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Fusion of Immunoscintigraphy Single Photon Emission Computed Tomography (SPECT) with CT of the Chest in Patients with Non-Small Cell Lung Cancer¹

New York University School of Medicine, [S. K.], Division of Nuclear Medicine [E. L. K., M. E. N.]; New York University Kaplan Cancer Center, Department of Radiology [E. L. K., A. C., A. S.], Division of Oncology, Department of Medicine [A. C.]; and Division of Radiation Oncology, Department of Radiology [A. S.], New York University Medical Center/Bellevue Hospital Center, New York, New York 10016

In non-small cell lung cancer (NSCLC), accurate staging is critical in deciding between potentially curative surgery and palliative treatment. Image registration, or fusion, combines the unique functional information provided by SPECT imaging with the excellent anatomic detail offered by computed tomography (CT) or magnetic resonance imaging to better characterize the imformation provided by each separate modality. In this study, we explored the role of fusion of immunoscintigraphy SPECT with CT in the staging of NSCLC. We fused chest CT with ^99mTc-labeled IMMU-4 anti-carcinoembryonic antigen Fab' antibody fragment SPECT in 14 patients with NSCLC using a landmark-based algorithm. The algorithm's accuracy was a measure from the center-to-center distance and the percentage overlap of two regions of interest: one drawn on CT and warped onto SPECT, the other drawn directly on the SPECT. We found that the average center-to-center distance was 1.3 ± 0.8 pixels. Average overlap was 46 ± 20%. CT-SPECT fusion helped differentiate tumor from normal blood pool, necrotic areas within viable tumor, tumor recurrence from scar, and malignant lymphadenopathy from hyperplasia. We conclude that fusion of CT and SPECT augments the information provided by each separate modality. Future clinical applications of fusion in NSCLC staging using immunoscintigraphy appear promising.