Fusion of SPECT and Multidetector CT Images for Accurate Localization of Pelvic Sentinel Lymph Nodes in Prostate Cancer Patients

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FIGURE 1.
Landmarks (arrows) on axial slices of CT (A) and SPECT (B).
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FIGURE 2.
Endoscopic lymphadenectomy by means of minilaparotomy.
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FIGURE 3.
Fusion of SPECT and CT images indicating left external iliac lymph node (arrow) in case 2. (A) Coronal slice. (B) Sagittal slice. (C) Axial slice. (D) Anterior planar lymphoscintigraphic image.
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FIGURE 4.
Fusion of SPECT and CT images indicating right obturator lymph node (arrow) in case 2. (A) Coronal slice. (B) Sagittal slice. (C) Axial slice. (D) Anterior planar lymphoscintigraphic image.

TABLE 1

Surgically Excised Regional Hot Lymph Nodes in 11 Patients

Case	Size, mm × mm (cps), of the following lymph node*:
		External iliac			Internal iliac			Obturator
		R	L	R	L	R	L
1	(252)		(1,740)			(110)
2		6 × 4 (717)^†			10 × 7 (10)
3						6 × 4 (34), 3 × 2 (4)
4						8 × 5 (522)
5	5 × 5 (196)			6 × 4 (12)
6	(1,673)	(105)			(220)
7						5 × 3 (3)^‡
8			9 × 6 (1)^‡		4 × 3 (2)^‡
9	9 × 4 (62)	2 × 2 (27)	5 × 4 (698)	4 × 3 (372)
10	5 × 5 (10), 7 × 5 (41)	8 × 7 (179), 10 × 8 (695)		4 × 4 (853)	7 × 5 (684)
11	15 × 10 (430)	8 × 7 (3,556)	3 × 3 (349), 4 × 3 (56)	2 × 2 (11)
Total	7	6	5	4	4	5

↵* Size measurements were not obtained for all lymph nodes. Totals represent numbers of lymph nodes.
↵† Positive for lymph node metastasis.
↵‡ Not detectable by lymphoscintigraphy.