Effects of Piecewise Spatial Smoothing in 4-D SPECT Reconstruction

In nuclear medicine, cardiac gated SPECT images are known to suffer from significantly increased noise owing to limited data counts. Consequently, spatial (and temporal) smoothing has been indispensable for suppressing the noise artifacts in SPECT reconstruction. However, recently we demonstrated that the benefit of spatial processing in motion-compensated reconstruction of gated SPECT (aka 4-D) could be outweighed by its adverse effects on the myocardium, which included degraded wall motion and perfusion defect detectability. In this work, we investigate whether we can alleviate these adverse effects by exploiting an alternative spatial smoothing prior in 4-D based on image total variation (TV). TV based prior is known to induce piecewise smoothing which can preserve edge features (such as boundaries of the heart wall) in reconstruction. However, it is not clear whether such a property would necessarily be beneficial for improving the accuracy of the myocardium in 4-D reconstruction. In particular, it is unknown whether it would adversely affect the detectability of perfusion defects that are small in size or low in contrast. In our evaluation study, we first use Monte Carlo simulated imaging with 4-D NURBS-based cardiac-torso (NCAT) phantom wherein the ground truth is known for quantitative comparison. We evaluated the accuracy of the reconstructed myocardium using a number of metrics, including regional and overall accuracy of the myocardium, accuracy of the phase activity curve (PAC) of the LV wall for wall motion, uniformity and spatial resolution of the LV wall, and detectability of perfusion defects using a channelized Hotelling observer (CHO). For lesion detection, we simulated perfusion defects with different sizes and contrast levels with the focus being on perfusion defects that are subtle. As a preliminary demonstration, we also tested on three sets of clinical acquisitions. From the quantitative results, it was demonstrated that TV smoothing could further reduce the error level in the myocardium in 4-D reconstruction along with motion-compensated temporal smoothing. In contrast to quadratic spatial smoothing, TV smoothing could reduce the noise level in the LV at a faster pace than the increase in the bias level, thereby achieving a net decrease in the error level. In particular, at the same noise level, TV smoothing could reduce the bias by about 30% compared to quadratic smoothing. Moreover, the CHO results indicate that TV could also improve the lesion detectability even when the lesion is small. The PAC results show that, at the same noise level, TV smoothing achieved lower temporal bias, which is also consistent with the improved spatial resolution of the LV in reconstruction. The improvement in blurring effects by TV was also observed in the clinical images.