A Method for Calculating Small Sizes of Volumes in Postsurgical Thyroid SPECT/CT Imaging

Differentiated thyroid cancer treatment typically involves the surgical removal of the whole or largest part of the thyroid gland. Diagnostic procedures are useful both before and after treatment to determine the need for radioiodine ablation, re-stage the disease, monitor disease progression, or evaluate treatment efficacy. SPECT/CT imaging can be utilized to identify small, distant iodine-avid metastatic lesions and assess their uptake and volume for the above purposes as well as for performing lesion-based dosimetry when indicated. The objective of this study was to develop and validate a method for calculating small sizes of volumes in SPECT/CT imaging as well as to perform calculations utilizing I-131 and I-123 postsurgical SPECT/CT images from a neck-thyroid phantom. In this approach, the calculated volume was unaffected by radiation spillover from high-uptake voxels since it was the result from the successive application of the gray-level histogram technique to SPECT and CT 3D matrices. Beforehand, the SPECT 3D matrix was resized and aligned to the corresponding CT one. The method was validated following the clinical protocols for postsurgical thyroid imaging by using I-123 and I-131 scatter and attenuation-corrected SPECT/CT images from a neck-thyroid phantom. The phantom could accommodate two volumes of different sizes (0.5, 1, 1.5, 3, and 10 mL) and enclose anatomical tissue-equivalent main scattering structures. For the 0.5 and 10 mL volumes, the % differences between the actual and the calculated volumes were 15.2% and 1.2%, respectively. Radiation spillover was only present in SPECT images, and it was more profound at higher administered activities, in I-131 than in I-123 images, and in smaller volumes. When SPECT/low-dose-CT imaging is performed, this method is capable of accurately calculating small volumes without the need of additional modalities.