CT nonuniform attenuation and TEW scatter corrections in brain Tc-99m ECD SPECT

Perfusion brain single photon emission computed tomography (SPECT) is currently used to evaluate patients with cognitive impairments. Although widely available, it has been reported to be significantly less sensitive than F-18 FDG positron emission tomography. Optimization of SPECT parameters using nonuniform attenuation correction (NUAC) and scatter correction (SC) might improve the accuracy of the method. This study assessed the effect of x-ray CT-based NUAC and triple-energy window (TEW-SC) on brain SPECT compared with Chang-uniform (UAC). A total of 31 patients with memory complaints underwent Tc-99m ECD SPECT/CT. CT-NUAC+TEW-SC and Chang-UAC were applied and compared. The images were spatially normalized to a default SPECT template supplied with Statistical Parametric Mapping software (SPM2). A paired t test image was then reconstructed. Regional cerebral blood flow measurements were apparently reduced in the frontal white-matter and in the frontotemporal cortex when CT-NUAC+TEW-SC were used. These findings need to be considered when interpreting Tc-99m ECD SPECT after applying CT-AC+TEW-SC. Further prospective studies with clinical correlations are needed.