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Sharma V, Awate SP. Adversarial EM for variational deep learning: Application to semi-supervised image quality enhancement in low-dose PET and low-dose CT. Med Image Anal 2024; 97:103291. [PMID: 39121545 DOI: 10.1016/j.media.2024.103291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
In positron emission tomography (PET) and X-ray computed tomography (CT), reducing radiation dose can cause significant degradation in image quality. For image quality enhancement in low-dose PET and CT, we propose a novel theoretical adversarial and variational deep neural network (DNN) framework relying on expectation maximization (EM) based learning, termed adversarial EM (AdvEM). AdvEM proposes an encoder-decoder architecture with a multiscale latent space, and generalized-Gaussian models enabling datum-specific robust statistical modeling in latent space and image space. The model robustness is further enhanced by including adversarial learning in the training protocol. Unlike typical variational-DNN learning, AdvEM proposes latent-space sampling from the posterior distribution, and uses a Metropolis-Hastings scheme. Unlike existing schemes for PET or CT image enhancement which train using pairs of low-dose images with their corresponding normal-dose versions, we propose a semi-supervised AdvEM (ssAdvEM) framework that enables learning using a small number of normal-dose images. AdvEM and ssAdvEM enable per-pixel uncertainty estimates for their outputs. Empirical analyses on real-world PET and CT data involving many baselines, out-of-distribution data, and ablation studies show the benefits of the proposed framework.
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Affiliation(s)
- Vatsala Sharma
- Computer Science and Engineering (CSE) Department, Indian Institute of Technology (IIT) Bombay, Mumbai, India.
| | - Suyash P Awate
- Computer Science and Engineering (CSE) Department, Indian Institute of Technology (IIT) Bombay, Mumbai, India
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2
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Ning Y, Teixayavong S, Shang Y, Savulescu J, Nagaraj V, Miao D, Mertens M, Ting DSW, Ong JCL, Liu M, Cao J, Dunn M, Vaughan R, Ong MEH, Sung JJY, Topol EJ, Liu N. Generative artificial intelligence and ethical considerations in health care: a scoping review and ethics checklist. Lancet Digit Health 2024:S2589-7500(24)00143-2. [PMID: 39294061 DOI: 10.1016/s2589-7500(24)00143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/25/2024] [Accepted: 06/18/2024] [Indexed: 09/20/2024]
Abstract
The widespread use of Chat Generative Pre-trained Transformer (known as ChatGPT) and other emerging technology that is powered by generative artificial intelligence (GenAI) has drawn attention to the potential ethical issues they can cause, especially in high-stakes applications such as health care, but ethical discussions have not yet been translated into operationalisable solutions. Furthermore, ongoing ethical discussions often neglect other types of GenAI that have been used to synthesise data (eg, images) for research and practical purposes, which resolve some ethical issues and expose others. We did a scoping review of the ethical discussions on GenAI in health care to comprehensively analyse gaps in the research. To reduce the gaps, we have developed a checklist for comprehensive assessment and evaluation of ethical discussions in GenAI research. The checklist can be integrated into peer review and publication systems to enhance GenAI research and might be useful for ethics-related disclosures for GenAI-powered products and health-care applications of such products and beyond.
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Affiliation(s)
- Yilin Ning
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | | | - Yuqing Shang
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
| | | | - Di Miao
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Mayli Mertens
- Centre for Ethics, Department of Philosophy, University of Antwerp, Antwerp, Belgium; Antwerp Center on Responsible AI, University of Antwerp, Antwerp, Belgium
| | - Daniel Shu Wei Ting
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; SingHealth AI Office, Singapore Health Services, Singapore
| | | | - Mingxuan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Jiuwen Cao
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Zhejiang, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, China
| | - Michael Dunn
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger Vaughan
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Joseph Jao-Yiu Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Eric J Topol
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Nan Liu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore; Institute of Data Science, National University of Singapore, Singapore.
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Chang W, D'Ascenzo N, Antonecchia E, Li B, Yang J, Mu D, Li A, Xie Q. Deep denoiser prior driven relaxed iterated Tikhonov method for low-count PET image restoration. Phys Med Biol 2024; 69:165019. [PMID: 39053501 DOI: 10.1088/1361-6560/ad67a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/25/2024] [Indexed: 07/27/2024]
Abstract
Objective. Low-count positron emission tomography (PET) imaging is an efficient way to promote more widespread use of PET because of its short scan time and low injected activity. However, this often leads to low-quality PET images with clinical image reconstruction, due to high noise and blurring effects. Existing PET image restoration (IR) methods hinder their own restoration performance due to the semi-convergence property and the lack of suitable denoiser prior.Approach. To overcome these limitations, we propose a novel deep plug-and-play IR method called Deep denoiser Prior driven Relaxed Iterated Tikhonov method (DP-RI-Tikhonov). Specifically, we train a deep convolutional neural network denoiser to generate a flexible deep denoiser prior to handle high noise. Then, we plug the deep denoiser prior as a modular part into a novel iterative optimization algorithm to handle blurring effects and propose an adaptive parameter selection strategy for the iterative optimization algorithm.Main results. Simulation results show that the deep denoiser prior plays the role of reducing noise intensity, while the novel iterative optimization algorithm and adaptive parameter selection strategy can effectively eliminate the semi-convergence property. They enable DP-RI-Tikhonov to achieve an average quantitative result (normalized root mean square error, structural similarity) of (0.1364, 0.9574) at the stopping iteration, outperforming a conventional PET IR method with an average quantitative result of (0.1533, 0.9523) and a state-of-the-art deep plug-and-play IR method with an average quantitative result of (0.1404, 0.9554). Moreover, the advantage of DP-RI-Tikhonov becomes more obvious at the last iteration. Experiments on six clinical whole-body PET images further indicate that DP-RI-Tikhonov successfully reduces noise intensity and recovers fine details, recovering sharper and more uniform images than the comparison methods.Significance. DP-RI-Tikhonov's ability to reduce noise intensity and effectively eliminate the semi-convergence property overcomes the limitations of existing methods. This advancement may have substantial implications for other medical IR.
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Affiliation(s)
- Weike Chang
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Nicola D'Ascenzo
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, People's Republic of China
- Department of Innovation in Engineering and Physics, Istituto Neurologico Mediterraneo NEUROMED I.R.C.C.S., Pozzilli, Italy
| | - Emanuele Antonecchia
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
- Department of Innovation in Engineering and Physics, Istituto Neurologico Mediterraneo NEUROMED I.R.C.C.S., Pozzilli, Italy
| | - Bingxuan Li
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dengyun Mu
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ang Li
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qingguo Xie
- School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, People's Republic of China
- Department of Electronic Engineering and Information Science, University of Science and Technology of China, Hefei, People's Republic of China
- Department of Innovation in Engineering and Physics, Istituto Neurologico Mediterraneo NEUROMED I.R.C.C.S., Pozzilli, Italy
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Pan S, Abouei E, Peng J, Qian J, Wynne JF, Wang T, Chang CW, Roper J, Nye JA, Mao H, Yang X. Full-dose whole-body PET synthesis from low-dose PET using high-efficiency denoising diffusion probabilistic model: PET consistency model. Med Phys 2024; 51:5468-5478. [PMID: 38588512 PMCID: PMC11321936 DOI: 10.1002/mp.17068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
PURPOSE Positron Emission Tomography (PET) has been a commonly used imaging modality in broad clinical applications. One of the most important tradeoffs in PET imaging is between image quality and radiation dose: high image quality comes with high radiation exposure. Improving image quality is desirable for all clinical applications while minimizing radiation exposure is needed to reduce risk to patients. METHODS We introduce PET Consistency Model (PET-CM), an efficient diffusion-based method for generating high-quality full-dose PET images from low-dose PET images. It employs a two-step process, adding Gaussian noise to full-dose PET images in the forward diffusion, and then denoising them using a PET Shifted-window Vision Transformer (PET-VIT) network in the reverse diffusion. The PET-VIT network learns a consistency function that enables direct denoising of Gaussian noise into clean full-dose PET images. PET-CM achieves state-of-the-art image quality while requiring significantly less computation time than other methods. Evaluation with normalized mean absolute error (NMAE), peak signal-to-noise ratio (PSNR), multi-scale structure similarity index (SSIM), normalized cross-correlation (NCC), and clinical evaluation including Human Ranking Score (HRS) and Standardized Uptake Value (SUV) Error analysis shows its superiority in synthesizing full-dose PET images from low-dose inputs. RESULTS In experiments comparing eighth-dose to full-dose images, PET-CM demonstrated impressive performance with NMAE of 1.278 ± 0.122%, PSNR of 33.783 ± 0.824 dB, SSIM of 0.964 ± 0.009, NCC of 0.968 ± 0.011, HRS of 4.543, and SUV Error of 0.255 ± 0.318%, with an average generation time of 62 s per patient. This is a significant improvement compared to the state-of-the-art diffusion-based model with PET-CM reaching this result 12× faster. Similarly, in the quarter-dose to full-dose image experiments, PET-CM delivered competitive outcomes, achieving an NMAE of 0.973 ± 0.066%, PSNR of 36.172 ± 0.801 dB, SSIM of 0.984 ± 0.004, NCC of 0.990 ± 0.005, HRS of 4.428, and SUV Error of 0.151 ± 0.192% using the same generation process, which underlining its high quantitative and clinical precision in both denoising scenario. CONCLUSIONS We propose PET-CM, the first efficient diffusion-model-based method, for estimating full-dose PET images from low-dose images. PET-CM provides comparable quality to the state-of-the-art diffusion model with higher efficiency. By utilizing this approach, it becomes possible to maintain high-quality PET images suitable for clinical use while mitigating the risks associated with radiation. The code is availble at https://github.com/shaoyanpan/Full-dose-Whole-body-PET-Synthesis-from-Low-dose-PET-Using-Consistency-Model.
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Affiliation(s)
- Shaoyan Pan
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
| | - Elham Abouei
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Junbo Peng
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Joshua Qian
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jacob F Wynne
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Tonghe Wang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chih-Wei Chang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jonathon A Nye
- Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Hui Mao
- Department of Radiology and Imaging Science, and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
- Department of Biomedical Informatics, Emory University, Atlanta, GA 30322, USA
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Cui J, Luo Y, Chen D, Shi K, Su X, Liu H. IE-CycleGAN: improved cycle consistent adversarial network for unpaired PET image enhancement. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06823-6. [PMID: 39042332 DOI: 10.1007/s00259-024-06823-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE Technological advances in instruments have greatly promoted the development of positron emission tomography (PET) scanners. State-of-the-art PET scanners such as uEXPLORER can collect PET images of significantly higher quality. However, these scanners are not currently available in most local hospitals due to the high cost of manufacturing and maintenance. Our study aims to convert low-quality PET images acquired by common PET scanners into images of comparable quality to those obtained by state-of-the-art scanners without the need for paired low- and high-quality PET images. METHODS In this paper, we proposed an improved CycleGAN (IE-CycleGAN) model for unpaired PET image enhancement. The proposed method is based on CycleGAN, and the correlation coefficient loss and patient-specific prior loss were added to constrain the structure of the generated images. Furthermore, we defined a normalX-to-advanced training strategy to enhance the generalization ability of the network. The proposed method was validated on unpaired uEXPLORER datasets and Biograph Vision local hospital datasets. RESULTS For the uEXPLORER dataset, the proposed method achieved better results than non-local mean filtering (NLM), block-matching and 3D filtering (BM3D), and deep image prior (DIP), which are comparable to Unet (supervised) and CycleGAN (supervised). For the Biograph Vision local hospital datasets, the proposed method achieved higher contrast-to-noise ratios (CNR) and tumor-to-background SUVmax ratios (TBR) than NLM, BM3D, and DIP. In addition, the proposed method showed higher contrast, SUVmax, and TBR than Unet (supervised) and CycleGAN (supervised) when applied to images from different scanners. CONCLUSION The proposed unpaired PET image enhancement method outperforms NLM, BM3D, and DIP. Moreover, it performs better than the Unet (supervised) and CycleGAN (supervised) when implemented on local hospital datasets, which demonstrates its excellent generalization ability.
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Affiliation(s)
- Jianan Cui
- The Institute of Information Processing and Automation, College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Yi Luo
- The State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China
| | - Donghe Chen
- The PET Center, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Kuangyu Shi
- The Department of Nuclear Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Xinhui Su
- The PET Center, Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
| | - Huafeng Liu
- The State Key Laboratory of Modern Optical Instrumentation, College of Optical Science and Engineering, Zhejiang University, Hangzhou, China.
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6
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Zhou X, Xue S, Li L, Seifert R, Dong S, Chen R, Huang G, Rominger A, Liu J, Shi K. Sedation-free pediatric [ 18F]FDG imaging on totalbody PET/CT with the assistance of artificial intelligence. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06818-3. [PMID: 38958680 DOI: 10.1007/s00259-024-06818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE While sedation is routinely used in pediatric PET examinations to preserve diagnostic quality, it may result in side effects and may affect the radiotracer's biodistribution. This study aims to investigate the feasibility of sedation-free pediatric PET imaging using ultra-fast total-body (TB) PET scanners and deep learning (DL)-based attenuation and scatter correction (ASC). METHODS This retrospective study included TB PET (uExplorer) imaging of 35 sedated pediatric patients under four years old to determine the minimum effective scanning time. A DL-based ASC method was applied to enhance PET quantification. Both quantitative and qualitative assessments were conducted to evaluate the image quality of ultra-fast DL-ASC PET. Five non-sedated pediatric patients were subsequently used to validate the proposed approach. RESULTS Comparisons between standard 300-second and ultra-fast 15-second imaging, CT-ASC and DL-ASC ultra-fast 15-second images, as well as DL-ASC ultra-fast 15-second images in non-sedated and sedated patients, showed no significant differences in qualitative scoring, lesion detectability, and quantitative Standard Uptake Value (SUV) (P = ns). CONCLUSIONS This study demonstrates that pediatric PET imaging can be effectively performed without sedation by combining ultra-fast imaging techniques with a DL-based ASC. This advancement in sedation-free ultra-fast PET imaging holds potential for broader clinical adoption.
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Affiliation(s)
- Xiang Zhou
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Song Xue
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Street Freiburgstr. 18, Bern, 3010, Switzerland
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Lianghua Li
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Robert Seifert
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Street Freiburgstr. 18, Bern, 3010, Switzerland
| | - Shunjie Dong
- College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Gang Huang
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Street Freiburgstr. 18, Bern, 3010, Switzerland
| | - Jianjun Liu
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Street Freiburgstr. 18, Bern, 3010, Switzerland
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Hashimoto F, Onishi Y, Ote K, Tashima H, Reader AJ, Yamaya T. Deep learning-based PET image denoising and reconstruction: a review. Radiol Phys Technol 2024; 17:24-46. [PMID: 38319563 PMCID: PMC10902118 DOI: 10.1007/s12194-024-00780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
This review focuses on positron emission tomography (PET) imaging algorithms and traces the evolution of PET image reconstruction methods. First, we provide an overview of conventional PET image reconstruction methods from filtered backprojection through to recent iterative PET image reconstruction algorithms, and then review deep learning methods for PET data up to the latest innovations within three main categories. The first category involves post-processing methods for PET image denoising. The second category comprises direct image reconstruction methods that learn mappings from sinograms to the reconstructed images in an end-to-end manner. The third category comprises iterative reconstruction methods that combine conventional iterative image reconstruction with neural-network enhancement. We discuss future perspectives on PET imaging and deep learning technology.
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Affiliation(s)
- Fumio Hashimoto
- Central Research Laboratory, Hamamatsu Photonics K. K, 5000 Hirakuchi, Hamana-Ku, Hamamatsu, 434-8601, Japan.
- Graduate School of Science and Engineering, Chiba University, 1-33, Yayoicho, Inage-Ku, Chiba, 263-8522, Japan.
- National Institutes for Quantum Science and Technology, 4-9-1, Anagawa, Inage-Ku, Chiba, 263-8555, Japan.
| | - Yuya Onishi
- Central Research Laboratory, Hamamatsu Photonics K. K, 5000 Hirakuchi, Hamana-Ku, Hamamatsu, 434-8601, Japan
| | - Kibo Ote
- Central Research Laboratory, Hamamatsu Photonics K. K, 5000 Hirakuchi, Hamana-Ku, Hamamatsu, 434-8601, Japan
| | - Hideaki Tashima
- National Institutes for Quantum Science and Technology, 4-9-1, Anagawa, Inage-Ku, Chiba, 263-8555, Japan
| | - Andrew J Reader
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Taiga Yamaya
- Graduate School of Science and Engineering, Chiba University, 1-33, Yayoicho, Inage-Ku, Chiba, 263-8522, Japan
- National Institutes for Quantum Science and Technology, 4-9-1, Anagawa, Inage-Ku, Chiba, 263-8555, Japan
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Bousse A, Kandarpa VSS, Shi K, Gong K, Lee JS, Liu C, Visvikis D. A Review on Low-Dose Emission Tomography Post-Reconstruction Denoising with Neural Network Approaches. ARXIV 2024:arXiv:2401.00232v2. [PMID: 38313194 PMCID: PMC10836084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Low-dose emission tomography (ET) plays a crucial role in medical imaging, enabling the acquisition of functional information for various biological processes while minimizing the patient dose. However, the inherent randomness in the photon counting process is a source of noise which is amplified in low-dose ET. This review article provides an overview of existing post-processing techniques, with an emphasis on deep neural network (NN) approaches. Furthermore, we explore future directions in the field of NN-based low-dose ET. This comprehensive examination sheds light on the potential of deep learning in enhancing the quality and resolution of low-dose ET images, ultimately advancing the field of medical imaging.
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Affiliation(s)
| | | | - Kuangyu Shi
- Lab for Artificial Intelligence & Translational Theranostics, Dept. Nuclear Medicine, Inselspital, University of Bern, 3010 Bern, Switzerland
| | - Kuang Gong
- The Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
| | - Jae Sung Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
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9
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Balaji V, Song TA, Malekzadeh M, Heidari P, Dutta J. Artificial Intelligence for PET and SPECT Image Enhancement. J Nucl Med 2024; 65:4-12. [PMID: 37945384 PMCID: PMC10755520 DOI: 10.2967/jnumed.122.265000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Nuclear medicine imaging modalities such as PET and SPECT are confounded by high noise levels and low spatial resolution, necessitating postreconstruction image enhancement to improve their quality and quantitative accuracy. Artificial intelligence (AI) models such as convolutional neural networks, U-Nets, and generative adversarial networks have shown promising outcomes in enhancing PET and SPECT images. This review article presents a comprehensive survey of state-of-the-art AI methods for PET and SPECT image enhancement and seeks to identify emerging trends in this field. We focus on recent breakthroughs in AI-based PET and SPECT image denoising and deblurring. Supervised deep-learning models have shown great potential in reducing radiotracer dose and scan times without sacrificing image quality and diagnostic accuracy. However, the clinical utility of these methods is often limited by their need for paired clean and corrupt datasets for training. This has motivated research into unsupervised alternatives that can overcome this limitation by relying on only corrupt inputs or unpaired datasets to train models. This review highlights recently published supervised and unsupervised efforts toward AI-based PET and SPECT image enhancement. We discuss cross-scanner and cross-protocol training efforts, which can greatly enhance the clinical translatability of AI-based image enhancement tools. We also aim to address the looming question of whether the improvements in image quality generated by AI models lead to actual clinical benefit. To this end, we discuss works that have focused on task-specific objective clinical evaluation of AI models for image enhancement or incorporated clinical metrics into their loss functions to guide the image generation process. Finally, we discuss emerging research directions, which include the exploration of novel training paradigms, curation of larger task-specific datasets, and objective clinical evaluation that will enable the realization of the full translation potential of these models in the future.
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Affiliation(s)
- Vibha Balaji
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; and
| | - Tzu-An Song
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; and
| | - Masoud Malekzadeh
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; and
| | - Pedram Heidari
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joyita Dutta
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, Massachusetts; and
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10
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Gong K, Johnson K, El Fakhri G, Li Q, Pan T. PET image denoising based on denoising diffusion probabilistic model. Eur J Nucl Med Mol Imaging 2024; 51:358-368. [PMID: 37787849 PMCID: PMC10958486 DOI: 10.1007/s00259-023-06417-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Due to various physical degradation factors and limited counts received, PET image quality needs further improvements. The denoising diffusion probabilistic model (DDPM) was a distribution learning-based model, which tried to transform a normal distribution into a specific data distribution based on iterative refinements. In this work, we proposed and evaluated different DDPM-based methods for PET image denoising. METHODS Under the DDPM framework, one way to perform PET image denoising was to provide the PET image and/or the prior image as the input. Another way was to supply the prior image as the network input with the PET image included in the refinement steps, which could fit for scenarios of different noise levels. 150 brain [[Formula: see text]F]FDG datasets and 140 brain [[Formula: see text]F]MK-6240 (imaging neurofibrillary tangles deposition) datasets were utilized to evaluate the proposed DDPM-based methods. RESULTS Quantification showed that the DDPM-based frameworks with PET information included generated better results than the nonlocal mean, Unet and generative adversarial network (GAN)-based denoising methods. Adding additional MR prior in the model helped achieved better performance and further reduced the uncertainty during image denoising. Solely relying on MR prior while ignoring the PET information resulted in large bias. Regional and surface quantification showed that employing MR prior as the network input while embedding PET image as a data-consistency constraint during inference achieved the best performance. CONCLUSION DDPM-based PET image denoising is a flexible framework, which can efficiently utilize prior information and achieve better performance than the nonlocal mean, Unet and GAN-based denoising methods.
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Affiliation(s)
- Kuang Gong
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, 32611, FL, USA.
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA.
| | - Keith Johnson
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA
| | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, MA, USA
| | - Tinsu Pan
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, 77030, TX, USA
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11
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Huang TL, Lu NH, Huang YH, Twan WH, Yeh LR, Liu KY, Chen TB. Transfer learning with CNNs for efficient prostate cancer and BPH detection in transrectal ultrasound images. Sci Rep 2023; 13:21849. [PMID: 38071254 PMCID: PMC10710441 DOI: 10.1038/s41598-023-49159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Early detection of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) is crucial for maintaining the health and well-being of aging male populations. This study aims to evaluate the performance of transfer learning with convolutional neural networks (CNNs) for efficient classification of PCa and BPH in transrectal ultrasound (TRUS) images. A retrospective experimental design was employed in this study, with 1380 TRUS images for PCa and 1530 for BPH. Seven state-of-the-art deep learning (DL) methods were employed as classifiers with transfer learning applied to popular CNN architectures. Performance indices, including sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), Kappa value, and Hindex (Youden's index), were used to assess the feasibility and efficacy of the CNN methods. The CNN methods with transfer learning demonstrated a high classification performance for TRUS images, with all accuracy, specificity, sensitivity, PPV, NPV, Kappa, and Hindex values surpassing 0.9400. The optimal accuracy, sensitivity, and specificity reached 0.9987, 0.9980, and 0.9980, respectively, as evaluated using twofold cross-validation. The investigated CNN methods with transfer learning showcased their efficiency and ability for the classification of PCa and BPH in TRUS images. Notably, the EfficientNetV2 with transfer learning displayed a high degree of effectiveness in distinguishing between PCa and BPH, making it a promising tool for future diagnostic applications.
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Affiliation(s)
- Te-Li Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung, 81362, Taiwan
| | - Nan-Han Lu
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
- Department of Pharmacy, Tajen University, No.20, Weixin Rd., Yanpu Township, Pingtung, 90741, Taiwan.
- Department of Radiology, E-DA Hospital, I-Shou University, No.1, Yida Rd., Jiao-Su Village, Yan-Chao District, Kaohsiung, 82445, Taiwan.
| | - Yung-Hui Huang
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
| | - Wen-Hung Twan
- Department of Life Sciences, National Taitung University, No.369, Sec. 2, University Rd., Taitung, 95092, Taiwan
| | - Li-Ren Yeh
- Department of Anesthesiology, E-DA Cancer Hospital, I-Shou University, No.1, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
| | - Kuo-Ying Liu
- Department of Radiology, E-DA Hospital, I-Shou University, No.1, Yida Rd., Jiao-Su Village, Yan-Chao District, Kaohsiung, 82445, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
- Institute of Statistics, National Yang Ming Chiao Tung University, No. 1001, University Road, Hsinchu, 30010, Taiwan.
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12
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Léost F, Barbet J, Beyler M, Chérel M, Delpon G, Garcion E, Lacerda S, Lepareur N, Rbah-Vidal L, Vaugier L, Visvikis D. ["New Modalities in Cancer Imaging and Therapy" XVth edition of the workshop organized by the network "Tumor Targeting, Imaging, Radiotherapies" of the Cancéropôle Grand-Ouest, 5-8 October 2022, France]. Bull Cancer 2023; 110:1322-1331. [PMID: 37880044 DOI: 10.1016/j.bulcan.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/16/2023] [Accepted: 08/13/2023] [Indexed: 10/27/2023]
Abstract
The fifteenth edition of the international workshop organized by the "Tumour Targeting and Radiotherapies network" of the Cancéropôle Grand-Ouest focused on the latest advances in internal and external radiotherapy from different disciplinary angles: chemistry, biology, physics, and medicine. The workshop covered several deliberately diverse topics: the role of artificial intelligence, new tools for imaging and external radiotherapy, theranostic aspects, molecules and contrast agents, vectors for innovative combined therapies, and the use of alpha particles in therapy.
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Affiliation(s)
- Françoise Léost
- Cancéropôle Grand-Ouest, IRS-UN, 8, quai Moncousu, 44007 Nantes cedex 1, France.
| | | | - Maryline Beyler
- Université de Brest, UMR CNRS-UBO 6521 CEMCA, 6, avenue V.-Le-Gorgeu, 29200 Brest, France
| | - Michel Chérel
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI(2)NA, Nantes, France
| | - Grégory Delpon
- Institut de cancérologie de l'Ouest, département de physique médicale, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, 4, rue Alfred-Kastler, 44307 Nantes cedex 3, France
| | - Emmanuel Garcion
- Université d'Angers, Inserm, CNRS, Nantes Université, CRCI(2)NA, Angers, France
| | - Sara Lacerda
- Université d'Orléans, centre de biophysique moléculaire, CNRS UPR 4301, rue Charles-Sadron, 45071 Orléans cedex 2, France
| | - Nicolas Lepareur
- Université de Rennes, Inrae, Inserm, CLCC Eugène-Marquis, institut nutrition, métabolismes et cancer (NUMECAN), UMR 1317, Rennes, France
| | - Latifa Rbah-Vidal
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI(2)NA, Nantes, France
| | - Loïg Vaugier
- Institut de cancérologie de l'Ouest, département de physique médicale, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Laboratoire SUBATECH, UMR 6457 CNRS-IN2P3, IMT Atlantique, 4, rue Alfred-Kastler, 44307 Nantes cedex 3, France
| | - Dimitris Visvikis
- Inserm, LaTIM, UMR 1101, IBSAM, UBO, UBL, 22, rue Camille-Desmoulins, 29238 Brest, France
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13
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Alberts I, Sari H, Mingels C, Afshar-Oromieh A, Pyka T, Shi K, Rominger A. Long-axial field-of-view PET/CT: perspectives and review of a revolutionary development in nuclear medicine based on clinical experience in over 7000 patients. Cancer Imaging 2023; 23:28. [PMID: 36934273 PMCID: PMC10024603 DOI: 10.1186/s40644-023-00540-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/25/2023] [Indexed: 03/20/2023] Open
Abstract
Recently introduced long-axial field-of-view (LAFOV) PET/CT systems represent one of the most significant advancements in nuclear medicine since the advent of multi-modality PET/CT imaging. The higher sensitivity exhibited by such systems allow for reductions in applied activity and short duration scans. However, we consider this to be just one small part of the story: Instead, the ability to image the body in its entirety in a single FOV affords insights which standard FOV systems cannot provide. For example, we now have the ability to capture a wider dynamic range of a tracer by imaging it over multiple half-lives without detrimental image noise, to leverage lower radiopharmaceutical doses by using dual-tracer techniques and with improved quantification. The potential for quantitative dynamic whole-body imaging using abbreviated protocols potentially makes these techniques viable for routine clinical use, transforming PET-reporting from a subjective analysis of semi-quantitative maps of radiopharmaceutical uptake at a single time-point to an accurate and quantitative, non-invasive tool to determine human function and physiology and to explore organ interactions and to perform whole-body systems analysis. This article will share the insights obtained from 2 years' of clinical operation of the first Biograph Vision Quadra (Siemens Healthineers) LAFOV system. It will also survey the current state-of-the-art in PET technology. Several technologies are poised to furnish systems with even greater sensitivity and resolution than current systems, potentially with orders of magnitude higher sensitivity. Current barriers which remain to be surmounted, such as data pipelines, patient throughput and the hindrances to implementing kinetic analysis for routine patient care will also be discussed.
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Affiliation(s)
- Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Hasan Sari
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Thomas Pyka
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland.
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14
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Jiang Y, Fang S, Feng J, Ruan Q, Zhang J. Synthesis and Bioevaluation of Novel Technetium-99m-Labeled Complexes with Norfloxacin HYNIC Derivatives for Bacterial Infection Imaging. Mol Pharm 2023; 20:630-640. [PMID: 36398935 DOI: 10.1021/acs.molpharmaceut.2c00830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To seek a novel 99mTc-labeled quinolone derivative for bacterial infection SPECT imaging that aims to lower nontarget organ uptake, a novel norfloxacin 6-hydrazinoicotinamide (HYNIC) derivative (HYNICNF) was designed and synthesized. It was radiolabeled with different coligands, such as tricine, trisodium triphenylphosphine-3,3',3″-trisulfonate (TPPTS), sodium triphenylphosphine-3-monosulfonate (TPPMS), and ethylenediamine-N,N'-diacetic acid (EDDA), to obtain three 99mTc-labeled norfloxacin HYNIC complexes, namely, [99mTc]Tc-tricine-TPPTS-HYNICNF, [99mTc]Tc-tricine-TPPMS-HYNICNF, and [99mTc]Tc-EDDA-HYNICNF. These complexes were purified (RCP > 95%) and evaluated in vitro and in vivo for targeting bacteria. All three complexes are hydrophilic, maintain good stability, and specifically bind Staphylococcus aureus in vitro. The biodistribution in mice with bacterial infection demonstrated that [99mTc]Tc-EDDA-HYNICNF showed a higher abscess uptake and lower nontarget organ uptake and was able to distinguish bacterial infection and sterile inflammation. Single photon emission computed tomography (SPECT) image study in bacterial infection mice showed there was a visible accumulation in the infection site, suggesting that [99mTc]Tc-EDDA-HYNICNF is a potential radiotracer for bacterial infection imaging.
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Affiliation(s)
- Yuhao Jiang
- Key Laboratory of Radiopharmaceuticals of Ministry of Education, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Product Administration), College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Si'an Fang
- Key Laboratory of Radiopharmaceuticals of Ministry of Education, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Product Administration), College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Junhong Feng
- Key Laboratory of Radiopharmaceuticals of Ministry of Education, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Product Administration), College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Qing Ruan
- Key Laboratory of Radiopharmaceuticals of Ministry of Education, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Product Administration), College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Junbo Zhang
- Key Laboratory of Radiopharmaceuticals of Ministry of Education, NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Product Administration), College of Chemistry, Beijing Normal University, Beijing 100875, China
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15
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Combined [68 Ga]Ga-PSMA-11 and low-dose 2-[18F]FDG PET/CT using a long-axial field of view scanner for patients referred for [177Lu]-PSMA-radioligand therapy. Eur J Nucl Med Mol Imaging 2023; 50:951-956. [PMID: 36136102 PMCID: PMC9852199 DOI: 10.1007/s00259-022-05961-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Performing 2-[18F]FDG PET/CT in addition to a PSMA-ligand PET/CT can assist in the detection of lesions with low PSMA expression and may help in prognostication and identification of patients who likely benefit from PSMA-radioligand therapy (PSMA-RLT). However, the cost and time needed for a separate PET/CT examination might hinder its routine implementation. In this communication, we present our initial experiences with additional low-dose 2-[18F]FDG PET/CT as part of a dual-tracer and same-day imaging protocol which exploits the higher sensitivity exhibited by long-axial field-of-view (LAFOV) and total-body PET/CT systems and demonstrates its feasibility. METHODS Fourteen patients referred for evaluation for PSMA-RLT received [68 Ga]Ga-PSMA-11 PET/CT at 1 h p.i. with a standard activity of 150 MBq and an additional low-dose 2-[18F]FDG PET/CT with 40 MBq 1 h thereafter using a long-axial field-of-view PET/CT system in a single sitting and as per institutional protocol. Scans were scrutinized by two experienced nuclear medicine physicians for mismatch findings. RESULTS The combined protocol identified additional lesions with low or absent PSMA-expression but high FDG-avidity in 1/14 (7%) patients. The protocol was easily implemented and well tolerated by all patients. CONCLUSION Additional low-dose 2-[18F]FDG-PET/CT is feasible as part of a same-day imaging protocol and can help reveal lesions of low PSMA avidity as part of therapy assessment for [177Lu]-PSMA radioligand therapy and demonstrates higher sensitivity compared to [68 Ga]Ga-PSMA-11 PET/CT alone in some patients.
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16
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Roy S, Meena T, Lim SJ. Demystifying Supervised Learning in Healthcare 4.0: A New Reality of Transforming Diagnostic Medicine. Diagnostics (Basel) 2022; 12:2549. [PMID: 36292238 PMCID: PMC9601517 DOI: 10.3390/diagnostics12102549] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
The global healthcare sector continues to grow rapidly and is reflected as one of the fastest-growing sectors in the fourth industrial revolution (4.0). The majority of the healthcare industry still uses labor-intensive, time-consuming, and error-prone traditional, manual, and manpower-based methods. This review addresses the current paradigm, the potential for new scientific discoveries, the technological state of preparation, the potential for supervised machine learning (SML) prospects in various healthcare sectors, and ethical issues. The effectiveness and potential for innovation of disease diagnosis, personalized medicine, clinical trials, non-invasive image analysis, drug discovery, patient care services, remote patient monitoring, hospital data, and nanotechnology in various learning-based automation in healthcare along with the requirement for explainable artificial intelligence (AI) in healthcare are evaluated. In order to understand the potential architecture of non-invasive treatment, a thorough study of medical imaging analysis from a technical point of view is presented. This study also represents new thinking and developments that will push the boundaries and increase the opportunity for healthcare through AI and SML in the near future. Nowadays, SML-based applications require a lot of data quality awareness as healthcare is data-heavy, and knowledge management is paramount. Nowadays, SML in biomedical and healthcare developments needs skills, quality data consciousness for data-intensive study, and a knowledge-centric health management system. As a result, the merits, demerits, and precautions need to take ethics and the other effects of AI and SML into consideration. The overall insight in this paper will help researchers in academia and industry to understand and address the future research that needs to be discussed on SML in the healthcare and biomedical sectors.
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Affiliation(s)
- Sudipta Roy
- Artificial Intelligence & Data Science, Jio Institute, Navi Mumbai 410206, India
| | - Tanushree Meena
- Artificial Intelligence & Data Science, Jio Institute, Navi Mumbai 410206, India
| | - Se-Jung Lim
- Division of Convergence, Honam University, 120, Honamdae-gil, Gwangsan-gu, Gwangju 62399, Korea
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17
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Wang Y, Galante JR, Haroon A, Wan S, Afaq A, Payne H, Bomanji J, Adeleke S, Kasivisvanathan V. The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer. Nat Rev Urol 2022; 19:475-493. [PMID: 35789204 DOI: 10.1038/s41585-022-00618-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Radiolabelled prostate-specific membrane antigen (PSMA)-based PET-CT has been shown in numerous studies to be superior to conventional imaging in the detection of nodal or distant metastatic lesions. 68Ga-PSMA PET-CT is now recommended by many guidelines for the detection of biochemically relapsed disease after radical local therapy. PSMA radioligands can also function as radiotheranostics, and Lu-PSMA has been shown to be a potential new line of treatment for metastatic castration-resistant prostate cancer. Whole-body (WB) MRI has been shown to have a high diagnostic performance in the detection and monitoring of metastatic bone disease. Prospective, randomized, multicentre studies comparing 68Ga-PSMA PET-CT and WB MRI for pelvic nodal and metastatic disease detection are yet to be performed. Challenges for interpretation of PSMA include tracer trapping in non-target tissues and also urinary excretion of tracers, which confounds image interpretation at the vesicoureteral junction. Additionally, studies have shown how long-term androgen deprivation therapy (ADT) affects PSMA expression and could, therefore, reduce tracer uptake and visibility of PSMA+ lesions. Furthermore, ADT of short duration might increase PSMA expression, leading to the PSMA flare phenomenon, which makes the accurate monitoring of treatment response to ADT with PSMA PET challenging. Scan duration, detection of incidentalomas and presence of metallic implants are some of the major challenges with WB MRI. Emerging data support the wider adoption of PSMA PET and WB MRI for diagnosis, staging, disease burden evaluation and response monitoring, although their relative roles in the standard-of-care management of patients are yet to be fully defined.
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Affiliation(s)
- Yishen Wang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.
| | - Joao R Galante
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Athar Haroon
- Department of Nuclear Medicine, Barts Health NHS Trust, London, UK
| | - Simon Wan
- Institute of Nuclear Medicine, University College London, London, UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College London, London, UK.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Heather Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College London, London, UK
| | - Sola Adeleke
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
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18
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Lan X, Huo L, Li S, Wang J, Cai W. State-of-the-art of nuclear medicine and molecular imaging in China: after the first 66 years (1956-2022). Eur J Nucl Med Mol Imaging 2022; 49:2455-2461. [PMID: 35665836 PMCID: PMC9167647 DOI: 10.1007/s00259-022-05856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Li Huo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Shuren Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin Madison, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
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19
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He P, Xiong Y, Ye J, Chen B, Cheng H, Liu H, Zheng Y, Chu C, Mao J, Chen A, Zhang Y, Li J, Tian J, Liu G. A clinical trial of super-stable homogeneous lipiodol-nanoICG formulation-guided precise fluorescent laparoscopic hepatocellular carcinoma resection. J Nanobiotechnology 2022; 20:250. [PMID: 35658966 PMCID: PMC9164554 DOI: 10.1186/s12951-022-01467-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Applying traditional fluorescence navigation technologies in hepatocellular carcinoma is severely restricted by high false-positive rates, variable tumor differentiation, and unstable fluorescence performance. RESULTS In this study, a green, economical and safe nanomedicine formulation technology was developed to construct carrier-free indocyanine green nanoparticles (nanoICG) with a small uniform size and better fluorescent properties without any molecular structure changes compared to the ICG molecule. Subsequently, nanoICG dispersed into lipiodol via a super-stable homogeneous intermixed formulation technology (SHIFT&nanoICG) for transhepatic arterial embolization combined with fluorescent laparoscopic hepatectomy to eliminate the existing shortcomings. A 52-year-old liver cancer patient was recruited for the clinical trial of SHIFT&nanoICG. We demonstrate that SHIFT&nanoICG could accurately identify and mark the lesion with excellent stability, embolism, optical imaging performance, and higher tumor-to-normal tissue ratio, especially in the detection of the microsatellite lesions (0.4 × 0.3 cm), which could not be detected by preoperative imaging, to realize a complete resection of hepatocellular carcinoma under fluorescence laparoscopy in a shorter period (within 2 h) and with less intraoperative blood loss (50 mL). CONCLUSIONS This simple and effective strategy integrates the diagnosis and treatment of hepatocellular carcinoma, and thus, it has great potential in various clinical applications.
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Affiliation(s)
- Pan He
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Yongfu Xiong
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
- Department of Hepatobiliary Surgery, Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637600, China
| | - Jinfa Ye
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Biaoqi Chen
- Fujian Provincial Key Laboratory of Biochemical Technology, Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, China
| | - Hongwei Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Hao Liu
- Fujian Provincial Key Laboratory of Biochemical Technology, Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, China
| | - Yating Zheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Chengchao Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
- Amoy Hopeful Biotechnology Co., Ltd, Xiamen, 361027, China
| | - Jingsong Mao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Aizheng Chen
- Fujian Provincial Key Laboratory of Biochemical Technology, Institute of Biomaterials and Tissue Engineering, Huaqiao University, Xiamen, 361021, China
| | - Yang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China.
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Academician (Expert) Workstation, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637600, China.
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, 361102, China.
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20
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Ghasemi-Tarie R, Kiasalari Z, Fakour M, Khorasani M, Keshtkar S, Baluchnejadmojarad T, Roghani M. Nobiletin prevents amyloid β 1-40-induced cognitive impairment via inhibition of neuroinflammation and oxidative/nitrosative stress. Metab Brain Dis 2022; 37:1337-1349. [PMID: 35294678 DOI: 10.1007/s11011-022-00949-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/01/2022] [Indexed: 01/17/2023]
Abstract
Alzheimer's disease (AD) is presented as an age-related neurodegenerative disease with multiple cognitive deficits and amyloid β (Aβ) accumulation is the most important involved factor in its development. Nobiletin is a bioflavonoid isolated from citrus fruits peels with anti-inflammatory and anti-oxidative activity as well as anti-dementia property that has shown potency to ameliorate intracellular and extracellular Ab. The aim of the present study was to assess protective effect of nobiletin against Aβ1-40-induced cognitive impairment as a consistent model of AD. After bilateral intrahippocampal (CA1 subfield) injection of Aβ1-40, rats were treated with nobiletin (10 mg/kg/day; p.o.) from stereotaxic surgery day (day 0) till day + 7. Cognition function was evaluated in a battery of behavioral tasks at week 3 with final assessment of hippocampal oxidative stress and inflammation besides Nissl staining and 3-nitrotyrosine (3-NT) immunohistochemistry. Analysis of behavioral data showed notable and significant improvement of alternation in Y maze test, discrimination ratio in novel object recognition task, and step through latency in passive avoidance test in nobiletin-treated Aβ group. Additionally, nobiletin treatment was associated with lower hippocampal levels of MDA and ROS and partial reversal of SOD activity and also improvement of Nrf2 with no significant effect on GSH and catalase. Furthermore, nobiletin attenuated hippocampal neuroinflammation in Aβ group as shown by lower tissue levels of TLR4, NF-kB, and TNFa. Histochemical findings showed that nobiletin prevents CA1 neuronal loss in Nissl staining in addition to its alleviation of 3-nitrotyrosine (3-NT) immunoreactivity as a marker of nitrosative stress. Collectively, these findings indicated neuroprotective and anti-dementia potential of nobiletin that is partly attributed to its anti-oxidative, anti-nitrosative, and anti-inflammatory property associated with proper modulation of TLR4/NF-kB/Nrf2 pathways.
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Affiliation(s)
| | - Zahra Kiasalari
- Neurophysiology Research Center, Department of Physiology, Shahed University, Tehran, Iran
| | - Marzieh Fakour
- Department of Physiology, School of Medicine, Shahed University, Tehran, Iran.
| | - Maryam Khorasani
- Department of Physiology, School of Medicine, Shahed University, Tehran, Iran
| | - Sedigheh Keshtkar
- Department of Physiology, School of Medicine, Shahed University, Tehran, Iran
| | | | - Mehrdad Roghani
- Neurophysiology Research Center, Department of Physiology, Shahed University, Tehran, Iran.
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21
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Vollnberg B, Alberts I, Genitsch V, Rominger A, Afshar-Oromieh A. Assessment of malignancy and PSMA expression of uncertain bone foci in [ 18F]PSMA-1007 PET/CT for prostate cancer-a single-centre experience of PET-guided biopsies. Eur J Nucl Med Mol Imaging 2022; 49:3910-3916. [PMID: 35482114 PMCID: PMC9399054 DOI: 10.1007/s00259-022-05745-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/19/2022] [Indexed: 11/20/2022]
Abstract
Purpose Uncertain focal bone uptake (UBU) with intensive radiopharmaceutical avidity are frequently observed in patients undergoing [18F]PSMA-1007 PET/CT for the detection of prostate cancer (PC). Such foci can pose diagnostic conundrums and risk incorrect staging. The aim of this short communication is to share the results of PET-guided biopsies of such foci. Methods A retrospective analysis revealed 10 patients who were referred to our department for PET-guided biopsy of UBU visible in a previous [18F]PSMA-1007 PET/CT. [18F]-PSMA-1007 PET-guided biopsy was conducted for 11 PSMA-avid bone foci in these 10 patients. The biopsy materials were analysed for tissue typing, and immunohistochemistry (IHC) was performed for prostate-specific-membrane-antigen (PSMA) expression. The scans were analysed by two experienced physicians in a consensus read for clinical characteristics and radiopharmaceutical uptake of foci. Results One out of 11 (9.1%) of the foci biopsied was confirmed as bone metastasis of PC with intense PSMA-expression, while 10/11 (90.9%) foci were revealed to be unremarkable bone tissue without evidence of PSMA expression at IHC. Amongst all bone foci assessed by biopsy, eight were visually classified as being at high risk of malignancy in the PET/CT (SUVmean 12.0 ± 8.1; SUVmax 18.8 ± 13.1), three as equivocal (SUVmean 4.6 ± 2.1; SUVmax 7.2 ± 3.0) and zero as low risk. No UBU had any CT correlate. Conclusions This cohort biopsy revealed that a small but relevant number of UBU are true metastases. For those confirmed as benign, no PSMA expression at IHC was observed, suggesting a non-PSMA mediated cause for intensive [18F]PSMA-1007 uptake of which the reason remains unclear. Readers must interpret such foci with caution in order to reduce the risk of erroneous staging and subsequent treatment. PET-guided biopsy, particularly in the absence of morphological changes in the CT, can be a useful method to clarify such foci. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05745-5.
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Affiliation(s)
- Bernd Vollnberg
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Vera Genitsch
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, CH-3010, Bern, Switzerland.
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22
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Pain CD, Egan GF, Chen Z. Deep learning-based image reconstruction and post-processing methods in positron emission tomography for low-dose imaging and resolution enhancement. Eur J Nucl Med Mol Imaging 2022; 49:3098-3118. [PMID: 35312031 PMCID: PMC9250483 DOI: 10.1007/s00259-022-05746-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/25/2022] [Indexed: 12/21/2022]
Abstract
Image processing plays a crucial role in maximising diagnostic quality of positron emission tomography (PET) images. Recently, deep learning methods developed across many fields have shown tremendous potential when applied to medical image enhancement, resulting in a rich and rapidly advancing literature surrounding this subject. This review encapsulates methods for integrating deep learning into PET image reconstruction and post-processing for low-dose imaging and resolution enhancement. A brief introduction to conventional image processing techniques in PET is firstly presented. We then review methods which integrate deep learning into the image reconstruction framework as either deep learning-based regularisation or as a fully data-driven mapping from measured signal to images. Deep learning-based post-processing methods for low-dose imaging, temporal resolution enhancement and spatial resolution enhancement are also reviewed. Finally, the challenges associated with applying deep learning to enhance PET images in the clinical setting are discussed and future research directions to address these challenges are presented.
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Affiliation(s)
- Cameron Dennis Pain
- Monash Biomedical Imaging, Monash University, Melbourne, Australia.
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Australia.
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
- Department of Data Science and AI, Monash University, Melbourne, Australia
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23
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18F- or 177Lu-labeled bivalent ligand of fibroblast activation protein with high tumor uptake and retention. Eur J Nucl Med Mol Imaging 2022; 49:2705-2715. [PMID: 35290473 DOI: 10.1007/s00259-022-05757-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Fibroblast activation protein (FAP) has become a promising cancer-related target for diagnosis and therapy. The aim of this study was to develop a bivalent FAP ligand for both diagnostic PET imaging and endoradiotherapy. METHODS We synthesized a bivalent FAP ligand (ND-bisFAP) and labeled it with 18F or 177Lu. FAP-positive A549-FAP cells were used to study competitive binding to FAP, cellular internalization, and efflux properties in vitro. Micro-PET imaging with [18F]AlF-ND-bisFAPI was conducted in mice bearing A549-FAP or U87MG tumors. Biodistribution and therapeutic efficacy of [177Lu]Lu-ND-bisFAPI were conducted in mice bearing A549-FAP tumors. RESULTS The FAP binding affinity of ND-bisFAPI is 0.25 ± 0.05 nM, eightfold higher in potency than the monomeric DOTA-FAPI-04 (IC50 = 2.0 ± 0.18 nM). In A549-FAP cells, ND-bisFAPI showed specific uptake, a high internalized fraction, and slow cellular efflux. Compared to the monomeric [18F]AlF-FAPI-42, micro-PET imaging with [18F]AlF-ND-bisFAPI showed higher specific tumor uptake and retention for at least 6 h. Biodistribution studies showed that [177Lu]Lu-ND-bisFAPI had higher tumor uptake than [177Lu]Lu-FAPI-04 at the 24, 72, 120, and 168 h time points (all P < 0.01). [177Lu]Lu-ND-bisFAPI delivered fourfold higher radiation than [177Lu]Lu-FAPI-04 to A549-FAP tumors. For the endoradiotherapy study, 37 MBq of [177Lu]Lu-ND-bisFAPI significantly reduced tumor growth compared to the same dose of [177Lu]Lu-FAPI-04. Half of the dose of [177Lu]Lu-ND-bisFAPI (18.5 MBq) has comparable median survival as 37 MBq of [177Lu]Lu-FAPI-04 (37 vs 36 days). CONCLUSION The novel bivalent FAP ligand was developed as a theranostic radiopharmaceutical and showed promising properties including higher tumor uptake and retention compared to the established radioligands [18F]AlF-FAPI-42 and [177Lu]Lu-FAPI-04. Preliminary experiments with 18F- or 177Lu-labeled ND-bisFAPI showed promising imaging properties and favorable anti-tumor responses.
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24
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Sui X, Tan H, Yu H, Xiao J, Qi C, Cao Y, Chen S, Zhang Y, Hu P, Shi H. Exploration of the total-body PET/CT reconstruction protocol with ultra-low 18F-FDG activity over a wide range of patient body mass indices. EJNMMI Phys 2022; 9:17. [PMID: 35239037 PMCID: PMC8894532 DOI: 10.1186/s40658-022-00445-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
Purpose The purpose of this study was to investigate the image quality and diagnostic performance of different reconstructions over a wide range of patient body mass indices (BMIs) obtained by total-body PET/CT with ultra-low 18F-FDG activity (0.37 MBq/kg). Methods A total of 63 patients who underwent total-body PET/CT with ultra-low activity (0.37 MBq/kg) 18F-FDG were enrolled. Patients were grouped by their BMIs. Images were reconstructed with the following two algorithms: the ordered subset expectation maximization (OSEM) algorithm (2, 3 iterations), both with time of flight (TOF) and point spread function (PSF) corrections (hereinafter referred as OSEM2, OSEM3) and HYPER Iterative algorithm (β-values of 0.3, 0.4, 0.5, 0.6) embedded TOF and PSF technologies (hereinafter referred as HYPER0.3, HYPER0.4, HYPER0.5 and HYPER0.6, respectively). Subjective image quality was assessed by two experienced nuclear medicine physicians according to the Likert quintile, including overall image quality, image noise and lesion conspicuity. The standard deviation (SD) and signal-to-noise ratio (SNR) of the liver, and maximum standard uptake value (SUVmax), peak standard uptake value (SUVpeak), tumour background ratio (T/N) and the largest diameter of lesions were quantitatively analysed by a third reader who did not participate in the subjective image assessment. Results Increased noise was associated with increased BMI in all reconstruction groups. Significant differences occurred in the liver SNR among BMI categories of OSEM reconstructions (P < 0.001) but no difference was seen in the HYPER Iterative reconstructions between any of the BMI categories (P > 0.05). With the increase in BMI, overall image quality and image noise scores decreased significantly in all reconstructions, but there was no statistically significant difference of lesion conspicuity. The overall image quality score of the obese group was not qualified (score = 2.7) in OSEM3, while the others were qualified. The lesion conspicuity scores were significantly higher in HYPER Iterative reconstructions and lower in OSEM2 than in OSEM3 (all P < 0.05). The values of SUVmax, SUVpeak and T/N in HYPER0.3, HYPER0.4 and HYPER0.5 were higher than those in OSEM3. In different reconstructions, there was a correlation between lesion size (median, 1.55 cm; range, 0.7–11.0 cm) and SUVpeak variation rate compared to OSEM3 (r = 0.388, − 0.515, − 0.495, − 0.464, and − 0.423, respectively, and all P < 0.001). Conclusion Considering the image quality and lesion analysis in 18F-FDG total-body PET/CT with ultra-low activity injection, OSEM reconstructions with 3 iterations meet the clinical requirements in patients with BMI < 30. In patients with BMI ≥ 30, it is recommended that the HYPER Iterative algorithm (β-value of 0.3–0.5) be used to ensure consistent visual image quality and quantitative assessment.
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Affiliation(s)
- Xiuli Sui
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Jie Xiao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Chi Qi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yanyan Cao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Shuguang Chen
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Pengcheng Hu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China.,Shanghai Institute of Medical Imaging, Shanghai, 200032, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China. .,Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
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25
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Zhang Z, He K, Chi C, Hu Z, Tian J. Intraoperative fluorescence molecular imaging accelerates the coming of precision surgery in China. Eur J Nucl Med Mol Imaging 2022; 49:2531-2543. [PMID: 35230491 PMCID: PMC9206608 DOI: 10.1007/s00259-022-05730-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023]
Abstract
Purpose China has the largest cancer population globally. Surgery is the main choice for most solid cancer patients. Intraoperative fluorescence molecular imaging (FMI) has shown its great potential in assisting surgeons in achieving precise resection. We summarized the typical applications of intraoperative FMI and several new trends to promote the development of precision surgery. Methods The academic database and NIH clinical trial platform were systematically evaluated. We focused on the clinical application of intraoperative FMI in China. Special emphasis was placed on a series of typical studies with new technologies or high-level evidence. The emerging strategy of combining FMI with other modalities was also discussed. Results The clinical applications of clinically approved indocyanine green (ICG), methylene blue (MB), or fluorescein are on the rise in different surgical departments. Intraoperative FMI has achieved precise lesion detection, sentinel lymph node mapping, and lymphangiography for many cancers. Nerve imaging is also exploring to reduce iatrogenic injuries. Through different administration routes, these fluorescent imaging agents provided encouraging results in surgical navigation. Meanwhile, designing new cancer-specific fluorescent tracers is expected to be a promising trend to further improve the surgical outcome. Conclusions Intraoperative FMI is in a rapid development in China. In-depth understanding of cancer-related molecular mechanisms is necessary to achieve precision surgery. Molecular-targeted fluorescent agents and multi-modal imaging techniques might play crucial roles in the era of precision surgery.
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Affiliation(s)
- Zeyu Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Kunshan He
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,State Key Laboratory of Computer Science and Beijing Key Lab of Human-Computer Interaction, Institute of Software, Chinese Academy of Sciences, Beijing, China
| | - Chongwei Chi
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China. .,University of Chinese Academy of Sciences, Beijing, China.
| | - Zhenhua Hu
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China. .,University of Chinese Academy of Sciences, Beijing, China.
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China. .,CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
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26
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Li Y, Zhang T, Feng J, Qian S, Wu S, Zhou R, Wang J, Sa G, Wang X, Li L, Chen F, Yang H, Zhang H, Tian M. Processing speed dysfunction is associated with functional corticostriatal circuit alterations in childhood epilepsy with centrotemporal spikes: a PET and fMRI study. Eur J Nucl Med Mol Imaging 2022; 49:3186-3196. [PMID: 35199226 PMCID: PMC9250469 DOI: 10.1007/s00259-022-05740-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/17/2022] [Indexed: 11/19/2022]
Abstract
Purpose Epilepsy with centrotemporal spikes (ECTS) is the most common epilepsy syndrome in children and usually presents with cognitive dysfunctions. However, little is known about the processing speed dysfunction and the associated neuroimaging mechanism in ECTS. This study aims to investigate the brain functional abnormality of processing speed dysfunction in ECTS patients by using the 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and resting-state functional magnetic resonance imaging (rs-fMRI). Methods This prospective study recruited twenty-eight ECTS patients who underwent the 18F-FDG PET, rs-fMRI, and neuropsychological examinations. Twenty children with extracranial tumors were included as PET controls, and 20 healthy children were recruited as MRI controls. The PET image analysis investigated glucose metabolism by determining standardized uptake value ratio (SUVR). The MRI image analysis explored abnormal functional connectivity (FC) within the cortical–striatal circuit through network-based statistical (NBS) analysis. Correlation analysis was performed to explore the relationship between SUVR, FC, and processing speed index (PSI). Results Compared with healthy controls, ECTS patients showed normal intelligence quotient but significantly decreased PSI (P = 0.04). PET analysis showed significantly decreased SUVRs within bilateral caudate, putamen, pallidum, left NAc, right rostral middle frontal gyrus, and frontal pole of ECTS patients (P < 0.05). Rs-fMRI analysis showed absolute values of 20 FCs were significantly decreased in ECTS patients compared with MRI controls, which connected 16 distinct ROIs. The average SUVR of right caudate and the average of 20 FCs were positively correlated with PSI in ECTS patients (P = 0.034 and P = 0.005, respectively). Conclusion This study indicated that ECTS patients presented significantly reduced PSI, which is closely associated with decreased SUVR and FC of cortical–striatal circuit. Caudate played an important role in processing speed dysfunction. Clinical trial registration NCT04954729; registered on July 8, 2021, public site, https://clinicaltrials.gov/ct2/show/NCT04954729 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05740-w.
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Affiliation(s)
- Yuting Li
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Teng Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shufang Qian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Guo Sa
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiawan Wang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lina Li
- College of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Feng Chen
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Yang
- Department of Radiology, The First Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China. .,The College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and Medical PET Center, The Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China. .,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
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