Fusion imaging in nuclear medicine--applications of dual-modality systems in oncology

Medical imaging has become of the utmost importance in evaluating patients with cancer. Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are accurate methods for detecting cancer and related metabolic abnormalities, but they often do not provide the anatomical landmarks needed to precisely localize lesions. Magnetic resonance imaging (MRI) and computed tomography (CT) scan, on the other hand, offer excellent anatomic detail but are less sensitive because they do not provide functional detail. Fusion imaging combines functional studies with morphological ones, so overcoming the drawbacks of both modalities. Software-based fusion of independently performed scintigraphic and radiological images has proven time consuming and impractical for routine use. Recently, dual-modality integrated imaging systems (SPECT/CT and PET/CT) have been developed: the acquired images are coregistered by means of the hardware in the same session. These new devices can be particularly useful for tumour imaging. The anatomical images provide precise localization and allow the exclusion of disease in sites of physiologic tracers' accumulation for SPECT and PET findings. Hybrid imaging in oncological applications has been very encouraging, indicating that these systems are suited for routine use in clinical practice. In fact, fused images provide additional information that improves diagnostic accuracy and impacts on patient management.