MRI-SPECT image registration using multiple MR pulse sequences to examine osteoarthritis of the knee

We have examined whether automated image registration can be used to combine metabolic information from SPECT knee scans with anatomical information from MRI. Ten patients, at risk of developing OA due to meniscal surgery, were examined. 99mTc methyldiphosphonate SPECT, T2-weighted fast spin echo (FSE) MRI, and T1-weighted, 3D fat-suppressed gradient recalled echo (SPGR) MRI images were obtained. Registration was performed using normalized mutual information. For each patient, FSE data was registered to SPGR data, providing a composite MRI image with each voxel represented by two intensities (ISPGR, IFSE). Modifications to the registration algorithm were made to allow registration of SPECT data (one intensity per voxel) to composite MRI data (2 intensities per voxel). Registration sources was assessed by visual inspection of uptake localization over expected anatomical locations, and the absence of uptake over unlikely sites. Three patients were discarded from SPECT-MRI registration tests since they had metallic artifacts that prevented co-registration of MR data. Registration of SPECT to SPGR or FSE data alone proved unreliable, with less than 50% of attempts succeeding. The modified algorithm, treating co-registered SPGR and FSE data as a two-value-per-voxel image, proved most reliable, allowing registration of all patients with no metallic artifacts on MRI.