Evaluation of simultaneous 201 Tl/ 99m Tc dual-isotope cardiac SPECT imaging with model-based crosstalk compensation using canine studies

Background Simultaneous 201 Tl/ 99m Tc-sestamibi dual-isotope myocardial perfusion SPECT imaging can reduce imaging time and produce perfectly registered rest/stress images. However, crosstalk from 99m Tc into 201 Tl images can significantly reduce 201 Tl image quality. We have developed a model-based compensation (MBC) method to compensate for this crosstalk. The method has previously been validated with phantom and simulation studies. In this study, we evaluated the MBC method using a canine model. Methods Left anterior descending or left circumflex coronary artery stenoses were created in 50 adult mongrel dogs weighing 20-30 kg. The dogs were injected with 111 MBq (3 mCi) of 201 Tl at rest, and a SPECT study acquired. Stress was induced by administering adenosine to the dog, followed by injection of 740 MBq (20 mCi) of 99m Tc-sestamibi at peak stress. A second SPECT study was performed with data acquired in both 201 Tl and 99m Tc energy windows to provide simultaneous dual-isotope projection data. The images were reconstructed using the ordered-subsets expectation-maximization reconstruction algorithm with compensation for attenuation, scatter, and detector response. For simultaneously acquired 201 Tl data, we also applied the MBC method to compensate for crosstalk contamination from 99m Tc. Results Without compensation, 99m Tc crosstalk increased the estimated 201 Tl activity concentration in the rest images and reduced defect contrast. After MBC, the 201 Tl images were in good agreement with the registered single-isotope images and ex vivo count data. The ischemic (IS) to non-ischemic (NIS) region 201 Tl activity concentration ratios were computed for single-isotope and dual-isotope studies. The correlation with ex vivo IS-NIS ratios was 0.815 after MBC, compared to the 0.495 from data without compensation. In addition, the regression line for the IS-NIS ratios with MBC was almost parallel to the line of identity with a slope of 0.93, compared to a slope of 0.45 without compensation. Conclusions These results demonstrate that model-based crosstalk compensation can provide substantial reduction of crosstalk effects in simultaneously acquired myocardial perfusion SPECT images in living biological systems.