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Nanoparticles are ultrafine particulate matter having considerable potential for treatment of central nervous system (CNS) disorders. Despite their tiny size, the blood-brain barrier (BBB) restricts their access to the CNS. Their direct cerebrospinal fluid (CSF) administration bypasses the BBB endothelium, but still fails to give adequate brain uptake. We present a novel approach for efficient CNS delivery of 111In-radiolabelled gold nanoparticles (AuNPs; 10–15 nm) via intra-cisterna magna administration, with tracking by SPECT imaging. To accelerate CSF brain influx, we administered AuNPs intracisternally in conjunction with systemic hypertonic saline, which dramatically increased the parenchymal AuNP uptake, especially in deep brain regions. AuNPs entered the CNS along periarterial spaces as visualized by MRI of gadolinium-labelled AuNPs and were cleared from brain within 24 h and excreted through the kidneys. Thus, the glymphatic-assisted perivascular network augment by systemic hypertonic saline is a pathway for highly efficient brain-wide distribution of small AuNPs.

Implant infections caused by Staphylococcus aureus are difficult to treat due to biofilm formation, which complicates surgical and antibiotic treatment. We introduce an alternative approach using monoclonal antibodies (mAbs) targeting S. aureus and provide evidence of the specificity and biodistribution of S.-aureus-targeting antibodies in a mouse implant infection model. The monoclonal antibody 4497-IgG1 targeting wall teichoic acid in S. aureus was labeled with indium-111 using CHX-A”-DTPA as a chelator. Single Photon Emission Computed Tomography/computed tomographyscans were performed at 24, 72 and 120 h after administration of the 111In-4497 mAb in Balb/cAnNCrl mice with a subcutaneous implant that was pre-colonized with S. aureus biofilm. The biodistribution of this labelled antibody over various organs was visualized and quantified using SPECT/CT imaging, and was compared to the uptake at the target tissue with the implanted infection. Uptake of the 111In-4497 mAbs at the infected implant gradually increased from 8.34 %ID/cm3 at 24 h to 9.22 %ID/cm3 at 120 h. Uptake at the heart/blood pool decreased over time from 11.60 to 7.58 %ID/cm3, whereas the uptake in the other organs decreased from 7.26 to less than 4.66 %ID/cm3 at 120 h. The effective half-life of 111In-4497 mAbs was determined to be 59 h. In conclusion, 111In-4497 mAbs were found to specifically detect S. aureus and its biofilm with excellent and prolonged accumulation at the site of the colonized implant. Therefore, it has the potential to serve as a drug delivery system for the diagnostic and bactericidal treatment of biofilm.

Microscopic nuclear imaging down to spatial resolutions of a few hundred microns can already be achieved using low-energy gamma emitters (e.g. 125I, ∼30 keV) and a basic single micro-pinhole gamma camera. This has been applied to in vivo mouse thyroid imaging, for example. For clinically used radionuclides such as 99mTc, this approach fails due to penetration of the higher-energy gamma photons through the pinhole edges. To overcome these resolution degradation effects, we propose a new imaging approach: scanning focus nuclear microscopy (SFNM). We assess SFNM using Monte Carlo simulations for clinically used isotopes. SFNM is based on the use of a 2D scanning stage with a focused multi-pinhole collimator containing 42 pinholes with narrow pinhole aperture opening angles to reduce photon penetration. All projections of different positions are used to iteratively reconstruct a three-dimensional image from which synthetic planar images are generated. SFNM imaging was tested using a digital Derenzo resolution phantom and a mouse ankle joint phantom containing 99mTc (140 keV). The planar images were compared with those obtained using a single-pinhole collimator, either with matched pinhole diameter or with matched sensitivity. The simulation results showed an achievable 99mTc image resolution of 0.04 mm and detailed 99mTc bone images of a mouse ankle with SFNM. SFNM has strong advantages over single-pinhole imaging in terms of spatial resolution.

A variety of polymer micelles are designed for the delivery of chemotherapeutic drugs to tumors. Although the promise of these nanocarriers is very high, in the clinic the effectivity is rather limited. Determining the in vivo fate of the micelles can greatly help to improve this treatment. Here, a simple and fast chelator-free method for radiolabeling of polymer micelles composed of different block copolymers is presented, which can allow evaluating the behavior of the nanocarriers in vivo using noninvasive nuclear imaging techniques (e.g., single photon computed tomography, SPECT). The radiolabeling method consists of adding the radioisotope ions, i.e., 111In(III), resulting in a high radiolabeling efficiencies up to 90%. The results suggest that the radiolabeling efficiency depends on two important factors: the properties of the hydrophobic block in the block copolymer composing the micelle core, and the speciation of the radiometal salts. The formation of metal hydroxides and their precipitation in the core of the micelles appears to be a key factor for high stability. Moreover, the method can be applied to radiolabel the micelles in the presence of chemotherapeutic drugs. Finally, a SPECT study shows that the radiolabeled samples are stable in vivo without any evident loss of 111In(III).

Implant-associated Staphylococcus aureus infections are difficult to treat because of biofilm formation. Bacteria in a biofilm are often insensitive to antibiotics and host immunity. Monoclonal antibodies (mAbs) could provide an alternative approach to improve the diagnosis and potential treatment of biofilm-related infections. Here, we show that mAbs targeting common surface components of S. aureus can recognize clinically relevant biofilm types. The mAbs were also shown to bind a collection of clinical isolates derived from different biofilm-associated infections (endocarditis, prosthetic joint, catheter). We identify two groups of antibodies: one group that uniquely binds S. aureus in biofilm state and one that recognizes S. aureus in both biofilm and planktonic state. Furthermore, we show that a mAb recognizing wall teichoic acid (clone 4497) specifically localizes to a subcutaneously implanted pre-colonized catheter in mice. In conclusion, we demonstrate the capacity of several human mAbs to detect S. aureus biofilms in vitro and in vivo.

Background Calcification and inflammation are atherosclerotic plaque compositional biomarkers that have both been linked to stroke risk. The aim of this study was to evaluate their co-existing prevalence in human carotid plaques with respect to plaque phenotype to determine the value of hybrid imaging for the detection of these biomarkers. Methods Human carotid plaque segments, obtained from endarterectomy, were incubated in [111In]In-DOTA-butylamino-NorBIRT ([111In]In-Danbirt), targeting Leukocyte Function-associated Antigen-1 (LFA-1) on leukocytes. By performing SPECT/CT, both inflammation from DANBIRT uptake and calcification from CT imaging were assessed. Plaque phenotype was classified using histology. Results On a total plaque level, comparable levels of calcification volume existed with different degrees of inflammation and vice versa. On a segment level, an inverse relationship between calcification volume and inflammation was evident in highly calcified segments, which classify as fibrocalcific, stable plaque segments. In contrast, segments with little or no calcification presented with a moderate to high degree of inflammation, often coinciding with the more dangerous fibrous cap atheroma phenotype. Conclusion Calcification imaging alone can only accurately identify highly calcified, stable, fibrocalcific plaques. To identify high-risk plaques, with little or no calcification, hybrid imaging of calcification and inflammation could provide diagnostic benefit.

Despite improvements in small animal PET instruments, many tracers cannot be imaged at sufficiently high resolutions due to positron range, while multi-tracer PET is hampered by the fact that all annihilation photons have equal energies. Here we realize multi-isotope and sub-mm resolution PET of isotopes with several mm positron range by utilizing prompt gamma photons that are commonly neglected. A PET-SPECT-CT scanner (VECTor/CT, MILabs, The Netherlands) equipped with a high-energy cluster-pinhole collimator was used to image 124I and a mix of 124I and 18F in phantoms and mice. In addition to positrons (mean range 3.4 mm) 124I emits large amounts of 603 keV prompt gammas that—aided by excellent energy discrimination of NaI—were selected to reconstruct 124I images that are unaffected by positron range. Photons detected in the 511 keV window were used to reconstruct 18F images. Images were reconstructed iteratively using an energy dependent matrix for each isotope. Correction of 18F images for contamination with 124I annihilation photons was performed by Monte Carlo based range modelling and scaling of the 124I prompt gamma image before subtracting it from the 18F image. Additionally, prompt gamma imaging was tested for 89Zr that emits very high-energy prompts (909 keV). In Derenzo resolution phantoms 0.75 mm rods were clearly discernable for 124I, 89Zr and for simultaneously acquired 124I and 18F imaging. Image quantification in phantoms with reservoirs filled with both 124I and 18F showed excellent separation of isotopes and high quantitative accuracy. Mouse imaging showed uptake of 124I in tiny thyroid parts and simultaneously injected 18F-NaF in bone structures. The ability to obtain PET images at sub-mm resolution both for isotopes with several mm positron range and for multi-isotope PET adds to many other unique capabilities of VECTor’s clustered pinhole imaging, including simultaneous sub-mm PET-SPECT and theranostic high energy SPECT.

SPECT imaging with 123I-FP-CIT is used for diagnosis of neurodegenerative disorders like Parkinson’s disease. Attenuation correction (AC) can be useful for quantitative analysis of 123I-FP-CIT SPECT. Ideally, AC would be performed based on attenuation maps ( μ -maps) derived from perfectly registered CT scans. Such μ -maps, however, are most times not available and possible errors in image registration can induce quantitative inaccuracies in AC corrected SPECT images. Earlier, we showed that a convolutional neural network (CNN) based approach allows to estimate SPECT-aligned μ -maps for full brain perfusion imaging using only emission data. Here we investigate the feasibility of similar CNN methods for axially focused 123I-FP-CIT scans. We tested our approach on a high-resolution multi-pinhole prototype clinical SPECT system in a Monte Carlo simulation study. Three CNNs that estimate μ -maps in a voxel-wise, patch-wise and image-wise manner were investigated. As the added value of AC on clinical 123I-FP-CIT scans is still debatable, the impact of AC was also reported to check in which cases CNN based AC could be beneficial. AC using the ground truth μ -maps (GT-AC) and CNN estimated μ -maps (CNN-AC) were compared with the case when no AC was done (No-AC). Results show that the effect of using GT-AC versus CNN-AC or No-AC on striatal shape and symmetry is minimal. Specific binding ratios (SBRs) from localized regions show a deviation from GT-AC ≤ 2.5% for all three CNN-ACs while No-AC systematically underestimates SBRs by 13.1%. A strong correlation ( r ≥ 0.99) was obtained between GT-AC based SBRs and SBRs from CNN-ACs and No-AC. Absolute quantification (in kBq ml−1) shows a deviation from GT-AC within 2.2% for all three CNN-ACs and of 71.7% for No-AC. To conclude, all three CNNs show comparable performance in accurate μ -map estimation and 123I-FP-CIT quantification. CNN-estimated μ -map can be a promising substitute for CT-based μ -map.

The use of multi-pinhole collimation has enabled ultra-high-resolution imaging of SPECT and PET tracers in small animals. Key for obtaining high-quality images is the use of statistical iterative image reconstruction with accurate energy-dependent photon transport modelling through collimator and detector. This can be incorporated in a system matrix that contains the probabilities that a photon emitted from a certain voxel is detected at a specific detector pixel. Here we introduce a fast Monte-Carlo based (FMC-based) matrix generation method for pinhole imaging that is easy to apply to various radionuclides. The method is based on accelerated point source simulations combined with model-based interpolation to straightforwardly change or combine photon energies of the radionuclide of interest. The proposed method was evaluated for a VECTor PET-SPECT system with (i) a HE-UHR-M collimator and (ii) an EXIRAD-3D 3D autoradiography collimator. Both experimental scans with 99mTc, 111In, and 123I, and simulated scans with 67Ga and 90Y were performed for evaluation. FMC was compared with two currently used approaches, one based on a set of point source measurements with 99mTc (dubbed traditional method), and the other based on an energy-dependent ray-tracing simulation (ray-tracing method). The reconstruction results show better image quality when using FMC-based matrices than when applying the traditional or ray-tracing matrices in various cases. FMC-based matrices generalise better than the traditional matrices when imaging radionuclides with energies deviating too much from the energy used in the calibration and are computationally more efficient for very-high-resolution imaging than the ray-tracing matrices. In addition, FMC has the advantage of easily combining energies in a single matrix which is relevant when imaging radionuclides with multiple photopeak energies (e.g. 67Ga and 111In) or with a continuous energy spectrum (e.g. 90Y). To conclude, FMC is an efficient, accurate, and versatile tool for creating system matrices for ultra-high-resolution pinhole SPECT.

Purpose Atherosclerotic plaque development and progression signifies a complex inflammatory disease mediated by a multitude of proinflammatory leukocyte subsets. Using single photon emission computed tomography (SPECT) coupled with computed tomography (CT), this study tested a new dual-isotope acquisition protocol to assess each radiotracer’s capability to identify plaque phenotype and inflammation levels pertaining to leukocytes expressing leukocyte function-associated antigen-1 (LFA-1) and the leukocyte subset of proinflammatory macrophages expressing somatostatin receptor subtype-2 (SST2). Individual radiotracer uptake was quantified and the presence of corresponding immunohistological cell markers was assessed. Methods Human symptomatic carotid plaque segments were obtained from endarterectomy. Segments were incubated in dual-isotope radiotracers [111In]In-DOTA-butylamino-NorBIRT ([111In]In-Danbirt) and [99mTc]Tc-[N0–14,Asp0,Tyr3]-octreotate ([99mTc]Tc-Demotate 2) before scanning with SPECT/CT. Plaque phenotype was classified as pathological intimal thickening, fibrous cap atheroma or fibrocalcific using histology sections based on distinct morphological characteristics. Plaque segments were subsequently immuno-stained with LFA-1 and SST2 and quantified in terms of positive area fraction and compared against the corresponding SPECT images. Results Focal uptake of co-localising dual-radiotracers identified the heterogeneous distribution of inflamed regions in the plaques which co-localised with positive immuno-stained regions of LFA-1 and SST2. [111In]In-Danbirt and [99mTc]Tc-Demotate 2 uptake demonstrated a significant positive correlation (r = 0.651; p = 0.001). Fibrous cap atheroma plaque phenotype correlated with the highest [111In]In-Danbirt and [99mTc]Tc-Demotate 2 uptake compared with fibrocalcific plaques and pathological intimal thickening phenotypes, in line with the immunohistological analyses. Conclusion A dual-isotope acquisition protocol permits the imaging of multiple leukocyte subsets and the pro-inflammatory macrophages simultaneously in atherosclerotic plaque tissue. [111In]In-Danbirt may have added value for assessing the total inflammation levels in atherosclerotic plaques in addition to classifying plaque phenotype.

Introduction: Autoradiography is an established technique for high-resolution imaging of radiolabelled molecules in biological tissue slices. Unfortunately, creating a 3D image from a set of these 2D images is extremely time-consuming and error-prone. MicroSPECT systems provide such 3D images but have a low resolution. Here we present EXIRAD-3D, a fast automated method as an alternative for 3D autoradiography from coupes based on ultra-high resolution microSPECT technology. Methods: EXIRAD-3D uses a very small bore focusing multi-pinhole collimator mounted in a SPECT system with stationary detectors (U-SPECT/CT, MILabs B.V. The Netherlands) using a sample holder with integrated tissue cooling to avoid activity leaking or tissue deformation during the scan. The system performance was experimentally evaluated using various phantoms and tissue samples of animals in vivo injected with technetium-99m and iodine-123. Results: The reconstructed spatial resolution obtained with a Derenzo hot rod phantom was 120 μm (or 1.7 nl). The voxel values of a syringe phantom image appear to be uniform and scale linearly with activity. Uptake in tiny details of the mouse knee joint, thyroid, and kidney could be clearly visualized. Conclusion: EXIRAD-3D opens up the possibility for fast and quantitative 3D imaging of radiolabelled molecules at a resolution far better than in vivo microSPECT and saves tremendous amounts of work compared to obtaining 3D data from a set of 2D autoradiographs. Advances in knowledge and implications for patient care: EXIRAD-3D offers superior image resolution over microSPECT, and it can be a very efficient alternative for autoradiography in pharmaceutical and biological studies.

We recently developed a dedicated focusing multi-pinhole collimator for a stationary SPECT system that offers down to 120 µm (or 1.7 nL) spatial resolution SPECT images of cryo-cooled tissue samples (EXIRAD-3D). This collimator is suitable for imaging isotopes that are often used in small animal and diagnostic SPECT such as 125I (27 keV), 201Tl (71 keV), 99mTc (140 keV), and 111In (171 and 245 keV). The goal of the present work is to develop high-resolution pinhole imaging of tissue samples containing isotopes with high-energy photon emissions, for example, therapeutic alpha and beta emitters that co-emit high energy gammas (e.g. 213Bi (440 keV) and 131I (364 keV)) or 511 keV annihilation photons from PET isotopes. To this end, we optimise and evaluate a new high energy small-bore multi-pinhole collimator through simulations. The collimator-geometry was first optimised by simulating a Derenzo phantom scan with a biologically realistic activity concentration of 18F at two system sensitivities (0.30% and 0.60%) by varying pinhole placements. Subsequently, the wall thickness was selected based on reconstructions of a Derenzo phantom and a uniform phantom. The obtained collimators were then evaluated for 131I (364 keV), 213Bi (440 keV), 64Cu (511 keV), and 124I (511 + 603 keV) with biologically realistic activity concentrations, and also for some high activity concentrations of 18F, using digital resolution, mouse knee joint, and xenograft phantoms. Our results show that placing pinhole centres at a distance of 8 mm from the collimator inner wall yields good image quality, while a wall thickness of 43 mm resulted in sufficient shielding. The collimators offer resolutions down to 0.35 mm, 0.6 mm, 0.5 mm, 0.6 mm, and 0.5 mm when imaging 131I, 213Bi, 18F, 64Cu, and 124I, respectively, contained in tissue samples at biologically achievable activity concentrations.

Today, versatile emission computed tomography (VECTor) technology using dedicated high-energy collimation enables simultaneous positron emission tomography (PET) and single photon emission computed tomography (SPECT) down to 0.6 mm and 0.4 mm resolution in mice, respectively. We recently showed that for optimal resolution and quantitative accuracy of PET images the long tails of the 511 keV point spread functions (PSFs) need to be fully modelled during image reconstruction. This, however, leads to very time consuming reconstructions and thus significant acceleration in reconstruction speed is highly desirable. To this end we propose and validate a combined dual-matrix dual-voxel (DM-DV) approach: for the forward projection the slowly varying PSF tails are modelled on a three times rougher voxel grid than the central parts of the PSFs, while in the backprojection only parts of the PSF tails are included. DM-DV reconstruction is implemented in pixel-based ordered subsets expectation maximization (POSEM) and in a recently proposed accelerated pixel-based similarity-regulated ordered subsets expectation maximization (SROSEM). Both a visual assessment and a quantitative contrast-noise analysis confirm that images of a hot-rod phantom are practically identical when reconstructed with standard POSEM, DM-DV-POSEM or DM-DV-SROSEM. However, compared to POSEM, DM-DV-POSEM can reach the same contrast 5.0 times faster, while with DM-DV-SROSEM this acceleration factor increases to 11.5. Furthermore, mouse cardiac and bone images reconstructed with DM-DV-SROSEM are visually almost indistinguishable from POSEM reconstructed images but typically need an order of magnitude less reconstruction time.

Pinhole collimation is widely recognized for offering superior resolution-sensitivity trade-off in SPECT imaging of small subjects. The newly developed EXIRAD-3D autoradiography technique (MILabs B.V.) based on a highly focusing multi-pinhole collimator achieves micron-resolution SPECT for cryo-cooled tissue samples. For such high resolutions, the choice of pinhole material may have a significant impact on images. Therefore, this paper aims to compare the performance of EXIRAD-3D with lead, tungsten, gold, and depleted uranium pinhole collimators designed such that they achieve equal sensitivities. Performance in terms of resolution is characterized for several radioisotopes, namely 111In (171 keV and 245 keV), 99mTc (140 keV), 201Tl (71 keV), and 125I (27 keV). Using Monte Carlo simulation, point spread functions were generated and their profiles as well as their full-width-at-half-maximum and full-width-at-tenth-maximum were determined and evaluated for different materials and isotopes. Additionally, simulated reconstructions of a Derenzo resolution phantom, validated with experimental data, were judged by assessment of the resolvable rods as well as a contrast-to-noise ratio (CNR) analysis. Our results indicate that using materials with higher photon-stopping power yields images with better CNR for the studied isotopes with improvements ranging from 1.9% to 36.6%. Visual assessment on the reconstructed images suggests that for EXIRAD-3D, the tungsten collimator is generally a good choice for a wide range of SPECT isotopes. For relatively high-energy isotopes such as 111In, using gold inserts can be beneficial.

Objective To evaluate the presence and localization of folate receptor expressing macrophages in the rat groove model of osteoarthritis and determine the suitability of a new folate conjugate with albumin-binding entity (cm09) for in vivo SPECT (single-photon emission computed tomography) analysis. Design In male Wistar rats, local cartilage damage was induced in addition to a standard ( n = 10) or high-fat diet ( n = 6). After 12 weeks, 111In labeled folate conjugates were administered, and SPECT/CT (computed tomography) imaging was performed after 24 hours. Subsequently, osteoarthritis severity and folate receptor expression were assessed using (immuno)-histological sections. Results In vivo SPECT/CT imaging of the new folate conjugate (cm09) was as useful as a folate conjugate without albumin-binding entity in the groove model of osteoarthritis with less renal accumulation. Induction of cartilage damage on a standard diet resulted in no effect on the amount of folate receptor expressing macrophages compared with the contralateral sham operated joints. In contrast, inducing cartilage damage in the high-fat diet group resulted in 28.4% increase of folate receptor expression as compared with the nondamaged control joints. Folate receptor expressing cells were predominantly present in the synovial lining and in subchondral bone as confirmed by immunohistochemistry. Conclusions Folate receptor expression, and thus macrophage activation, can clearly be demonstrated in vivo, in small animal models of osteoarthritis using the new 111In-folate conjugate with specific binding to the folate receptor. Increased macrophage activity only plays a role in the groove model of osteoarthritis when applied in a high-fat diet induced dysmetabolic condition, which is in line with the higher inflammatory state of that specific model.

Anger cameras based on monolithic NaI scintillators read out by an array of PMTs are predominant in planar gamma imaging and SPECT. However, position estimation of gamma interactions is usually severely degraded near the edges of the scintillator which can be extremely undesirable for applications like breast imaging. Here we propose a relatively cost-effective solution based on the use of scintillators with absorptive edges with an unconventional light-guide-PMT layout employing a maximum likelihood positioning algorithm. The basic design on which we aim to improve consists of a monolithic NaI(Tl) scintillator read out by 3 × 5 square PMTs (conventional layout, CL) that could be suitable for molecular breast imaging. To better detect gamma interactions near the crystal’s critical edge, we tried different set-ups: we replaced the 5 large PMTs near the edge by 11 smaller PMTs (small-sensor layout, SSL); we emulated rectangular PMTs along the critical edge by inserting a row of 5 rectangular light-guides that direct the light toward square PMTs placed behind (shifted layout, SL); we inserted rectangular light-guides alternatingly, such that the PMTs are in an interlocking pattern (alternating shifted layout, ASL). The performance of our designs was tested with Monte Carlo simulations. Results showed that SSL, SL, and ASL gave better spatial resolution near the critical edge than CL (3.4, 3.6, and 4.1 mm near the edge compared with 5.3 mm for CL), and thus resulted in a larger usable detector area. To conclude, for applications where small dead edges are crucial, our designs may be cost-effective solutions.

Cardiac parameters obtained from single-photon emission computed tomographic (SPECT) images can be affected by respiratory motion, image filtering, and animal positioning. We investigated the influence of these factors on ultra-high-resolution murine myocardial perfusion SPECT. Five mice were injected with 99m technetium (Tc-99m)-tetrofosmin, and each was scanned in supine and prone positions in a U-SPECT-II scanner with respiratory and electrocardiographic (ECG) gating. ECG-gated SPECT images were created without applying respiratory motion correction or with two different respiratory motion correction strategies. The images were filtered with a range of three-dimensional gaussian kernels, after which end-diastolic volumes (EDVs), end-systolic volumes (ESVs), and left ventricular ejection fractions were calculated. No significant differences in the measured cardiac parameters were detected when any strategy to reduce or correct for respiratory motion was applied, whereas big differences (> 5%) in EDV and ESV were found with regard to different positioning of animals. A linear relationship (p

Understanding how nanoparticle properties such as size, morphology and rigidity influence their circulation time and biodistribution is essential for the development of nanomedicine therapies. Herein we assess the influence of morphology on cellular internalization, in vivo biodistribution and circulation time of nanocarriers using polystyrene-b-poly(ethylene oxide) micelles of spherical or elongated morphology. The glassy nature of polystyrene guarantees the morphological stability of the carriers in vivo and by encapsulating Indium-111 in their core, an assessment of the longitudinal in vivo biodistribution of the particles in healthy mice is performed with single photon emission computed tomography imaging. Our results show prolonged blood circulation, longer than 24 hours, for all micelle morphologies studied. Dynamics of micelle accumulation in the liver and other organs of the reticuloendothelial system show a size-dependent nature and late stage liver clearance is observed for the elongated morphology. Apparent contradictions between recent similar studies can be resolved by considering the effects of flexibility and degradation of the elongated micelles on their circulation time and biodistribution.

Introduction: Ex vivo storage phosphor imaging rat studies reported increased brain dopamine D-2/3 receptor (DRD2/3) availability following treatment with varenicline, a nicotinergic drug. However, ex vivo studies can only be performed using cross-sectional designs. Small-animal imaging offers the opportunity to perform serial assessments. We evaluated whether high-resolution pinhole single photon emission computed tomography (SPECT) imaging in rats was able to reproduce previous ex vivo findings. Methods: Rats were imaged for baseline striatal DRD2/3 availability using ultra-high-resolution pinhole SPECT (U-SPECT-II) and [I-123] IBZM as a radiotracer, and randomized to varenicline (n=7; 2 mg/kg) or saline (n=7). Following 2 weeks of treatment, a second scan was acquired. Results: Significantly increased striatal DRD2/3 availability was found following varenicline treatment compared to saline (time*treatment effect): posttreatment difference in binding potential between groups corrected for initial baseline differences was 2.039 (P=.022), indicating a large effect size (d=1.48). Conclusions: Ultra-high-resolution pinhole SPECT can be used to assess varenicline-induced changes in DRD2/3 availability in small laboratory animals over time. Future small-animal studies should include imaging techniques to enable repeated within-subjects measurements and reduce the amount of animals. (C) 2012 Elsevier Inc. All rights reserved

We have investigated the timing performance of Hamamatsu Multi-Pixel Photon Counter (MPPC) photosensors in light of their use in time-of-flight (TOF) positron emission tomography detectors. Measurements using picosecond laser pulses show a single photo-electron root-mean-square (RMS) timing resolution down to about 100ps. In coincidences of 511 keV photons detected with an LYSO crystal coupled to a MPPC and a BaF(2) detector, an optimum FWHM timing resolution of 600ps was obtained with leading edge time pickoff at the 1-1.5 photo-electron level. By optimizing the LYSO/MPPC coupling, this can be improved by a factor of 2. We further conclude that the use of stored digitized pulses allows great flexibility and efficiency in developing data analysis algorithms. (C) 2009 Elsevier B.V. All rights reserved.

A pivotal question in neuropharmacology is how the function of neurotransmitter systems relates to psychiatric diseases. In experimental neuropharmacology, we have dreamt about a looking glass that would allow us to see neurotransmitter systems in action, and about animals that would faithfully serve us as models for human psychiatric disease. Analysis of animal models has been limited by the availability of methods to study in vivo neurotransmitter dynamics. Now, a single photon emission computed tomography system called U-SPECT can localize dopamine transporters in sub-compartments of the mouse brain during a range of points in time. Applied to the midbrain dopamine system of different models of disease, this will aid the understanding of dynamic processes of this neurotransmitter that underlie brain functions and human brain pathology.

Single photon emission computed tomography (SPECT) images are degraded by the detection of scattered photons and photons that penetrate the collimator septa. In this paper, a previously proposed Monte Carlo software that employs fast object scatter simulation using convolution-based forced detection (CFD) is extended towards a wide range of medium and high energy isotopes measured using various collimators. To this end, a fast method was developed for incorporating effects of septal penetrating (SP) photons. The SP contributions are obtained by calculating the object attenuation along the path from primary emission to detection followed by sampling a pre-simulated and scalable septal penetration point spread function (SP-PSF). We found that with only a very slight reduction in accuracy, we could accelerate the SP simulation by four orders of magnitude. To achieve this, we combined: (i) coarse sampling of the activity and attenuation distribution; (ii) simulation of the penetration only for a coarse grid of detector pixels followed by interpolation and (iii) neglection of SP-PSF elements below a certain threshold. By inclusion of this SP-PSF-based simulation it became possible to model both primary and septal penetrated photons while only 10% extra computation time was added to the CFD-based Monte Carlo simulator. As a result, a SPECT simulation of a patient-like distribution including SP now takes less than 5 s per projection angle on a dual processor PC. Therefore, the simulator is well-suited as an efficient projector for fully 3D model-based reconstruction or as a fast data-set generator for applications such as image processing optimization or observer studies.

In trauma and orthopedic surgery, infection of implants has a major impact on the outcome for patients. Infections may develop either during the initial implantation or during the lifetime of an implant. Both infections, as well as aseptic loosening of the implant, are reasons for revision of the implants. Therefore, discrimination between aseptic-mechanical-loosening and septic-bacterial-loosening of implants is critical during selection of a patient-tailored treatment policy. Specific detection and visualization of infections is a challenge because it is difficult to discriminate infections from inflammation. An imaging tracer that facilitates bacterial identification in a pre- and intraoperative setting may aid the workup for patients suspicious of bacterial infections. In this study we evaluated an antimicrobial peptide conjugated to a hybrid label, which contains both a radioisotope and a fluorescent dye. After synthesis of DTPA-Cy5-UBI29-41 and-when necessary-radiolabeling with (111)In (yield 96.3 ± 2.7%), in vitro binding to various bacterial strains was evaluated using radioactivity counting and confocal fluorescence microscopy. Intramuscular bacterial infections (S. aureus or K. pneumoniae) were also visualized in vivo using a combined nuclear and fluorescence imaging system. The indium-111 was chosen as label as it has a well-defined coordination chemistry, and in pilot studies labeling DTPA-Cy5-UBI29-41 with technetium-99m, we encountered damage to the Cy5 dye after the reduction with SnCl2. As a reference, we used the validated tracer (99m)Tc-UBI29-41. Fast renal excretion of (111)In-DTPA-Cy5-UBI29-41 was observed. Target to nontarget (T/NT) ratios were highest at 2 h post injection: radioactivity counting yielded T/NT ratios of 2.82 ± 0.32 for S. aureus and 2.37 ± 0.05 for K. pneumoniae. Comparable T/NT ratios with fluorescence imaging of 2.38 ± 0.09 for S. aureus and 3.55 ± 0.31 for K. pneumoniae were calculated. Ex vivo confocal microscopy of excised infected tissues showed specific binding of the tracer to bacteria. Using a combination of nuclear and fluorescence imaging techniques, the hybrid antimicrobial peptide conjugate DTPA-Cy5-UBI29-41 was shown to specifically accumulate in bacterial infections. This hybrid tracer may facilitate integration of noninvasive identification of infections and their extent as well as real-time fluorescence guidance during surgical resection of infected areas.

Contains fulltext : 118360.pdf (Publisher’s version ) (Open Access) BACKGROUND: In single-photon emission computed tomography (SPECT), attenuation of photon flux in tissue affects quantitative accuracy of reconstructed images. Attenuation maps derived from X-ray computed tomography (CT) can be employed for attenuation correction. The attenuation coefficients as well as registration accuracy between SPECT and CT can be influenced by several factors. Here we investigate how such inaccuracies influence micro-SPECT quantification. METHODS: Effects of (1) misalignments between micro-SPECT and micro-CT through shifts and rotation, (2) globally altered attenuation coefficients and (3) combinations of these were evaluated. Tests were performed with a NEMA NU 4-2008 phantom and with rat cadavers containing sources with known activity. RESULTS: Changes in measured activities within volumes of interest in phantom images ranged from

International audience; To achieve ultra-high spatial resolution gamma ray imaging, the use of charge-coupled devices (CCOs) has become of great interest. However, these detectors still suffer from performances degradations due to their high intrinsic noise level. In our developped electron-multiplying CCO based gamma camera, we have introduced the use of solid state photomultipliers in side detection of a continuous crystal to improve the signal-to-background ratio and energy resolution. The so-called silicon photomultipliers (SiPMs) are individually read-out to measure the previously lost optical photons escaping through the crystal sides to give an a-priori evaluation of the energy and position of the gamma-rays interactions to a statistical algorithm for EM-CCD image analysis. In this work, we show the results obtained using 12 SiPMs optically coupled to a 3 mm thick CsI:Tl crystal where the prelocated events are reconstructed using a maximum likelihood algorithm. This algorithm uses Look-Up Tables (LUTs) evaluated by Monte-Carlo simulations to retrieve the interaction positions via the individual SiPMs signals. The spatial resolution obtained with this process is evaluated at 0.8 mm using a 200 mu m pinhole collimator with a Tc-99m source. The energy resolution is then measured at 19% for the 140 keY gamma-rays emission.

We aim to study the effects of activity distribution for multiplexing multi-pinhole (MPH) SPECT. Three digital phantoms, including a hot rod, a cold rod and a cold sphere phantom, were used. Different degrees of multiplexing were obtained by (i) adjusting the MPH pattern for the same 4-pinhole collimator (scheme 1) and (ii) increasing the number of pinholes (scheme 2). Noise-free and noisy projections were generated using a 3D analytical MPH projector based on the same acquisition time. Projections were reconstructed using OS–EM without resolution recovery. Normalized mean-square-error (NMSE), noise, image profiles and signal-to-background ratios (SBR) were assessed. For the hot rod phantom, the NMSE-noise trade-offs slightly improves for multiplexing designs in scheme 2. Substantial artifacts were observed and the NMSE-noise trade-offs slightly worsened for multiplexing designs for the cold phantoms. Resolutions slightly degraded for higher degrees of multiplexing (~39–65%) for the cold rod phantom. For the cold sphere phantom, image profiles showed non-multiplexing designs better emulated the phantom, while ~20% multiplexing performs similarly as compared to non-multiplexing in SBR. Our results indicate that multiplexing can help for sparse objects but leads to a significant image degradation in non-sparse distributions. Since many tracers are not highly specific, and the gain of detection efficiency by allowing multiplexing is fairly offset by image degradations, multiplexing needs to be kept to a minimum for optimum MPH collimator designs.

Electron-multiplying charge-coupled devices (EMCCDs) coupled to scintillation crystals can be used for high-resolution imaging of gamma rays in scintillation counting mode. However, the detection of false events as a result of EMCCD noise deteriorates the spatial and energy resolution of these gamma cameras and creates a detrimental background in the reconstructed image. In order to improve the performance of an EMCCD-based gamma camera with a monolithic scintillation crystal, arrays of silicon photon-multipliers (SiPMs) can be mounted on the sides of the crystal to detect escaping scintillation photons, which are otherwise neglected. This will provide a priori knowledge about the correct number and energies of gamma interactions that are to be detected in each CCD frame. This information can be used as an additional detection criterion, e.g. for the rejection of otherwise falsely detected events. The method was tested using a gamma camera based on a back-illuminated EMCCD, coupled to a 3 mm thick continuous CsI:Tl crystal. Twelve SiPMs have been mounted on the sides of the CsI:Tl crystal. When the information of the SiPMs is used to select scintillation events in the EMCCD image, the background level for (99m)Tc is reduced by a factor of 2. Furthermore, the SiPMs enable detection of (125)I scintillations. A hybrid SiPM-/EMCCD-based gamma camera thus offers great potential for applications such as in vivo imaging of gamma emitters.

The response of a silicon photomultiplier (SiPM) to optical signals is inherently nonproportional due to saturation, afterpulsing, and crosstalk. Existing models of the SiPM response do not account for all of these effects, and therefore, these models are not sufficiently accurate for many applications. In this work, a comprehensive model of the SiPM response is developed that is generally applicable to exponentially decaying light pulses and that can be simplified in the case of very short (e.g., laser) light pulses. The model accounts for the total number and the temporal distribution of the incident photons as well as for the relevant SiPM parameters, viz. the recovery time, afterpulsing, crosstalk, and their cross correlations. The model is shown to correspond well with measurements on a SiPM-based scintillation detector. Furthermore, it is shown to be in agreement with several cases for which the SiPM response is known a priori. Having thus validated the model, its use is demonstrated by predicting the response of the Hamamatsu multipixel photon counter (MPPC) S10362-33-050C SiPM to several different scintillators.

The use of time-of-flight (TOF) information in positron emission tomography (PET) enables significant improvement in image noise properties and, therefore, lesion detection. Silicon photomultipliers (SiPMs) are solid-state photosensors that have several advantages over photomultiplier tubes (PMTs). SiPMs are small, essentially transparent to 511 keV gamma rays and insensitive to magnetic fields. This enables novel detector designs aimed at e.g. compactness, high resolution, depth-of-interaction (DOI) correction and MRI compatibility. The goal of the present work is to study the timing performance of SiPMs in combination with LaBr(3):Ce(5%), a relatively new scintillator with promising characteristics for TOF-PET. Measurements were performed with two, bare, 3 mm x 3 mm x 5 mm LaBr(3):Ce(5%) crystals, each coupled to a 3 mm x 3 mm SiPM. Using a (22)Na point source placed at various positions in between the two detectors, a coincidence resolving time (CRT) of approximately 100 ps FWHM for 511 keV annihilation photon pairs was achieved, corresponding to a TOF positioning resolution of approximately 15 mm FWHM. At the same time, pulse height spectra with well-resolved full-energy peaks were obtained. To our knowledge this is the best CRT reported for SiPM-based scintillation detectors to date. It is concluded that SiPM-based scintillation detectors can provide timing resolutions at least as good as detectors based on PMTs.

State-of-the-art small-animal single photon emission computed tomography (SPECT) enables sub-half-mm resolution imaging of radio-labelled molecules. Due to severe photon penetration through pinhole edges, current multi-pinhole SPECT is not suitable for high-resolution imaging of photons with high energies, such as the annihilation photons emitted by positron emitting tracers (511 keV). To deal with this edge penetration, we introduce here clustered multi-pinhole SPECT (CMP): each pinhole in a cluster has a narrow opening angle to reduce photon penetration. Using simulations, CMP is compared with (i) a collimator with traditional pinholes that is currently used for sub-half-mm imaging of SPECT isotopes (U-SPECT-II), and (ii), like (i) but with collimator thickness adapted to image high-energy photons (traditional multi-pinhole SPECT, TMP). At 511 keV, U-SPECT-II is able to resolve the 0.9 mm rods of an iteratively reconstructed Jaszczak-like capillary hot rod phantom, and while TMP only leads to small improvements, CMP can resolve rods as small as 0.7 mm. Using a digital tumour phantom, we show that CMP resolves many details not assessable with standard USPECT-II and TMP collimators. Furthermore, CMP makes it possible to visualize uptake of positron emitting tracers in sub-compartments of a digital mouse striatal brain phantom. This may open up unique possibilities for analysing processes such as those underlying the function of neurotransmitter systems. Additional potential of CMP may include (i) the imaging of other high-energy single-photon emitters (e.g. I-131) and (ii) localized imaging of positron emitting tracers simultaneously with single photon emitters, with an even better resolution than coincidence PET.

Introduction. Spatially registering SPECT with CT makes it possible to anatomically localize SPECT tracers. In this study, an accurate method for the coregistration of ultra-high-resolution SPECT volumes and multiple cone-beam CT volumes is developed and validated, which does not require markers during animal scanning.Methods. Transferable animal beds were developed with an accurate mounting interface. Simple calibration phantoms make it possible to obtain both the spatial transformation matrix for stitching multiple CT scans of different parts of the animal and to register SPECT and CT. The spatial transformation for image coregistration is calculated once using Horn's matching algorithm. Animal images can then be coregistered without using markers.Results. For mouse-sized objects, average coregistration errors between SPECT and CT inX,Y, andZdirections are within 0.04 mm, 0.10 mm, and 0.19 mm, respectively. For rat-sized objects, these numbers are 0.22 mm, 0.14 mm, and 0.28 mm. Average 3D coregistration errors were within 0.24 mm and 0.42 mm for mouse and rat imaging, respectively.Conclusion. Extending the field-of-view of cone-beam CT by stitching is improved by prior registration of the CT volumes. The accuracy of registration between SPECT and CT is typically better than the image resolution of current ultra-high-resolution SPECT.

Charge Coupled Devices (CCDs) optically coupled to scintillation crystals can be used to construct high resolution gamma cameras. Previously, several groups have reported intrinsic detector spatial resolutions below 100 microns. When the CCD images can be read out fast enough., the energy and interaction position of individual gamma quanta can be estimated by a real-time image analysis of the scintillation light flashes. The Electron-Multiplying CCD (EMCCD) is well-suited for fast read out, since even at high frame rates it has extremely low readout noise. However, due to the often very low light levels present in scintillation gamma cameras, further reduction of noise is desirable. Here, the EMCCD is optically coupled to a 1000-mu m-thick columnar CsI(TI) crystal for Tc-99m and 1-125 imaging. We investigate noise reduction through summing of signals in pixels before the gain register and readout circuit of the EMCCD ("pixel binning"). We compare the energy and spatial resolution, photopeak efficiency (PE) and signal-to-noise ratio (SNR) of an EMCCD-based gamma camera for the case of binning vs. non-binning. When pixels were read out simultaneously in groups of 4 the spatial resolution is slightly worse in the direction of binning, but the number of false-positive counts resulting from background noise for 1-125 was reduced by 74% compared to the no binning case. We conclude that the use of charge binning when reading out EMCCDs may significantly improve the energy spectra and noise properties of CCD-based high-resolution gamma cameras.

Purpose Small field-of-view (FOV) dedicated cardiac SPECT systems suffer from truncated projection data. This results in (1) neglect of liver activity that otherwise could be used to estimate (and subsequently correct) the amount of scatter in the myocardium by model-based scatter correction, and (2) distorted attenuation maps. In this study, we investigated to what extent truncation impacts attenuation correction and model-based scatter correction in the cases of 99mTc, 201Tl, and simultaneous 99mTc/201Tl studies. In addition, we evaluated a simple correction method to mitigate the effects of truncation. Methods Digital thorax phantoms of different sizes were used to simulate the full FOV SPECT projections for 99mTc, 201Tl, and simultaneous 99mTc/201Tl studies. Small FOV projections were obtained by artificially truncating the full FOV projections. Deviations from ideal heart positioning were simulated by axially shifting projections resulting in more severe liver truncation. Effects of truncation on SPECT images were tested for ordered subset (OS) expectation maximization reconstruction with (1) attenuation correction and detector response modelling (OS-AD), and (2) with additional Monte-Carlo-based scatter correction (OS-ADS). To correct truncation-induced artefacts, we axially extended truncated projections on both sides by duplicating pixel values on the projection edge. Results For both 99mTc and 201Tl, differences in the reconstructed myocardium between full FOV and small FOV projections were negligible. In the nine myocardial segments, the maximum deviations of the average pixel values were 1.3% for OS-AD and 3.5% for OS-ADS. For the simultaneous 99mTc/201Tl studies, reconstructed 201Tl SPECT images from full FOV and small FOV projections showed clearly different image profiles due to truncation. The maximum deviation in defected segments was found to be 49% in the worst-case scenario. However, artificially extending projections reduced deviations in defected segments to a few percent. Conclusion Our results indicate that, for single isotope studies, using small FOV systems has little impact on attenuation correction and model-based scatter correction. For simultaneous 99mTc/201Tl studies, artificial projection extension almost fully eliminates the adverse effects of projection truncation.

High-resolution imaging of x-ray and gamma-ray distributions can be achieved with cameras that use charge coupled devices (CCDs) for detecting scintillation light flashes. The energy and interaction position of individual gamma photons can be determined by rapid processing of CCD images of individual flashes. Here we investigate the improvement of such a gamma camera when a micro-machined retro-reflector is used to increase the light output of a continuous scintillation crystal. At 122 keV we found that retro-reflectors improve the intrinsic energy resolution (full width at half maximum (FWHM)) by 32% (from 50% to 34%) and the signal-to-noise (SNR) ratio by 18%. The spatial resolution (FWHM) was improved by about 4%, allowing us to obtain a resolution of 159 microm. The full width at tenth maximum (FWTM) improvement was 13%. Therefore, this enhancement is a next step towards realizing compact high-resolution devices for imaging gamma emitters.

We have investigated the time-of-flight (TOF) capability of a monolithic 20 rum x 20 mm x 12 mm LYSO crystal coupled to a Hamamatsu position-sensitive H8711-03 4x4 multi-anode photomultiplier tube. The x-, y-, and z-coordinates of the photoconversion location inside the crystal are determined using a maximum likelihood estimation algorithm, based on a calibration scan with a pencil beam of 511 keV photons across the front and one of the side surfaces of the crystal. A FWHM resolution in x- and y-direction of 2.7 mm is obtained. In the z-direction, i.e. the depth-of-interaction (DOI), the FWHM resolution ranges from 2.5 mm near the photomultiplier tube to 4 mm at a distance of 10 mm from the photomultiplier tube. Artifacts are observed at all edges of the crystal. A timing resolution of 349 ps FWHM is obtained in coincidence with a fast BaF(2) detector. DOI time walk is observed to strongly depend on the region of the crystal selected. In the present setup, a software correction of the DOI time walk of less than 100 ps across the detector does not significantly improve the coincidence timing resolution, as the walk effect is much smaller than the system timing resolution. A simulation of the DOI time walk effect in the coincidence of two 30 mm thick LaBr(3) crystals indicates that a DOI time walk correction may lead to a significant improvement in timing resolution.

SPECT imaging with low dose or short acquisition time can lead to very noisy reconstructed images. With the U-SPECT-II system we study the effect of low-count scans, and 3D Gaussian blurring to suppress statistical errors. Three different groups of short-time cardiac rat scans were derived from a long-time scan. Images were reconstructed and then smoothed with 3D Gaussian filters with different kernel sizes. We used the standard deviations of voxel values in the reconstructions from each short-time group to indicate the quality of the blurred images. The results show that a good cardiac rat SPECT image can be obtained from a scan in the U-SPECT-II system within very short time (2 minutes) or with very low dose (0.30 mCi activity injected) if some additional blurring is accomplished to the reconstruction.

PURPOSE: Thallous (201Tl) chloride is a single-photon emission computed tomography (SPECT) tracer mainly used for assessing perfusion and viability of myocardial tissue. 201Tl emits X-rays around 72 keV and gammas at 167 keV, and has a half-life of 73 h. Regulations allow an intrinsic contamination up to 3-5%, which is mainly caused by 200Tl (368 keV; 26 h) and by 202Tl (439 keV; 12.2 days). Contra-intuitive to the low-level percentages in which these contaminants are present, their impact may be significant because of much higher gamma camera sensitivity for these high-energy photon emissions. Therefore, we investigate the effects of the contaminants in terms of detected fractions of photons in projections and contrast degradation in reconstructed images. METHODS: Acquisitions of a digital thorax phantom filled with thallous (201Tl) chloride were simulated with a validated Monte Carlo tool, thereby, modelling 1% of contamination by 200Tl and 202Tl each. In addition, measurements of a thorax phantom on a dual-headed gamma camera were performed. The product used was contaminated by 0.17% of 200Tl and 0.24% of 202Tl at activity reference time (ART). This ART is specified by the manufacturer, thereby, accounting for the difference in half-lives of 201Tl and its contaminants. These measurements were repeated at different dates associated with various contamination levels. RESULTS: Simulations showed that, with 1% of 200Tl and 202Tl, the total contamination in the 72 keV window can rise up to one out of three detected photons. For the 167 keV window, the contamination is even more pronounced: more than four out of five detections in this photopeak window originate from contaminants. Measurements indicate that cold lesion contrast in myocardial perfusion SPECT imaging is at maximum close to ART. In addition to a higher noise level, relative contrast decreases 15% 2 days early to ART, which is explained by an increase in 200Tl contamination. After ART, contrast decreased by 16% when the 202Tl contamination increased to the maximal allowed limit. CONCLUSIONS: Contra-intuitive to the low-level percentages in which they are typically present, penetration and downscatter of high-energy photons from 200Tl and 202Tl significantly contribute to thallous (201Tl) chloride images, thereby, reducing contrast and adding noise. These findings may prompt for improved production methods, for updated policies with regard to timing of usage, and they also render the usefulness of adding the high photopeak window (167 keV) questionable. A window-based correction method for this contamination is advisable

Preclinical imaging with SPECT combined with CT or MRI is used more and more frequently and has proven to be very useful in translational research. In this article, an overview of current preclinical research applications and trends of SPECT combined with CT or MRI, mainly in tumour imaging and neuroscience imaging, is given and the advantages and disadvantages of the different approaches are described. Today SPECT and CT systems are often integrated into a single device (commonly called a SPECT/CT system), whereas at present combined SPECT and MRI is almost always carried out with separate systems and fiducial markers to combine the separately acquired images. While preclinical SPECT/CT is most widely applied in oncology research, SPECT combined with MRI (SPECT/MRI when integrated in one system) offers the potential for both neuroscience applications and oncological applications. Today CT and MRI are still mainly used to localize radiotracer binding and to improve SPECT quantification, although both CT and MRI have additional potential. Future technology developments may include fast sequential or simultaneous acquisition of (dynamic) multimodality data, spectroscopy, fMRI along with high-resolution anatomic MRI, advanced CT procedures, and combinations of more than two modalities such as combinations of SPECT, PET, MRI and CT all together. This will all strongly depend on new technologies. With further advances in biology and chemistry for imaging molecular targets and (patho)physiological processes in vivo, the introduction of new imaging procedures and promising new radiopharmaceuticals in clinical practice may be accelerated.