Dose Optimization in TOF-PET/MR Compared to TOF-PET/CT

Purpose

To evaluate the possible activity reduction in FDG-imaging in a Time-of-Flight (TOF) PET/MR, based on cross-evaluation of patient-based NECR (noise equivalent count rate) measurements in PET/CT, cross referencing with phantom-based NECR curves as well as initial evaluation of TOF-PET/MR with reduced activity.

Materials and Methods

A total of 75 consecutive patients were evaluated in this study. PET/CT imaging was performed on a PET/CT (time-of-flight (TOF) Discovery D 690 PET/CT). Initial PET/MR imaging was performed on a newly available simultaneous TOF-PET/MR (Signa PET/MR). An optimal NECR for diagnostic purposes was defined in clinical patients (NECR_P) in PET/CT. Subsequent optimal activity concentration at the acquisition time ([A]₀) and target NECR (NECR_T) were obtained. These data were used to predict the theoretical FDG activity requirement of the new TOF-PET/MR system. Twenty-five initial patients were acquired with (retrospectively reconstructed) different imaging times equivalent for different activities on the simultaneous PET/MR for the evaluation of clinically realistic FDG-activities.

Results

The obtained values for NECR_P, [A]₀ and NECR_T were 114.6 (± 14.2) kcps (Kilocounts per second), 4.0 (± 0.7) kBq/mL and 45 kcps, respectively. Evaluating the NECR_T together with the phantom curve of the TOF-PET/MR device, the theoretical optimal activity concentration was found to be approximately 1.3 kBq/mL, which represents 35% of the activity concentration required by the TOF-PET/CT. Initial evaluation on patients in the simultaneous TOF-PET/MR shows clinically realistic activities of 1.8 kBq/mL, which represent 44% of the required activity.

Conclusion

The new TOF-PET/MR device requires significantly less activity to generate PET-images with good-to-excellent image quality, due to improvements in detector geometry and detector technologies. The theoretically achievable dose reduction accounts for up to 65% but cannot be fully translated into clinical routine based on the coils within the FOV and MR-sequences applied at the same time. The clinically realistic reduction in activity is slightly more than 50%. Further studies in a larger number of patients are needed to confirm our findings.

Intra-individual comparison of PET/CT with different body weight-adapted FDG dosage regimens

Background

18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/ computed tomography (CT) imaging demands guidelines to safeguard sufficient image quality at low radiation exposure. Various FDG dose regimes have been investigated; however, body weight-adapted dose regimens and related image quality (IQ) have not yet been compared in the same patient.

Purpose

To investigate the relationship between FDG dosage and image quality in PET/CT in the same patient and determine prerequisites for low dosage scanning.

Material and Methods

This study included 61 patients undergoing a clinically indicated PET/CT imaging study and follow-up with a normal (NDS, 5 MBq/kg body weight [BW]) and low dosage scanning protocol (LDS, 4 MBq/kg BW), respectively, using a Discovery VCT64 scanner. Two blinded and independent readers randomly assessed IQ of PET using a 5-point Likert scale and signal-to-noise ratio (SNR) of the liver.

Results

Body mass index (BMI) was significantly lower at LDS (P = 0.021) and represented a significant predictor of SNR at both NDS (P < 0.001) and LDS (P = 0.005). NDS with a mean administered activity of 340 MBq resulted in significantly higher IQ (P < 0.001) and SNR as compared with LDS with a mean of 264 MBq (F-value = 23.5, P < 0.001, mixed model ANOVA adjusted for covariate BMI). Non-diagnostic IQ at LDS was associated with a BMI > 22 kg/m².

Conclusion

FDG dosage significantly predicts IQ and SNR in PET/CT imaging as demonstrated in the same patient with optimal IQ achieved at 5 MBq/kg BM. PET/CT imaging at 4 MBq/kg BW may only be recommended in patients with a BMI ≤ 22 kg/m² to maintain diagnostic IQ.

Zero TE MR bone imaging in the head

PURPOSE

To investigate proton density (PD)-weighted zero TE (ZT) imaging for morphological depiction and segmentation of cranial bone structures.

METHODS

A rotating ultra-fast imaging sequence (RUFIS) type ZT pulse sequence was developed and optimized for 1) efficient capture of short T2 bone signals and 2) flat PD response for soft-tissues. An inverse logarithmic image scaling (i.e., -log(image)) was used to highlight bone and differentiate it from surrounding soft-tissue and air. Furthermore, a histogram-based bias-correction method was developed for subsequent threshold-based air, soft-tissue, and bone segmentation.

RESULTS

PD-weighted ZT imaging in combination with an inverse logarithmic scaling was found to provide excellent depiction of cranial bone structures. In combination with bias correction, also excellent segmentation results were achieved. A two-dimensional histogram analysis demonstrates a strong, approximately linear correlation between inverse log-scaled ZT and low-dose CT for Hounsfield units (HU) between -300 HU and 1,500 HU (corresponding to soft-tissue and bone).

CONCLUSIONS

PD-weighted ZT imaging provides robust and efficient depiction of bone structures in the head, with an excellent contrast between air, soft-tissue, and bone. Besides structural bone imaging, the presented method is expected to be of relevance for attenuation correction in positron emission tomography (PET)/MR and MR-based radiation therapy planning.

Clinical image quality perception and its relation to NECR measurements in PET

Background

The purpose of this study is to describe a clinical relation of noise equivalent count rate (NECR) - an objective measurement of positron emission tomography (PET) systems - measured in a large number of patients, to clinical image quality of PET and their relation to 18F-fluoro-2-deoxyglucose (FDG) activity and patient's weight.

Methods

A total of 71 consecutive patients were evaluated in this retrospective study. All data was automatically analysed using Matlab to estimate the noise equivalent count rate. Then, image quality was evaluated according to two subjective scores: the IQ local score was a 3-point scale assigned to each bed position in all patients and the IQ global score was a 10-point scale assigned after evaluating the coronal whole-body PET. Patient data was also analysed concerning weight, body mass index, FDG dose at the start of acquisition (D_Acq), presence of bowel uptake and presence of FDG-positive pathologic lesions. Two additional parameters were defined for each patient: the ratio between D_Acq and patient weight (R_DW) and the ratio between D_Acq and patient BMI (R_DBMI).

Results

Clinically perceived image quality in PET has a significant positive correlation with NECR measured in patients, R_DW, R_DBMI and presence of pathologic lesions. Clinical image quality furthermore has significant negative correlation with weight, body mass index (BMI) and presence of bowel uptake. Thresholds of R_DW and R_DBMI in which clinical IQ is good to excellent in more than 90% of the patients were 2.6 and 8.0, respectively.

Conclusions

Clinically perceived image quality in PET systems is positively and significantly related to NECR measured in patients. An optimal threshold for the R_DW and R_DBMI was defined in which clinical IQ is good to excellent in more than 90% of patients. With this data, it is possible to extrapolate technical as well as clinical image quality to other PET system and to predict clinical image perception.

Metal artifact reduction in patients with dental implants using multispectral three-dimensional data acquisition for hybrid PET/MRI

BACKGROUND

Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) shows high potential for patients with oropharyngeal cancer. Dental implants can cause substantial artifacts in the oral cavity impairing diagnostic accuracy. Therefore, we evaluated new MRI sequences with multi-acquisition variable-resonance image combination (MAVRIC SL) in comparison to conventional high-bandwidth techniques and in a second step showed the effect of artifact size on MRI-based attenuation correction (AC) with a simulation study.

METHODS

Twenty-five patients with dental implants prospectively underwent a trimodality PET/CT/MRI examination after informed consent was obtained under the approval of the local ethics committee. A conventional 3D gradient-echo sequence (LAVA-Flex) commonly used for MRI-based AC of PET (acquisition time of 14 s), a T1w fast spin-echo sequence with high bandwidth (acquisition time of 3.2 min), as well as MAVRIC SL sequence without and with increased phase acceleration (MAVRIC, acquisition time of 6 min; MAVRIC-fast, acquisition time of 3.5 min) were applied. The absolute and relative reduction of the signal void artifact was calculated for each implant and tested for statistical significance using the Wilcoxon signed-rank test. The effect of artifact size on PET AC was simulated in one case with a large tumor in the oral cavity. The relative difference of the maximum standardized uptake value (SUVmax) in the tumor was calculated for increasing artifact sizes centered over the second molar.

RESULTS

The absolute reduction of signal void from LAVA-Flex sequences to the T1-weighted fast spin-echo (FSE) sequences was 416 mm(2) (range 4 to 2,010 mm(2)) to MAVRIC 481 mm(2) (range 12 to 2,288 mm(2)) and to MAVRIC-fast 486 mm(2) (range 39 to 2,209 mm(2)). The relative reduction in signal void was significantly improved for both MAVRIC and MAVRIC-fast compared to T1 FSE (-75%/-78% vs. -62%, p < 0.001 for both). The relative error for SUVmax was negligible for artifacts of 0.5-cm diameter (-0.1%), but substantial for artifacts of 5.2-cm diameter (-33%).

CONCLUSIONS

MAVRIC-fast could become useful for artifact reduction in PET/MR for patients with dental implants. This might improve diagnostic accuracy especially for patients with tumors in the oropharynx and substantially improve accuracy of PET quantification.

Hybrid PET/MR imaging: an algorithm to reduce metal artifacts from dental implants in Dixon-based attenuation map generation using a multiacquisition variable-resonance image combination sequence

It was the aim of this study to implement an algorithm modifying Dixon-based MR imaging datasets for attenuation correction in hybrid PET/MR imaging with a multiacquisition variable resonance image combination (MAVRIC) sequence to reduce metal artifacts.

METHODS

After ethics approval, in 8 oncologic patients with dental implants data were acquired in a trimodality setup with PET/CT and MR imaging. The protocol included a whole-body 3-dimensional dual gradient-echo sequence (Dixon) used for MR imaging-based PET attenuation correction and a high-resolution MAVRIC sequence, applied in the oral area compromised by dental implants. An algorithm was implemented correcting the Dixon-based μ maps using the MAVRIC in areas of Dixon signal voids. The artifact size of the corrected μ maps was compared with the uncorrected MR imaging μ maps.

RESULTS

The algorithm was robust in all patients. There was a significant reduction in mean artifact size of 70.5% between uncorrected and corrected μ maps from 697 ± 589 mm(2) to 202 ± 119 mm(2) (P = 0.016).

CONCLUSION

The proposed algorithm could improve MR imaging-based attenuation correction in critical areas, when standard attenuation correction is hampered by metal artifacts, using a MAVRIC.

Systematic Comparison of the Performance of Integrated Whole-Body PET/MR Imaging to Conventional PET/CT for ¹⁸F-FDG Brain Imaging in Patients Examined for Suspected Dementia

Technologic specifications of recently introduced integrated PET/MR instrumentation, such as MR-based attenuation correction, may particularly affect brain imaging procedures. To evaluate the qualitative performance of PET/MR in clinical neuroimaging, we systematically compared results obtained with integrated PET/MR with conventional PET/CT in the same patients examined for assessment of cognitive impairment.

METHODS

Thirty patients underwent a single-injection ((18)F-FDG), dual-imaging protocol including PET/CT and integrated PET/MR imaging in randomized order. Attenuation and scatter correction were performed using low-dose CT for the PET/CT and segmented Dixon MR imaging data for the PET/MR. Differences between PET/MR and PET/CT were assessed via region-of-interest (ROI)-based and voxel-based statistical group comparison. Analyses involved attenuation-corrected (AC) and non-attenuation-corrected (NAC) data. Individual PET/MR and PET/CT datasets were compared versus a predefined independent control population, using 3-dimensional stereotactic surface projections.

RESULTS

Generally, lower measured PET signal values were obtained throughout the brain in ROI-based quantification of the PET signal for PET/MR as compared with PET/CT in AC and NAC data, independently of the scan order. After elimination of global effects, voxel-based and ROI-based group comparison still revealed significantly lower relative tracer signal in PET/MR images in frontoparietal portions of the neocortex but significantly higher relative signal in subcortical and basal regions of the brain than the corresponding PET/CT images of the AC data. In the corresponding NAC images, the discrepancies in frontoparietal portions of the neocortex were diminished, but the subcortical overestimation of tracer intensity by PET/MR persisted.

CONCLUSION

Considerable region-dependent differences were observed between brain imaging data acquired on the PET/MR, compared with corresponding PET/CT images, in patients evaluated for neurodegenerative disorders. These findings may only in part be explained by inconsistencies in the attenuation-correction procedures. The observed differences may interfere with semiquantitative evaluation and with individual qualitative clinical assessment and they need to be considered, for example, for clinical trials. Improved attenuation-correction algorithms and a PET/MR-specific healthy control database are recommended for reliable and consistent application of PET/MR for clinical neuroimaging.

MR-driven metal artifact reduction in PET/CT

Among the proposed system architectures capable of delivering positron emission tomography/magnetic resonance (PET/MR) datasets, tri-modality systems open an interesting field in which the synergies between these modalities can be exploited to address some of the problems encountered in standalone systems. In this paper we present a feasibility study of the correction of dental streak artifacts in computed tomography (CT)-based attenuation correction images using complementary MR data. The frequency and severity of metal artifacts in oncology patients was studied by inspecting the CT scans of 152 patients examined at our hospital. A prospective correction algorithm using CT and MR information to automatically locate and edit the region affected by metal artifacts was developed and tested retrospectively on data from 15 oncology patients referred for a PET/CT scan. In datasets without malignancies, the activity in Waldeyer's ring was used to measure the maximum uptake variation when the proposed correction was applied. The measured bias ranged from 10% to 30%. In datasets with malignancies on the slices affected by artifacts, the correction led to lesion uptake variations of 6.1% for a lesion 3 cm away from the implant, 1.5% for a lesion 7 cm away and <1% for a lesion 8 cm away.

PET-MR imaging using a tri-modality PET/CT-MR system with a dedicated shuttle in clinical routine

Tri-modality PET/CT-MRI includes the transfer of the patient on a dedicated shuttle from one system into the other. Advantages of this system include a true CT-based attenuation correction, reliable PET-quantification and higher flexibility in patient throughput on both systems. Comparative studies of PET/MRI versus PET/CT are readily accomplished without repeated PET with a different PET scanner at a different time point. Additionally, there is a higher imaging flexibility based on the availability of three imaging modalities, which can be combined for the characterization of the disease. The downside is a somewhat higher radiation dose of up to 3 mSv with a low dose CT based on the CT-component, longer acquisition times and potential misalignment between the imaging components. Overall, the tri-modality PET/CT-MR system offers comparative studies using the three different imaging modalities in the same patient virtually at the same time, and may help to develop reliable attenuation algorithms at the same time.

Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner

The recently released Biograph mMR is the first commercially available integrated whole-body PET/MR scanner. There are considerable advantages to integrating both modalities in a single scanner that enables truly simultaneous acquisition. However, there are also concerns about the possible degradation of both PET and MR performance in an integrated system. This paper evaluates the performance of the Biograph mMR during independent and simultaneous acquisition of PET and morphologic MR data.

METHODS

The NEMA NU 2-2007 protocol was followed for studying the PET performance. The following measurements were performed: spatial resolution; scatter fraction, count losses, and randoms; sensitivity; accuracy of the correction for count losses and randoms; and image quality. The quality control manual of the American College of Radiology was followed for studying the MR performance. The following measurements were performed: geometric accuracy, spatial resolution, low-contrast detectability, signal-to-noise ratio, static field (B(0)) homogeneity, radiofrequency field (B(1)) homogeneity, and radiofrequency noise.

RESULTS

An average spatial resolution of 4.3 mm in full width at half maximum was measured at 1 cm offset from the center of the field of view. The system sensitivity was 15.0 kcps/MBq along the center of the scanner. The scatter fraction was 37.9%, and the peak noise-equivalent count rate was 184 kcps at 23.1 kBq/mL. The maximum absolute value of the relative count rate error due to dead-time losses and randoms was 5.5%. The average residual error in scatter and attenuation correction was 12.1%. All MR parameters were within the tolerances defined by the American College of Radiology. B(0) inhomogeneities below 1 ppm were measured in a 120-mm radius. B(1) homogeneity and signal-to-noise ratio were equivalent to those of a standard MR scanner. No radiofrequency interference was detected.

CONCLUSION

These results compare favorably with other state-of-the-art PET/CT and PET/MR scanners, indicating that the integration of the PET detectors in the MR scanner and their operation within the magnetic field do not have a perceptible impact on the overall performance. The MR subsystem performs essentially like a standalone system. However, further work is necessary to evaluate the more advanced MR applications, such as functional imaging and spectroscopy.

A positron emission tomograph based on LSO-APD modules with a sampling ADC read-out system for a students' advanced laboratory course

A one-day laboratory course on positron emission tomography (PET) for the education of physics students and PhD students in medical physics has been set up. In the course, the physical background and the principles of a PET scanner are introduced. Course attendees set the system in operation, calibrate it using a (22)Na point source and reconstruct different source geometries filled with (18)F. The PET scanner features an individual channel read-out of 96 lutetium oxyorthosilicate (LSO) scintillator crystals coupled to avalanche photodiodes (APD). The analog data of each APD are digitized by fast sampling analog to digital converters (SADC) and processed within field programmable gate arrays (FPGA) to extract amplitudes and time stamps. All SADCs are continuously sampling with a precise rate of 80MHz, which is synchronous for the whole system. The data is transmitted via USB to a Linux PC, where further processing and the image reconstruction are performed. The course attendees get an insight into detector techniques, modern read-out electronics, data acquisition and PET image reconstruction. In addition, a short introduction to some common software applications used in particle and high energy physics is part of the course.

Preliminary study of the detectability of coronary plaque with PET

The evaluation of coronary plaque vulnerability could be of great diagnostic value in cardiology. Positron emission tomography (PET) is a good candidate due to its ability to quantify micromolar concentrations of targeted drugs. However, the detectability of sub-voxel targets such as coronary plaque is limited by partial volume effects and by cardiorespiratory motion. The goal of this paper is to investigate the impact of these factors in the detectability of plaque uptake. Radioactive markers were implanted on the epicardium of a pig and in vivo scans were performed. This was complemented with phantom measurements to determine the minimum detectable uptake as a function of background activity. Simulations were used to evaluate the effect of cardiorespiratory motion on the reconstructed lesions. Despite cardiorespiratory motion of up to 7 mm, the markers were detectable in the in vivo scans even after the injection of background. A lower limit of 250 Bq was found for a target to be detectable. Motion reduced the contrast of the reconstructed lesions to 23% of their static counterpart. Respiratory gating improved this to 49% of the static value. The results suggest that coronary plaque evaluation with PET is possible, provided that sufficient plaque-to-myocardium uptake contrast (50 to 100) can be achieved. This requirement increases exponentially for lesions with uptake below 250 Bq. The described experiments provide a means of estimating the minimum uptake and contrast required to ensure the detectability of plaque lesions.

Semiautomatic algorithm for lymph node analysis corrected for partial volume effects in combined positron emission tomography-computed tomography

Positron emission tomography-computed tomography (PET-CT) is superior compared to stand-alone PET in evaluation of malignancies. Few studies have employed high-resolution structural information to correct PET. We designed a semiautomatic algorithm using CT and PET to obtain a partial volume corrected (PVC) standardized uptake value (SUV) and a combined morphologic and functional parameter (multimodal SUV) for lymph node assessment. Lesions were segmented by a semiautomatic algorithm in CT images. Lesion volume was used for PVC and for calculating the multimodal SUV. The method was applied to 47 lymph nodes (30 patients) characterized as suspicious in 18F-fluorodeoxyglucose-PET-CT. In phantoms, PVC improved significantly the measured uptake of the lesion. In patients, 36 lymph nodes could be segmented without problems; in 11 lesions, a manual interaction was necessary. SUVs before PVC (mean 1.29) increased significantly (p < .0005) after PVC (mean 2.8). If SUV 2.5 was used as a threshold value to distinguish between benign and malignant lesions, 11 of the 47 lesions changed from benign to malignant after the PVC. The mean multimodal SUV was 0.39 mL for the benign lesions and 4.47 mL for the malignant lesions. In this work we presented a method for quantitative analysis of lymph nodes in PET-CT. PVC leads to significant differences in SUV.

PET/MRI system design

INTRODUCTION

The combination of clinical MRI and PET systems has received increased attention in recent years. In contrast to currently used PET/CT systems, PET/MRI offers not only improved soft-tissue contrast and reduced levels of ionizing radiation, but also a wealth of MRI-specific information such as functional, spectroscopic and diffusion tensor imaging. Combining PET and MRI, however, has proven to be very challenging, due to the detrimental cross-talk effects between the two systems.

OBJECTIVE

Significant progress has been made in the recent years to overcome these difficulties, with several groups reporting PET/MRI prototypes for animal imaging and a clinical insert for neurological applications being demonstrated at the 2007 Annual Meeting of the Society of Nuclear Medicine.

DISCUSSION

In this paper we review different architectures for clinical PET/MRI systems, and their possibilities, limitations and technological obstacles.

PET/MRI system design

INTRODUCTION

The combination of clinical MRI and PET systems has received increased attention in recent years. In contrast to currently used PET/CT systems, PET/MRI offers not only improved soft-tissue contrast and reduced levels of ionizing radiation, but also a wealth of MRI-specific information such as functional, spectroscopic and diffusion tensor imaging. Combining PET and MRI, however, has proven to be very challenging, due to the detrimental cross-talk effects between the two systems.

OBJECTIVE

Significant progress has been made in the recent years to overcome these difficulties, with several groups reporting PET/MRI prototypes for animal imaging and a clinical insert for neurological applications being demonstrated at the 2007 Annual Meeting of the Society of Nuclear Medicine.

DISCUSSION

In this paper we review different architectures for clinical PET/MRI systems, and their possibilities, limitations and technological obstacles.

Explicit incorporation of prior anatomical information into a nonrigid registration of thoracic and abdominal CT and 18-FDG whole-body emission PET images

The aim of this paper is to develop a registration methodology in order to combine anatomical and functional information provided by thoracic/abdominal computed tomography (CT) and whole-body positron emission tomography (PET) images. The proposed procedure is based on the incorporation of prior anatomical information in an intensity-based nonrigid registration algorithm. This incorporation is achieved in an explicit way, initializing the intensity-based registration stage with the solution obtained by a nonrigid registration of corresponding anatomical structures. A segmentation algorithm based on a hierarchically ordered set of anatomy-specific rules is used to obtain anatomical structures in CT and emission PET scans. Nonrigid deformations are modeled in both registration stages by means of free-form deformations, the optimization of the control points being achieved by means of an original vector field-based approach instead of the classical gradient-based techniques, considerably reducing the computational time of the structure registration stage. We have applied the proposed methodology to 38 sets of images (33 provided by standalone machines and five by hybrid systems) and an assessment protocol has been developed to furnish a qualitative evaluation of the algorithm performance.