

¹Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany

› Institutsangaben

Abstract

Summary

Aim of this work is to report first experiences of the feasibility and applicability of a hybrid freehandSPECT/ultrasound (fh-SPECT/US) imaging concept, with regard to SLN imaging, in patients with breast cancer and malignant melanoma. Patients, methods: 18 patients with breast cancer or malignant melanoma received standard SLN scintigraphy. Following this, fh-SPECT using declipse®SPECT (SurgicEye, Munich, Germany) was performed, a handheld-gamma camera-based method to visualize activity distribution within a region of interest as a cross-sectional data set. These data were transferred to an ultrasound device and sensor-navigated ultrasound was performed combining fhSPECT data with ultrasound images, displaying superimposed images. Quality of fh- SPECT and co-registration accuracy was assigned to one of four categories and occurrence of artefacts was assessed. Results: In 4/18 examinations, there was a no deviation regarding co-registration of both data sets. For 9/18 patients, there was a deviation of <1 cm (mean 0.7±0.3 cm, range 0.3–1.0 cm). For 3/18 patients, a deviation >1 cm was present (mean 1.7±0.3 cm, range 1.5–2.0 cm). In 2/18 examinations no lymph node was found in the region of highest activity. Fh-SPECT reconstruction artifacts occurred in 6/18 examinations. Conclusion: The fusion imaging concept combining SLN information with ultrasound images presented here proves to be feasible and technically successful. However, significant technical limitations were shown in fh-SPECT quality and fusion precision. Subject to technical optimisation of SPECT quality and co-registration, a meaningful contribution to the preoperative planning of lymph node therapy is imaginable. Thus, fundamentally a preoperative histological examination by fh-SPECT/US-guided biopsy is possible.

Zusammenfassung

Ziel dieser Arbeit ist es, über erste Anwendungserfahrungen eines hybriden Freihand- SPECT/Ultraschallkonzeptes (fh-SPECT/US) bei der Sentinel-Lymphknoten-(SLN)-Szintigraphie an Patienten mit Mammakarzinom und malignem Melanom zu berichten. Patienten, Methoden: Zunächst wurde bei 18 Patienten mit Brustkrebs oder malignem Melanom eine leitliniengerechte SLN-Szintigraphie durchgeführt. Anschließend wurde mit einer mobilen Hand-Gammasonde und einem Ortungssystem (declipse®SPECT, SurgicEye, München, Deutschland) die dreidimensionale Aktivitätsverteilung (fh-SPECT) der Lymphabflussregion aufgezeichnet und dieser Datensatz auf ein Ultraschallgerät transferiert. Es folgte eine Ultraschalluntersuchung der Lymphabflussregion. Dabei wurden fh-SPECT-Daten- satz und Ultraschallbilder mittels sensornavi-gierter Sonographie in Echtzeit überlagert und auf dem Ultraschallbildschirm angezeigt. Qualität des fh-SPECT und Genauigkeit der Überlagerung wurden in Kategorien eingeteilt und das Auftreten von Artefakten wurde untersucht. Ergebnisse: In 4/18 Untersuchungen trat keine räumliche Abweichung zwischen beiden Datensätzen auf. Bei 9/18 Patienten war eine geringe Abweichung <1 cm feststellbar (Mittelwert: 0,7±0,3 cm, Intervall 0,3-1,0 cm). 3/18 Untersuchungen zeigten ein Offset von >1 cm (Mittelwert: 1,7±0,3 cm, Intervall 1,5-2,0 cm). In 2/18 Untersuchungen konnte an der Stelle der höchsten Aktivität sonographisch kein Lymphknoten gefunden werden. Rekonstruktionsartefakte des fh-SPECT traten in 6/18 Untersuchungen auf. Schlussfolgerung: Das Fusionskonzept der SLN-Szintigraphie und der Sonographie hat sich in dieser Studie als technisch erfolgreich und praktikabel erwiesen. Allerdings sind deutliche technische Limitationen bezüglich der fh-SPECT-Qualität und der Fusionsgenauigkeit vorhanden. Unter der Voraussetzung, dass diese Limitationen optimiert werden, kann die fh-SPECT/US-Fusion einen sinnvollen Beitrag zur präoperativen Planung leisten, indem zum Beispiel eine fh-SPECT/ US-gestützte Biopsie des SLN erfolgt und somit eine valide histologische SLN-Analyse der eigentlichen Operation vorgeschaltet wird.

Keywords

Hybrid imaging - fh-SPECT/US fusion - free-hand-SPECT - SPECT/US fusion - SPECT/ultra-sound

Schlüsselwörter

Hybridbildgebung - fh-SPECT/US-Fusion - Frei- hand-SPECT - SPECT/US-Fusion - SPECT/Ultra- schall

Volltext

Referenzen

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