761 research outputs found
Improved correction for the tissue fraction effect in lung PET/CT imaging
Get PDFRecently, there has been an increased interest in imaging different pulmonary disorders using PET techniques. Previous work has shown, for static PET/CT, that air content in the lung influences reconstructed image values and that it is vital to correct for this 'tissue fraction effect' (TFE). In this paper, we extend this work to include the blood component and also investigate the TFE in dynamic imaging. CT imaging and PET kinetic modelling are used to determine fractional air and blood voxel volumes in six patients with idiopathic pulmonary fibrosis. These values are used to illustrate best and worst case scenarios when interpreting images without correcting for the TFE. In addition, the fractional volumes were used to determine correction factors for the SUV and the kinetic parameters. These were then applied to the patient images. The kinetic parameters K1 and Ki along with the static parameter SUV were all found to be affected by the TFE with both air and blood providing a significant contribution to the errors. Without corrections, errors range from 34-80% in the best case and 29-96% in the worst case. In the patient data, without correcting for the TFE, regions of high density (fibrosis) appeared to have a higher uptake than lower density (normal appearing tissue), however this was reversed after air and blood correction. The proposed correction methods are vital for quantitative and relative accuracy. Without these corrections, images may be misinterpreted
Effect of positron range on PET quantification in diseased and normal lungs
Get PDFThe impact of positron range on PET image reconstruction has often been
investigated as a blurring effect that can be partly corrected by adding an element to
the PET system matrix in the reconstruction, usually based on a Gaussian kernel
constructed from the attenuation values. However, the physics involved in PET is
more complex. In regions where density does not vary, positron range indeed involves
mainly blurring. However, in more heterogeneous media it can cause other effects. This
work focuses on positron range in the lungs and its impact on quantification, especially
in the case of pathologies such as cancer or pulmonary fibrosis, for which the lungs have
localised varying density. Using Monte Carlo simulations, we evaluate the effects of
positron range for multiple radionuclides (18F, 15O, 68Ga, 89Zr, 82Rb, 64Cu and 124I) as,
for novel radiotracers, the choice of the labelling radionuclide is important. The results
demonstrate quantification biases in highly heterogeneous media, where the measured
uptake of high-density regions can be increased by the neighbouring radioactivity from
regions of lower density, with the effect more noticeable for radionuclides with highenergy positron emission. When the low-density regions are considered to have less
radioactive uptake (e.g. due to the presence of air), the effect is less severe
The Challenge of Staging Breast Cancer With PET/CT in the Era of COVID Vaccination
Get PDFWe report a case series of biopsy-proven reactive axillary lymph nodes, which were avid on FDG PET/CT in breast cancer patients post COVID-19 vaccination. With 4 cases presenting in a consecutive 10-day period, it became apparent that metabolically active axillary lymphadenopathy is an adverse effect of COVID-19 vaccines, currently being deployed worldwide. This may lead to patients undergoing unnecessary biopsy. We have started taking a COVID-19 vaccine status history before PET/CT. If enlarged/metabolically active axillary nodes are identified in the ipsilateral vaccinated arm, then axillary ultrasound at 4 weeks is suggested
Density variation during respiration affects PET quantitation in the lung
Get PDFPET quantitation depends on the accuracy of the CT-derived attenuation correction map. In the lung, respiration leads to both positional and density mismatches, causing PET quantitation errors at lung borders but also within the whole lung. The aim of this work is to determine the extent of the associated errors on the measured time activity curves (TACs) and the corresponding kinetic parameter estimates. 5 patients with idiopathic pulmonary fibrosis underwent dynamic 18 F-FDG PET and cine-CT imaging as part of an ongoing study. The cine-CT was amplitude gated using PCA techniques to produce end expiration (EXP), end inspiration (INS) and mid-breathing cycle (MID) gates representative of a short clinical CT acquisition. The ungated PET data were reconstructed with each CT gate and the TACs and kinetic parameters compared. Patient representative XCAT simulations with varying lung density, both with and without motion, were also produced to represent the above study allowing comparison of true to measured results. In all cases, the obtained PET TACs differed with each CT gate. For ROIs internal to the lung, the effect was dominated by changes in density, as opposed to motion. The errors in the TACs varied with time, providing evidence that errors due to attenuation mismatch depend on activity distribution. In the simulations, some kinetic parameters were over- and under-estimated by a factor of 2 in the INS and EXP gates respectively. For the patients, the maximum variation in kinetic parameters was 20%. Our results show that whole lung density changes during the respiratory cycle have a significant impact on PET quantitation. This is especially true of the kinetic parameter estimates as the extent of the error is dependent on tracer distribution which varies with time. It is therefore vital to use matched PET/CT for attenuation correction
Additional Clinical Value for PET/MRI in Oncology: Moving Beyond Simple Diagnosis
Get PDFInitial clinical research comparing the diagnostic performance of PET/MRI and PET/CT has largely shown equivalent diagnostic capabilities for these modalities in oncology. These uncertainties about the magnitude of diagnostic benefit are compounded by the considerable health economic challenges associated with clinical implementation. Therefore, there is a need to identify ways to extend the use of this technology beyond simple diagnosis so that PET/MRI can add sufficient clinical value beyond PET/CT or MRI alone and become a cost-effective imaging modality in clinical practice. A major advantage of PET/MRI over other imaging modalities is the ability to generate multiple quantitative images from a single examination. This article describes how a multiparametric PET/MRI approach not only can add clinical value through contributing to precision medicine but also can establish PET/MRI as a potentially cost-effective imaging modality in oncology
CT-based texture analysis potentially provides prognostic information complementary to interim fdg-pet for patients with hodgkin's and aggressive non-hodgkin's lymphomas
Get PDFOBJECTIVES: The purpose of this study was to investigate the ability of computed tomography texture analysis (CTTA) to provide additional prognostic information in patients with Hodgkin's lymphoma (HL) and high-grade non-Hodgkin's lymphoma (NHL).
METHODS: This retrospective, pilot-study approved by the IRB comprised 45 lymphoma patients undergoing routine 18F-FDG-PET-CT. Progression-free survival (PFS) was determined from clinical follow-up (mean-duration: 40 months; range: 10-62 months). Non-contrast-enhanced low-dose CT images were submitted to CTTA comprising image filtration to highlight features of different sizes followed by histogram-analysis using kurtosis. Prognostic value of CTTA was compared to PET FDG-uptake value, tumour-stage, tumour-bulk, lymphoma-type, treatment-regime, and interim FDG-PET (iPET) status using Kaplan-Meier analysis. Cox regression analysis determined the independence of significantly prognostic imaging and clinical features.
RESULTS: A total of 27 patients had aggressive NHL and 18 had HL. Mean PFS was 48.5 months. There was no significant difference in pre-treatment CTTA between the lymphoma sub-types. Kaplan-Meier analysis found pre-treatment CTTA (medium feature scale, p=0.010) and iPET status (p<0.001) to be significant predictors of PFS. Cox analysis revealed that an interaction between pre-treatment CTTA and iPET status was the only independent predictor of PFS (HR: 25.5, 95% CI: 5.4-120, p<0.001). Specifically, pre-treatment CTTA risk stratified patients with negative iPET.
CONCLUSION: CTTA can potentially provide prognostic information complementary to iPET for patients with HL and aggressive NHL
Respiratory Motion Correction in Dynamic PET with a Single Attenuation Map
Get PDFIn addition to static tracer uptake values used routinely in clinical facilities, PET imaging can provide useful information on tracer kinetics via the use of dynamic acquisitions where a set of time frames are acquired starting from the injection/inhalation of the radiotracer. In lung studies, kinetic parameters, estimated from compartmental modelling, are however affected by respiratory motion. When only one attenuation image is available, most existing motion compensation strategies are not appropriate for the initial short time frames, especially as the activity distribution changes rapidly over the early part of the dynamic acquisition. This work presents a preliminary study to handle respiratory motion using a two-step process that uses gated dynamic data as input. We first use joint reconstruction of activity and motion on the entire gated PET data to estimate deformation fields. This allows the subsequent reconstruction of each time frame separately with motion compensation. We present results comparing on one hand the compartment model fit residuals with and without respiratory motion compensation and on the other hand the diaphragm position in non-attenuation corrected images and from this method
Radiomics-Based Texture Analysis of Ga-68-DOTATATE Positron Emission Tomography and Computed Tomography Images as a Prognostic Biomarker in Adults With Neuroendocrine Cancers Treated With Lu-177-DOTATATE
Get PDFPurpose: Neuroendocrine tumors (NET) are rare cancers with variable behavior. A better understanding of prognosis would aid individualized management. The aim of this hypothesis-generating pilot study was to investigate the prognostic potential of tumor heterogeneity and tracer avidity in NET using texture analysis (TA) of 68Ga-DOTATATE positron emission tomography (PET) and non-enhanced computed tomography (CT) performed at baseline in patients treated with 177Lu-DOTATATE. It aims to justify a larger-scale study to evaluate its clinical value.
Methods: The pretherapy 68Ga-DOTATATE PET-CT scans of 44 patients with metastatic NET (carcinoid, pancreatic, thyroid, head and neck, catecholamine-secreting, and unknown primary NET) treated with 177Lu-DOTATATE were analyzed retrospectively using commercially available texture analysis research software. Image filtration extracted and enhanced objects of different sizes (fine, medium, coarse), then quantified heterogeneity by statistical and histogram-based parameters (mean intensity, standard deviation, entropy, mean of positive pixels, skewness, and kurtosis). Regions of interest were manually drawn around up to five of the most 68Ga-DOTATATE avid lesions for each patient. 68Gallium uptake on PET was quantified as SUVmax and SUVmean. Associations between imaging and clinical markers with progression-free (PFS) and overall survival (OS) were assessed using univariate Kaplan-Meier analysis. Independence of the significant univariate markers of survival was tested using multivariate Cox regression analysis.
Results: Measures of heterogeneity (higher kurtosis, higher entropy, and lower skewness) on coarse-texture scale CT and unfiltered PET images predicted shorter PFS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness: p=0.03) and shorter OS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness p=0.02). Conventional PET parameters such as SUVmax and SUVmean showed trends towards predicting outcome but were not statistically significant. Multivariate analysis identified that CT-TA (coarse kurtosis: HR=2.57, 95% CI=1.22–5.38, p=0.013) independently predicted PFS, and PET-TA (unfiltered skewness: HR=9.05, 95% CI=1.19–68.91, p=0.033) independently predicted OS.
Conclusion: These preliminary data generate a hypothesis that radiomic analysis of neuroendocrine cancer on 68Ga-DOTATATE PET-CT may be of prognostic value and a valuable addition to the assessment of patients
Optimisation of the air fraction correction for lung PET/CT: addressing resolution mismatch
Get PDFBackground: Increased pulmonary 18 F-FDG metabolism in patients with idiopathic pulmonary fibrosis, and other forms of diffuse parenchymal lung disease, can predict measurements of health and lung physiology. To improve PET quantification, voxel-wise air fractions (AF) determined from CT can be used to correct for variable air content in lung PET/CT. However, resolution mismatches between PET and CT can cause artefacts in the AF-corrected image.
Methods: Three methodologies for determining the optimal kernel to smooth the CT are compared with noiseless simulations and non-TOF MLEM reconstructions of a patient-realistic digital phantom: (i) the point source insertion-and-subtraction method, hpts ; (ii) AF-correcting with varyingly smoothed CT to achieve the lowest RMSE with respect to the ground truth (GT) AF-corrected volume of interest (VOI), hAFC ; iii) smoothing the GT image to match the reconstruction within the VOI, hPVC . The methods were evaluated both using VOI-specific kernels, and a single global kernel optimised for the six VOIs combined. Furthermore, hPVC was implemented on thorax phantom data measured on two clinical PET/CT scanners with various reconstruction protocols.
Results: The simulations demonstrated that at < 200 iterations (200 i), the kernel width was dependent on iteration number and VOI position in the lung. The hpts method estimated a lower, more uniform, kernel width in all parts of the lung investigated. However, all three methods resulted in approximately equivalent AF-corrected VOI RMSEs (<10%) at ≥ 200i. The insensitivity of AF-corrected quantification to kernel width suggests that a single global kernel could be used. For all three methodologies, the computed global kernel resulted in an AF-corrected lung RMSE <10% at ≥ 200i, while larger lung RMSEs were observed for the VOI–specific kernels. The global kernel approach was then employed with the hPVC method on measured data. The optimally smoothed GT emission matched the reconstructed image well, both within the VOI and the lung background. VOI RMSE was <10%, pre-AFC, for all reconstructions investigated.
Conclusions: Simulations for non-TOF PET indicated that around 200i were needed to approach image resolution stability in the lung. In addition, at this iteration number, a single global kernel, determined from several VOIs, for AFC, performed well over the whole lung. The hPVC method has the potential to be used to determine the kernel for AFC from scans of phantoms on clinical scanners
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