Virtual platform for computer simulation of radionuclide imaging in nuclear cardiology: Comparison with clinical data

Мұқаба

Дәйексөз келтіру

Толық мәтін

Аннотация

BACKGROUND: In radionuclide imaging, in vivo human clinical studies are limited because of radiation exposure and ethical concerns; therefore, mathematical modeling and in silico computer simulations based on digital models are becoming increasingly important. In the English-language literature, this approach is called “virtual clinical trials.”

AIMS: This study aimed to develop software tools for the simulation of radionuclide visualization of myocardial perfusion by single-photon emission computed tomography combined with computed tomography using 99mTc-MIBI as the radiopharmaceutical and perform studies aimed at improving the accuracy of single-photon emission computed tomography.

MATERIALS AND METHODS: A software package “Virtual platform for simulations of single-photon emission computed tomography combined with computed tomography method in nuclear cardiology” was developed using digital patient models, a scanner, and assessment of the state of the myocardium using digital images of the left ventricle in the form of a “polar map.” Verification of the software package was performed by comparison with clinical data obtained at the National Medical Research Center of Cardiology Named After Academician E.I. Chazov (Moscow). Simulation computer tests were performed, in which the accuracy of assessing the state of the myocardium was assessed, depending on the approach to normalizing the polar map and corrective factors in the reconstruction algorithm.

RESULTS: The results of the simulation tests revealed that the assessment of left ventricular myocardial perfusion significantly depended on the method of normalizing the polar map and considered corrective factors in the reconstruction algorithm. The most accurate estimates were obtained by calculating the normalization coefficient from the average value of activity in the normal zone of the myocardium. The common approach to pixel normalization with maximum intensity can lead to errors. The results of the virtual trials were fully consistent with clinical observations.

CONCLUSIONS: The transition from relative normalized values of activity in the myocardium to absolute quantitative estimates may eliminate existing limitations and uncertainties and is the main condition for improving the diagnostic accuracy of single-photon emission computed tomography combined with computed tomography in nuclear cardiology.

Толық мәтін

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Авторлар туралы

Natalya Denisova

Novosibirsk State University; Khristianovich Institute of Theoretical and Applied Mechanics

Хат алмасуға жауапты Автор.
Email: NVDenisova2011@mail.ru
ORCID iD: 0000-0001-9374-1753
SPIN-код: 4928-8185

Dr. Sci. (Phys.-Math.), Professor

Ресей, Novosibirsk; Novosibirsk

Mikhail Gurko

Novosibirsk State University; Khristianovich Institute of Theoretical and Applied Mechanics

Email: m.gurko@g.nsu.ru
ORCID iD: 0000-0002-6154-172X
SPIN-код: 3214-5765
Ресей, Novosibirsk; Novosibirsk

Inna Kolinko

Novosibirsk State University; Khristianovich Institute of Theoretical and Applied Mechanics

Email: kiina131313@gmail.com
ORCID iD: 0009-0001-6779-1535
SPIN-код: 1625-6043
Ресей, Novosibirsk; Novosibirsk

Alexey Ansheles

National Medical Research Centre of Cardiology Named After Academician E.I. Chazov

Email: aansheles@gmail.com
ORCID iD: 0000-0002-2675-3276
SPIN-код: 7781-6310

MD, Dr. Sci. (Med.), Assistant Professor

Ресей, Moscow

Vladimir Sergienko

National Medical Research Centre of Cardiology Named After Academician E.I. Chazov

Email: vbsergienko@yandex.ru
ORCID iD: 0000-0002-0487-6902
SPIN-код: 4918-3443

MD, Dr. Sci. (Med.), Professor

Ресей, Moscow

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2. Fig. 1. Three-dimensional mathematical model of the torso, simulating the anatomical structure of the average male patient in a position with arms raised up: a - front view; b — rear view. The model is specified in a discrete representation of 128×128×128.

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3. Fig. 2. Clinical data. Relative values (pulse/voxel) of accumulation of the radiopharmaceutical 99mTc-MIBI in the patient’s chest organs. The images were obtained during examination of the patient using single-photon emission computed tomography combined with computed tomography using a Philips BrightView XCT installation at the Federal State Budgetary Institution “National Medical Research Center for Cardiology named after Academician E.I. Chazov" of the Ministry of Health of the Russian Federation.

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4. Fig. 3. a — radiopharmaceutical accumulation map: three-dimensional distribution of relative concentration values of 99mTc-MIBI, calculated based on a mathematical model of the torso. The map is specified in a discrete representation of 128×128×100; b - attenuation map generated based on the mathematical model of the torso. The map is specified in a discrete representation of 128×128×100. A central longitudinal section is shown.

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5. Fig. 4. Comparison of projections obtained in a clinical setting when examining a patient (top) and calculated by the Monte Carlo method (bottom) using a three-dimensional activity map of a virtual patient: a - left anterior oblique projection; b — frontal projection; c — right anterior oblique projection; d — left lateral projection. Clinical data were obtained during examination of a patient using single-photon emission computed tomography using a Philips BrightView XCT installation at the Federal State Budgetary Institution “National Medical Research Center for Cardiology named after Academician E.I. Chazov" of the Ministry of Health of the Russian Federation.

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6. Fig. 5. Distribution of the radiopharmaceutical 99mTc-MIBI in the chest organs: a - phantom; b - reconstruction; c — clinical case. A clinical case was obtained during examination of a patient using single-photon emission computed tomography at the Federal State Budgetary Institution “National Medical Research Center for Cardiology named after Academician E.I. Chazov" of the Ministry of Health of the Russian Federation.

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7. Fig. 6. Graphical presentation of the results of a clinical examination of myocardial perfusion using single-photon emission computed tomography. The images were obtained using the QPS software package when examining a patient at the Federal State Budgetary Institution “National Medical Research Center for Cardiology named after Academician E.I. Chazov" of the Ministry of Health of the Russian Federation.

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8. Fig. 7. The vertical long axis (VLA, left) section of the left ventricle model is divided into short axis (SAX) layers, and the accumulated activity values in each section are projected onto the polar diagram in concentric rings so that the basal part of the left ventricle corresponds to the outer ring, and the apical part — internal (arrows show where each layer is projected onto the polar map).

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9. Fig. 8. Reference polar map of left ventricular myocardial perfusion of a virtual patient with healthy myocardium (normal). SRS (Summed Rest Score) values:

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10. Fig. 9. AC/RR. Polar map of reconstructed left ventricular myocardial perfusion image. The reconstruction was carried out with attenuation correction (AC) and resolution recovery (RR). Values of the Summed Rest Score (SRS) indicator for three methods for calculating the polar map: a - Smax=10; b — S90=1; c — Snorm=3.

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11. Fig. 10. non-AC/RR. Polar map of the reconstructed left ventricle. The reconstruction was performed without attenuation correction (non-AC), but with resolution restoration (RR). Values of the Summed Rest Score (SRS): a — Smax=17; b - S90=9; c — Snorm=4.

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12. Fig. 11. AC/non-RR. Polar map of reconstructed left ventricular myocardial perfusion image. The reconstruction was carried out with attenuation correction (AC), but without taking into account resolution restoration (non-RR). Summed Rest Score (SRS): a — Smax=9; b — S90=3; c — Snorm=4.

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13. Fig. 12. Reference polar maps of left ventricular perfusion with ischemic lesions. Values of the Summed Rest Score (SRS): a — Smax=6; b — S90=5; c — Snorm=6.

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14. Fig. 13. AC/RR. Polar maps of reconstructed left ventricular myocardial perfusion images. The reconstruction was carried out with absorption correction (AC) and taking into account resolution restoration (RR). Summed Rest Score (SRS) scores: a — Smax=12; b - S90=6; c — Snorm=6.

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15. Fig. 14. non-AC/RR. Polar map of reconstructed left ventricular perfusion image. The reconstruction was carried out without attenuation correction (non-AC), but taking into account resolution restoration (RR). Summed Rest Score (SRS) scores: a — Smax=23; b - S90=7; c — Snorm=2.

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16. Fig. 15. AC/non-RR. Polar map of the reconstructed left ventricle. The reconstruction was carried out with attenuation correction, but without taking into account the resolution restoration. Summed Rest Score (SRS) scores: a — Smax=21; b - S90=10; c — Snorm=6.

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