Graphical 3D medical image registration and quantification

We present a graphical three-dimensional method that facilitates image registration and fusion, and provides quantitative geometric and volume information. In particular it enhances the use of functional (radiopharmaceutical) imaging (SPECT, PET) which, though a powerful clinical tool, has the disadvantage of low spatial resolution and ill-defined boundaries. Registration between functional images and structural images (MRI, CT) can augment the anatomical context of these functional images.     

Super-early iodine-123-iodoamphetamine SPECT imaging of human primary motor cortex

This study was designed to visualize the motor function area related to finger movements in normal human brain using super-early (first 640 sec of acquisition) [123l]iodoamphetamine ([123I]IMP) SPECT. METHODS: Seven healthy male volunteers performed paired, isolated baseline and task sessions. The task was a right thumb-to-fingers opposition task, which was loaded for the initial 11 min of the session. A high-performance, four-head SPECT camera was used. At each session, administration of 222 MBq [123I]IMP was followed by 16 serial 160-sec dynamic SPECT acquisitions. To obtain matched brain anatomical images, MRI was also performed using the same slice formation as in the SPECT study. After image reconstruction, ROIs were set on bilateral sensorimotor hand areas (SMHA), the supplementary motor area (SMA), the frontal, temporal and occipital lobes and the cerebellar hemispheres. The percent increase of ROI activity (%INC) in the task session compared with that in the baseline session was calculated in each ROI after normalization to the global brain radioactivity. RESULTS: There was significant activation of the left SMHA by the task, the amplitude of which was maximal in the initial phase of dynamic images (the super-early phase). This area was located in the left peri-central area identified on the analogous slice in the MR image. The left SMHA showed gradual and statistically significant decrease of %INC during the three phases. CONCLUSION: Super-early [123I]IMP may be used to identify the primary motor cortex and to evaluate its function in some pathological conditions.     

Quantitative myocardial perfusion SPECT

In recent years, there has been much interest in the clinical application of attenuation compensation to myocardial perfusion single photon emission computed tomography (SPECT) with the promise that accurate quantitative images can be obtained to improve clinical diagnoses. The different attenuation compensation methods that are available create confusion and some misconceptions. Also, attenuation-compensated images reveal other image-degrading effects including collimator-detector blurring and scatter that are not apparent in uncompensated images. This article presents basic concepts of the major factors that degrade the quality and quantitative accuracy of myocardial perfusion SPECT images, and includes a discussion of the various image reconstruction and compensation methods and misconceptions and pitfalls in implementation. The differences between the various compensation methods and their performance are demonstrated. Particular emphasis is directed to an approach that promises to provide quantitative myocardial perfusion SPECT images by accurately compensating for the 3-dimensional (3-D) attenuation, collimator-detector response, and scatter effects. With advances in the computer hardware and optimized implementation techniques, quantitatively accurate and high-quality myocardial perfusion SPECT images can be obtained in clinically acceptable processing time. Examples from simulation, phantom, and patient studies are used to demonstrate the various aspects of the investigation. We conclude that quantitative myocardial perfusion SPECT, which holds great promise to improve clinical diagnosis, is an achievable goal in the near future.     

Quantitative imaging in electron and confocal microscopies for applications in biology

Among the large number of topics related to the quantification of images in electron and confocal microscopies for applications in biology, we selected four subjects that we consider to be representative of some recent tendencies. The first is the quantification of three-dimensional data sets recorded routinely in scanning confocal microscopy. The second is the quantification of the textural and fractal appearance of images. The two other topics are related to image series, which are more and more often provided by imaging instruments. The first kind of series concerns electron energy-filtered images. We show that the parametric (modelling) approach can be complemented by non-parametric approaches (e.g., different variants of multivariate statistical techniques). The other kind of series consists of multiple mappings of a specimen. We describe several new tools for the study and quantification of the co-location, with potential application to multiple mappings in microanalysis or in fluorescence microscopy.     

一种改进的非刚性图像配准算法

非刚性图像配准一直是计算机视觉领域的研究重点. 为解决上述问题, 提出一种改进的光流场模型算法, 以提高光流估计的准确度. 算法首先对原始变分光流模型进行了改进, 提出利用新的各向异性正则项来代替原来的同向扩散函数, 以避免图像模糊, 保留图像的边缘特征与细节特征; 此外, 通过引入包含邻域信息的非局部平滑项来去除光流噪点, 同时增加了一个结合图像结构与光流运动信息的权函数, 以减少过平滑所造成的细节丢失, 提高算法的鲁棒性. 最后, 利用交替最小化与金字塔分层迭代策略相结合的方法求解位移场, 实现非刚性图像的自动配准. 仿真实验结果表明, 与传统方法相比, 本文算法对不同类型的非刚性图像均具有较高的鲁棒性, 取得了理想的图像配准效果.      

MR evaluation of the articular cartilage of the femoral head during traction. Correlation with resected femoral head

As a result of a high percentage of hypoactive upper poles of kidneys in traditional 99mTc-dimercaptosuccinic acid (DMSA) SPECT, a prospective study was conducted using 180 degrees acquisition technique compared with 360 degrees to minimize tissue attenuation. METHODS: Anterior 180 degrees, posterior 180 degrees and 360 degrees renal SPECT images were obtained simultaneously using a dual-head camera. Forty-one subjects without renal disease and 16 subjects with 21 cortical defects were included in this study. The total counts of the raw data in the anterior 180 degrees, posterior 180 degrees and full 360 degrees were calculated. Small regions of interest were drawn over the cortex of the kidney on coronal and reoriented sagittal slices. Quantitative evaluation of regional activity was performed on the same frames in all three acquisition methods. RESULTS: Comparison of the total renal counts between the anterior and posterior 180 degrees data showed reduced counts in the anterior 180 degrees data collection (P < 0.01). Visual evaluation of the reconstructed images from anterior 180 degrees, posterior 180 degrees and full 360 degrees data collection showed the best image uniformity in the posterior 180 degrees image. The upper/lower pole ratio in the posterior 180 degrees renal SPECT images increased significantly in comparison to full 360 degrees renal SPECT images (P < 0.01) and anterior 180 degrees SPECT images (P < 0.01). The renal defects were more clearly visualized in the posterior 180 degrees renal SPECT images than the full 360 degrees renal SPECT images. The defect/normal cortex ratios in the posterior 180 degrees renal SPECT images were much lower than those from the full 360 degrees SPECT images (P < 0.01) and those from the anterior 180 degrees SPECT images (P < 0.01). CONCLUSION: The posterior 180 degrees acquisition technique can avoid the problem of hypoactive upper pole and can be less time consuming in 99mTc-DMSA SPECT images. It also provides superior lesion contrast in the clinical evaluation of patients with renal scarring.     

Use of the selective linogram in cardiac tomography quality control

BACKGROUND: Quality control for detection of patient motion is essential in tomographic myocardial imaging. Despite significant limitations, the summation image or conventional "linogram" has long been advocated as a useful image in the detection of vertical motion. In this study a new quality control image entitled the "selective linogram" is proposed to replace the summation image in routine cardiac single-photon emission cardiac tomography (SPECT) quality control. The selective linogram is constructed in a manner somewhat analogous to the sinogram. In the sinogram, each row represents a different projection angle; in the selective linogram each column represents a different projection angle. METHODS AND RESULTS: After selection of eight motion-free studies from acquisitions at our clinical center, vertical motion of various types (bounces, shifts, and creep) were added to the projection frames. Summation image and selective linogram quality control images from these motion-containing studies and the original motion-free studies were presented in a blinded manner to two observers for scoring of patient motion. The selective linogram was significantly more accurate in allowing detection of vertical motion than was the summation image (accuracy 89% vs 47%). CONCLUSIONS: The selective linogram image is markedly superior to the summation image for the detection of vertical patient motion during cardiac SPECT. This new technique can be a valuable aid in SPECT quality control.     

Effect of geometrical distortion correction in MR on image registration accuracy

In this article we investigate the effect of geometrical distortion correction in MR images on the accuracy of the registration of X-ray CT and MR head images for both a fiducial marker (extrinsic point) method and a surface-matching technique. We use CT and T2-weighted MR image volumes acquired from seven patients who underwent craniotomies in a stereotactic neurosurgical clinical trial. Each patient had four external markers attached to transcutaneous posts screwed into the outer table of the skull. The MR images are corrected for static field inhomogeneity by using an image rectification technique and corrected for scale distortion (gradient magnitude uncertainty) by using an attached stereotactic frame as an object of known shape and size. We define target registration error (TRE) as the distance between corresponding marker positions after registration and transformation. The accuracy of the fiducial marker method is determined by using each combination of three markers to estimate the transformation and the remaining marker to calculate registration error. Surface-based registration is accomplished by fitting MR contours corresponding to the CSF-dura interface to CT contours derived from the inner surface of the skull. The mean point-based TRE using three noncollinear fiducials improved 34%-from 1.15 to 0.76 mm-after correcting for both static field inhomogeneity and scale distortion. The mean surface-based TRE improved 46%-from 2.20 to 1.19 mm. Correction of geometrical distortion in MR images can significantly improve the accuracy of point-based and surface-based registration of CT and MR head images. Distortion correction can be important in clinical situations such as stereotactic and functional neurosurgery where 1 to 2 mm accuracy is required.     

123I-metaiodobenzylguanidine (MIBG) scintigraphy for the staging of neuroblastoma

Nineteen children with neuroblastoma (aged 2 w.-7 y.o.) were studied to evaluate the optimal scan conditions for Iodine-123-Metaiodobenzylguanidine (MIBG) scintigraphy for accurate staging at the time of diagnosis. Six and 24 hours after an injection of 123I-MIBG, whole body image and truncal spot and SPECT images were obtained. Compared with other studies (CT or MRI and bone scintigraphy), each 123I-MIBG image was evaluated visually to investigate which image can demonstrate the extent of neuroblastoma most exactly. MIBG images demonstrated primary tumors in all patients, and metastatic lymphadenopathy in 8 of 9 patients. Twenty-four hour SPECT images gave us the most detailed information about the extent of abnormal accumulation. As to bone and bone marrow lesions, 6 hour images were superior to 24 hour images in detectability. Moreover, MIBG showed many more lesions and more extended accumulation than the bone scan. 123I-MIBG scintigraphy was very useful in detecting neuroblastomas. In order to get the most valuable information, both delayed SPECT and early whole body planar images should be obtained.     

基于监督学习的前列腺MR/TRUS图像分割和配准方法

前列腺核磁超声图像配准融合有助于实现前列腺肿瘤的靶向穿刺。传统的配准方法主要是针对手动分割的前列腺核磁（Magnetic resonance, MR）和经直肠超声（Trans-rectal ultrasound, TRUS）图像上对应的生理特征点作为参考点,进行刚体或非刚体配准。针对超声图像因成像质量低导致手动分割配准效率低下的问题,提出一种基于监督学习的前列腺MR/TRUS图像自动分割方法,与术前核磁图像进行非刚体配准。首先,针对图像分割任务训练前列腺超声图像的活动表观模型（Active appearance model, AAM）,并基于随机森林建立边界驱动的数学模型,实现超声图像自动分割。接着,提取术前分割的核磁图像与自动分割的超声图像建立轮廓的形状特征矢量,进行特征匹配与图像配准。实验结果表明,本文方法能准确实现前列腺超声图像自动分割与配准融合,9组配准结果的戴斯相似性系数（Dice similarity coefficient, DSC）均大于0.98,同时尿道口处特征点的平均定位精度达1.64 mm,相比传统方法具有更高的配准精度。      

Automatic registration of pelvic computed tomography data and magnetic resonance scans including a full circle method for quantitative accuracy evaluation

The purpose of this study is to develop a method for registration of CT and MR scans of the pelvis with minimal user interaction and to obtain a means for objective quantification of the registration accuracy of clinical data without markers. CT scans were registered with proton density MR scans using chamfer matching on automatically segmented bone. A fixed threshold was used to segment CT, while morphological filters were used to segment MR. The method was tested with transverse and coronal MR scans of 18 patients and sagittal MR scans of 8 patients. The registration accuracy was estimated by comparing (triangulating) registrations of a single CT scan with MR in different orientations in a "full circle." For example, CT is first matched on transverse MR, next transverse MR is matched independently on coronal MR, and finally coronal MR is matched independently on CT. The product of the three transformations is the identity if all matching steps are perfect. Deviations from identity occur both due to random errors and due to some types of systematic errors. MR was registered on MR (to close the "circle") by minimization of rms voxel value differences. CT-MR registration takes about 1 min, including user interaction. The random error for CT-MR registration with transverse or coronal MR was 0.5 mm in translation and 0.4 degree in rotation (standard deviation) for each axis. A systematic registration error of about 1 mm was demonstrated along the MR frequency encoding direction, which is attributed to the chemical shift. In conclusion, the presented algorithm efficiently and accurately registers pelvic CT and MR scans on bone. The "full circle" method provides an estimate of the registration accuracy on clinical data.     

Comparison of inferior myocardial defect between planar and SPECT image of 123I-metaiodobenzylguanidine cardiac scintigraphy

Discordant findings of inferior MIBG defect between SPECT and planar images were sometimes observed in the clinical studies. In this study, we compared inferior myocardial findings between planar and SPECT image of 123I-metaiodobenzyl-guanidine (MIBG) cardiac scintigraphy in 29 patients. All patients were estimated as normal in anterior accumulation of MIBG. The patients were divided into 3 groups according to the visual finding of inferior defect in the planar and SPECT image; normal group (normal inferior accumulation of MIBG both in the planar and SPECT image, N = 10), discordance group (inferior MIBG defect was only observed in the SPECT image, but was not observed in the planar image, N = 7), inferior defect group (inferior MIBG defect was observed both in the planar and SPECT image, N = 12). Inferior/anterior count ratio of SPECT and planar image were 0.96 +/- 0.11 vs. 0.97 +/- 0.05 in normal group, 0.59 +/- 0.21 vs. 0.99 +/- 0.13 in discordance group, 0.46 +/- 0.13 vs. 0.82 +/- 0.04 in inferior defect group. Liver/heart count ratio was significantly higher in the discordance group (2.07 +/- 0.49) than that in the normal (1.14 +/- 0.15) and inferior defect group (1.45 +/- 0.39). In phantom study, it has been reported that increased liver accumulation of MIBG causes artifactual inferior defect adjacent to the liver. These data indicate that increased liver/heart count ratio may cause artifactual inferior defect on MIBG SPECT image in the clinical studies. Planar image evaluation may be helpful to distinct the artifactual inferior defect on SPECT image.     

Enantioselective pharmacokinetics of dl-threo-methylphenidate in humans

We review and discuss different classes of image segmentation methods. The usefulness of these methods is illustrated by a number of clinical cases. Segmentation is the process of assigning labels to pixels in 2D images or voxels in 3D images. Typically the effect is that the image is split up into segments, also called regions or areas. In medical imaging it is essential for quantification of outlined structures and for 3D visualization of relevant image data. Based on the level of implemented model knowledge we have classified these methods into (1) manual delineation, (2) low-level segmentation, and (3) model-based segmentation. Pure manual delineation of structures in a series of images is time-consuming and user-dependent and should therefore be restricted to quick experiments. Low-level segmentation analyzes the image locally at each pixel in the image and is practically limited to high-contrast images. Model-based segmentation uses knowledge of object structure such as global shape or semantic context. It typically requires an initialization, for example in the form of a rough approximation of the contour to be found. In practice it turns out that the use of high-level knowledge, e.g. anatomical knowledge, in the segmentation algorithm is quite complicated. Generally, the number of clinical applications decreases with the level and extent of prior knowledge needed by the segmentation algorithm. Most problems of segmentation inaccuracies can be overcome by human interaction. Promising segmentation methods for complex images are therefore user-guided and thus semi-automatic. They require manual intervention and guidance and consist of fast and accurate refinement techniques to assist the human operator.     

Determining the imaging quality of intraocular lenses

This paper describes research work motivated by an innovative medical application: computer-assisted transbronchial biopsy. This project involves the registration, with no external localization device, of a preoperative three-dimensional (3-D) computed tomography (CT) scan of the thoracic cavity (showing a tumor that requires a needle biopsy), and an intraoperative endoscopic two-dimensional (2-D) image sequence, in order to provide assistance in transbronchial puncture of the tumor. Because of the specific difficulties resulting from the data being processed, a multilevel strategy was introduced. For each analysis level, the relevant information to process and the corresponding algorithms were defined. This multilevel strategy, thus, provides the best possible accuracy. Original image processing methods were elaborated, dealing with segmentation, registration and 3-D reconstruction of the bronchoscopic images. In particular, these methods involve adapted mathematical morphology tools, a "daemon-based" registration algorithm, and a model-based shape-from-shading algorithm. This pilot study presents the application of these algorithms to recorded bronchoscopic video sequences for five patients. The preliminary results presented here demonstrate that it is possible to precisely localize the endoscopic camera within the CT data coordinate system. The computer can thus synthesize in near real-time the CT-derived virtual view that corresponds to the actual endoscopic view.     

Registration of MR and SPECT without using external fiducial markers

The aim of our work is to present, test and validate an automated registration method used for matching brain SPECT scans with corresponding MR scans. The method was applied on a data set consisting of ten brain IDEX SPECT scans and ten T1- and T2-weighted MR scans of the same subjects. Of two subjects a CT scan was also made. (Semi-) automated algorithms were used to extract the brain from the MR, CT and SPECT images. Next, a surface registration technique called chamfer matching was used to match the segmented brains. A perturbation study was performed to determine the sensitivity of the matching results to the choice of the starting values. Furthermore, the SPECT segmentation threshold was varied to study its effect on the resulting parameters and a comparison between the use of MR T1- and T2-weighted images was made. Finally, the two sets of CT scans were used to estimate the accuracy by matching MR to CT and comparing the MR-SPECT match to the SPECT-CT match. The perturbation study showed that for initial perturbations up to 6 cm the algorithm fails in less than 4% of the cases. A variation of the SPECT segmentation threshold over a realistic range (25%) caused an average variation in the optimal match of 0.28 cm vector length. When T2 is used instead of T1 the stability of the algorithm is comparable but the results are less realistic due the large deformations. Finally, a comparison of the direct SPECT-MR match and the indirect match with CT as intermediate yields a discrepancy of 0.4 cm vector length. We conclude that the accuracy of our automatic matching algorithm for SPECT and MR, in which no external markers were used, is comparable to the accuracies reported in the literature for non-automatic methods or methods based on external markers. The proposed method is efficient and insensitive to small variations in SPECT segmentation.     

Satisfaction of the "Mister Employee": a goal to be reached]

Six patients with pulmonary emphysema scheduled to undergo thoracoscopic lung volume reduction surgery (TLVRS) were evaluated by three-dimensional (3-D) dynamic pulmonary xenon-133 SPECT. Serial 30-second dynamic SPECT data for equilibrium and washout (for 5 min) were acquired using a continuous repetitive rotating acquisition mode with a triple-detector SPECT system. SPECT data were reconstructed to 3-D images with a color, surface-rendering technique, and a 3-D fusion image of the 3-min washout image over the equilibrium image was obtained. Regional ventilation was visually assessed on the fusion 3-D images and quantified by xenon-133 half-washout time (T1/2) and mean transit time (MTT). The 3-D fusion image localized and lateralized the worst diseased sites with xenon-133 retention. Xenon-133 retention, T1/2 and MTT were reduced on these images in five patients with improved pulmonary function tests following TLVRS. However, xenon-133 retention was greater in one with asynchronous diaphragm movement after TLVRS. This modality will assist TLVRS in determining the lung resection target and in evaluating the treatment effect.     

Accuracy evaluation of fusion of CT, MR, and spect images using commercially available software packages (SRS PLATO and IFS)

PURPOSE: A problem for clinicians is to mentally integrate information from multiple diagnostic sources, such as computed tomography (CT), magnetic resonance (MR), and single photon emission computed tomography (SPECT), whose images give anatomic and metabolic information. METHODS AND MATERIALS: To combine this different imaging procedure information, and to overlay correspondent slices, we used commercially available software packages (SRS PLATO and IFS). The algorithms utilize a fiducial-based coordinate system (or frame) with 3 N-shaped markers, which allows coordinate transformation of a clinical examination data set (9 spots for each transaxial section) to a stereotactic coordinate system. The N-shaped markers were filled with fluids visible in each modality (gadolinium for MR, calcium chloride for CT, and 99mTc for SPECT). The frame is relocatable, in the different acquisition modalities, by means of a head holder to which a face mask is fixed so as to immobilize the patient. Position errors due to the algorithms were obtained by evaluating the stereotactic coordinates of five sources detectable in each modality. RESULTS: SPECT and MR position errors due to the algorithms were evaluated with respect to CT: deltax was < or = 0.9 mm for MR and < or = 1.4 mm for SPECT, deltay was < or = 1 mm and < or = 3 mm for MR and SPECT, respectively. Maximal differences in distance between estimated and actual fiducial centers (geometric mismatch) were in the order of the pixel size (0.8 mm for CT, 1.4 mm for MR, and 1.8 mm for SPECT). In an attempt to distinguish necrosis from residual disease, the image fusion protocol was studied in 35 primary or metastatic brain tumor patients. CONCLUSIONS: The image fusion technique has a good degree of accuracy as well as the potential to improve the specificity of tissue identification and the precision of the subsequent treatment planning.     

Vitiligo melanocytes in long-term culture show normal constitutive and cytokine-induced expression of intercellular adhesion molecule-1 and major histocompatibility complex class I and class II molecules

The main objective of this study was to characterize changes in brain perfusion associated with normal aging and gender. METHODS: Perfusion SPECT images using 99mTc-hexamethyl propyleneamine oxime (HMPAO) were obtained from 152 healthy subjects (67 men, 85 women) aged 50-92 yr. An automated method was developed to objectively assess image data from a large number of brain regions. Image data were reduced with singular value decomposition (SVD), which produced 20 eigenvectors capturing 97.05% of the total information content of 4320 regions from each subject. Subjects were scored individually on each vector. RESULTS: Multivariate analyses demonstrated that there were no significant differences in whole-brain HMPAO uptake with age, but age-related regional declines were seen in lateral ventricular regions. Women had higher HMPAO uptake than men in estimates of global perfusion and regional perfusion in the midcingulate/corpus callosum, inferior temporal and inferior parietal areas. CONCLUSION: These discriminations demonstrate that singular value deomposition of SPECT data may be used to assess differences in perfusion patterns between groups of subjects. They replicate several previous findings, both with respect to age-related changes in perfusion and with respect to gender differences. In addition, they identify a previously unreported gender difference in biparietal regions.     

Reactive oxygen species act at both TGF-beta-dependent and -independent steps during induction of apoptosis of transformed cells by normal cells

PURPOSE: In clinical practice, physicians are constantly comparing multiple images taken at various times during the patient's treatment course. One goal of such a comparison is to accurately define the gross tumor volume (GTV). The introduction of three-dimensional treatment planning has greatly enhanced the ability to define the GTV, but there are times when the GTV is not visible on the treatment-planning computed tomography (CT) scan. We have modified our treatment-planning software to allow for interactive display of multiple, registered images that enhance the physician's ability to accurately determine the GTV. METHODS AND MATERIALS: Images are registered using interactive tools developed at the University of North Carolina at Chapel Hill (UNC). Automated methods are also available. Images registered with the treatment-planning CT scan are digitized from film. After a physician has approved the registration, the registered images are made available to the treatment-planning software. Structures and volumes of interest are contoured on all images. In the beam's eye view, wire loop representations of these structures can be visualized from all image types simultaneously. Each registered image can be seamlessly viewed during the treatment-planning process, and all contours from all image types can be seen on any registered image. A beam may, therefore, be designed based on any contour. RESULTS: Nineteen patients have been planned and treated using multimodality imaging from November 1993 through August 1994. All registered images were digitized from film, and many were from outside institutions. Brain has been the most common site (12), but the techniques of registration and image display have also been used for the thorax (4), abdomen (2), and extremity (1). The registered image has been an magnetic resonance (MR) scan in 15 cases and a diagnostic CT scan in 5 cases. In one case, sequential MRs, one before treatment and another after 30 Gy, were used to plan patient's initial fields and boost, respectively. Case illustrations are shown. CONCLUSIONS: We have successfully integrated multimodality imaging into our treatment-planning system, and its routine use is increasing. Multimodality imaging holds out the promise of improving treatment planning accuracy and, thus, takes maximum advantage of three dimensional treatment planning systems.     

An improved method for rapid and efficient radioiodination of iodine-123-IQNB

The SPECT radioligand, 3-quinuclidinyl-4-[123I]iodobenzilate ([123I]IQNB), binds to muscarinic receptors and has generated interest as a potential agent for clinical SPECT. Unfortunately, cumbersome and inefficient radioiodination procedures have limited the practicality of [123I]IQNB SPECT imaging. METHODS: We report a rapid (5 min) and simple radioiodination procedure for preparing [123I]IQNB from a tri-n-butylstannyl precursor in a no-carrier-added reaction that yields high specific activity with radiochemical yield exceeding 60%. The radiochemical purity of the final product exceeds 95%. RESULTS: We have used this procedure to radioiodinate the four stereoisomers of [123I]IQNB. The procedure is highly reliable and reproducible. SPECT studies on a healthy human volunteer at 1, 2, 6 and 24 hr after injection of each of the four stereoisomers reveal expected differences in the kinetic and binding characteristics of the four stereoisomers. (R,S)-[123I]IQNB appears to be the SPECT agent of choice. CONCLUSION: Radioiodination of [123I]IQNB from our tri-n-butylstannyl precursor is simpler, more efficient and less expensive than previous techniques. The potential exists for a "kit" which would be practical in a typical clinical setting.