SPECT/CT - standing on the shoulders of giants, it is time to reach for the sky!
Journal of Nuclear Medicine
Twenty years ago single photon emission computed tomography/x-ray computed tomography (SPECT/CT) became commercially available, combining the strengths of both techniques: the diagnostic sensitivity of SPECT and the anatomic detail of CT. Other benefits initially included attenuation correction of SPECT reconstructions, ultimately evolving to correction techniques that would enable absolute tracer uptake quantification. Recent developments in SPECT hardware include solid state digital systems
... e digital systems with higher sensitivity and resolution, using novel collimator designs based on tungsten. Similar advances in CT technology have been introduced in hybrid SPECT/CT systems, replacing low-end X-ray tubes, with high-end multislice CTs equipped with iterative reconstruction and metal artefact reduction algorithms, and dual-energy capabilities. More recently, the design of whole-body SPECT/CT systems has taken another major leap with the introduction of a ring-shaped gantry equipped with multiple movable detectors surrounding the patient. These exciting developments have fueled efforts to develop novel SPECT radiopharmaceuticals, creating new chelators and prosthetic groups for radiolabeling. Innovative SPECT radionuclide pairs have now become available for radiolabeling with the potential for use as theranostic agents. The growth of precision medicine and the associated need for accurate radionuclide treatment dosimetry will likely drive the use of SPECT/CT in the near future. In addition, expanding clinical applications of SPECT/CT in other areas such as orthopedics, offer exciting opportunities. While it is true that the SPECT/CT ecosystem has seen a number of challenges during its development over the past two decades, it is now a feature-rich and mature tool ready for clinical prime time.