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Christensen NL, Nordström J, Madsen S, Madsen MA, Gormsen LC, Kero T, Lubberink M, Tolbod LP. Detection and correction of patient motion in dynamic 15O-water PET MPI. J Nucl Cardiol 2023; 30:2736-2749. [PMID: 37639181 PMCID: PMC10682105 DOI: 10.1007/s12350-023-03358-5] [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: 02/09/2023] [Accepted: 07/12/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Patient motion constitutes a limitation to 15O-water cardiac PET imaging. We examined the ability of image readers to detect and correct patient motion using simulated motion data and clinical patient scans. METHODS Simulated data consisting of 16 motions applied to 10 motion-free scans were motion corrected using two approaches, pre-analysis and post-analysis for motion identification. Both approaches employed a manual frame-by-frame correction method. In addition, a clinical cohort was analyzed for assessment of prevalence and effect of motion and motion correction. RESULTS Motion correction was performed on 94% (pre-analysis) and 64% (post-analysis) of the scans. Large motion artifacts were corrected in 91% (pre-analysis) and 74% (post-analysis) of scans. Artifacts in MBF were reduced in 56% (pre-analysis) and 58% (post-analysis) of the scans. The prevalence of motion in the clinical patient cohort (n = 762) was 10%. Motion correction altered exam interpretation in only 10 (1.3%) clinical patient exams. CONCLUSION Frame-by-frame motion correction after visual inspection is useful in reducing motion artifacts in cardiac 15O-water PET. Reviewing the initial results (parametric images and polar maps) as part of the motion correction process, reduced erroneous corrections in motion-free scans. In a large clinical cohort, the impact of motion correction was limited to few patients.
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Affiliation(s)
- Nana L Christensen
- Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, 8000, Aarhus C, Denmark.
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus N, Denmark.
| | - Jonny Nordström
- Centre for Research & Development, Uppsala/Gävleborg County, Gävle, Sweden
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | - Simon Madsen
- Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, 8000, Aarhus C, Denmark
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus N, Denmark
| | - Michael A Madsen
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus N, Denmark
| | - Lars C Gormsen
- Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, 8000, Aarhus C, Denmark
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus N, Denmark
| | - Tanja Kero
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | - Lars P Tolbod
- Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, 8000, Aarhus C, Denmark
- Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus N, Denmark
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Siekkinen R, Han C, Maaniitty T, Teräs M, Knuuti J, Saraste A, Teuho J. A retrospective evaluation of Bayesian-penalized likelihood reconstruction for [ 15O]H 2O myocardial perfusion imaging. J Nucl Cardiol 2023; 30:1602-1612. [PMID: 36656496 PMCID: PMC10371909 DOI: 10.1007/s12350-022-03164-5] [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: 02/22/2022] [Accepted: 11/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND New Block-Sequential-Regularized-Expectation-Maximization (BSREM) image reconstruction technique has been introduced for clinical use mainly for oncologic use. Accurate and quantitative image reconstruction is essential in myocardial perfusion imaging with positron emission tomography (PET) as it utilizes absolute quantitation of myocardial blood flow (MBF). The aim of the study was to evaluate BSREM reconstruction for quantitation in patients with suspected coronary artery disease (CAD). METHODS AND RESULTS We analyzed cardiac [15O]H2O PET studies of 177 patients evaluated for CAD. Differences between BSREM and Ordered-Subset-Expectation-Maximization with Time-Of-Flight (TOF) and Point-Spread-Function (PSF) modeling (OSEM-TOF-PSF) in terms of MBF, perfusable tissue fraction, and vascular volume fraction were measured. Classification of ischemia was assessed between the algorithms. OSEM-TOF-PSF and BSREM provided similar global stress MBF in patients with ischemia (1.84 ± 0.21 g⋅ml-1⋅min-1 vs 1.86 ± 0.21 g⋅ml-1⋅min-1) and no ischemia (3.26 ± 0.34 g⋅ml-1⋅min-1 vs 3.28 ± 0.34 g⋅ml-1⋅min-1). Global resting MBF was also similar (0.97 ± 0.12 g⋅ml-1⋅min-1 and 1.12 ± 0.06 g⋅ml-1⋅min-1). The largest mean relative difference in MBF values was 7%. Presence of myocardial ischemia was classified concordantly in 99% of patients using OSEM-TOF-PSF and BSREM reconstructions CONCLUSION: OSEM-TOF-PSF and BSREM image reconstructions produce similar MBF values and diagnosis of myocardial ischemia in patients undergoing [15O]H2O PET due to suspected obstructive coronary artery disease.
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Affiliation(s)
- Reetta Siekkinen
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Chunlei Han
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Teemu Maaniitty
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Mika Teräs
- Department of Medical Physics, Turku University Hospital, Turku, Finland
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Teuho
- Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
- Turku PET Centre, University of Turku, Turku, Finland
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Murphy J, AlJaroudi WA, Hage FG. Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: positron emission tomography, computed tomography, and magnetic resonance. J Nucl Cardiol 2023; 30:941-954. [PMID: 37204688 DOI: 10.1007/s12350-023-03283-7] [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: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
In 2022, the Journal of Nuclear Cardiology® published many excellent original research articles and editorials focusing on imaging in patients with cardiovascular disease. In this review of 2022, we summarize a selection of articles to provide a concise recap of major advancements in the field. In the first part of this 2-part series, we addressed publications pertaining to single-photon emission computed tomography. In this second part, we focus on positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance. We specifically review advances in imaging of non-ischemic cardiomyopathy, cardio-oncology, infectious disease cardiac manifestations, atrial fibrillation, detection and prognostication of atherosclerosis, and technical improvements in the field. We hope that this review will be useful to readers as a reminder to articles they have seen during the year as well as ones they have missed.
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Affiliation(s)
- John Murphy
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Augusta University, Augusta, GA, USA
| | - Fadi G Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, GSB 446, 1900 University BLVD, Birmingham, AL, 35294, USA.
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Nordström J, Lindström E, Kero T, Sörensen J, Lubberink M. Influence of image reconstruction on quantitative cardiac 15O-water positron emission tomography. J Nucl Cardiol 2023; 30:716-725. [PMID: 35927378 PMCID: PMC10126040 DOI: 10.1007/s12350-022-03075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The impact on quantitative 15O-water PET/CT of a wide range of different reconstruction settings, including regularized reconstruction by block-sequential regularized expectation maximization (BSREM), was investigated. METHODS Twenty clinical stress scans from patients referred for assessment of myocardial ischemia were included. Patients underwent a 4-min dynamic stress PET scan with 15O-water on a digital PET/CT scanner. Twenty-two reconstructions were generated from each scan and a clinical reconstruction was used as reference. Varied parameters were number of iterations, filter, exclusion of time-of-flight and point-spread function, and regularization parameter with BSREM. Analyses were performed in aQuant utilizing two different methods and resulting regional myocardial blood flow (MBF), perfusable tissue fraction (PTF), and transmural MBF (MBFt) values were evaluated. RESULTS Across the two analyses, correlations toward the reference reconstruction were strong for all parameters (ρ ≥ 0.83). Using automated analysis and the diagnostic threshold of hyperemic MBF at 2.3 mL⋅g-1⋅min-1, diagnosis was unchanged irrespective of reconstruction method in all patients except for one, where only four of the most extreme reconstruction methods resulted in a change of diagnosis. CONCLUSION The low sensitivity of MBF values to reconstruction method and, as previously shown, scanner type and PET/CT misalignment, confirms that diagnostic hyperemic MBF cutoff values can be consistently used for 15O-water.
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Affiliation(s)
- Jonny Nordström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala/Gävleborg County, Gävle, Sweden
| | - Elin Lindström
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Medical Physics, Uppsala University Hospital, 75185, Uppsala, Sweden.
| | - Tanja Kero
- PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Jens Sörensen
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- PET Center, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, 75185, Uppsala, Sweden
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Sörensen J, Nordström J, Baron T, Mörner S, Granstam SO, Lubberink M, Tolbod L, van den Berg J, Flachskampf FA, Kero T, Magnusson P, Harms HJ. Diagnosis of left ventricular hypertrophy using non-ECG-gated 15O-water PET. J Nucl Cardiol 2022; 29:2361-2373. [PMID: 34286452 PMCID: PMC9553817 DOI: 10.1007/s12350-021-02734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
AIM To develop a method for diagnosing left ventricular (LV) hypertrophy from cardiac perfusion 15O-water positron emission tomography (PET). METHODS We retrospectively pooled data from 139 subjects in four research cohorts. LV remodeling patterns ranged from normal to severe eccentric and concentric hypertrophy. 15O-water PET scans (n = 197) were performed with three different PET devices. A low-end scanner (66 scans) was used for method development, and remaining scans with newer devices for a blinded evaluation. Dynamic data were converted into parametric images of perfusable tissue fraction for semi-automatic delineation of the LV wall and calculation of LV mass (LVM) and septal wall thickness (WT). LVM and WT from PET were compared to cardiac magnetic resonance (CMR, n = 47) and WT to 2D-echocardiography (2DE, n = 36). PET accuracy was tested using linear regression, Bland-Altman plots, and ROC curves. Observer reproducibility were evaluated using intraclass correlation coefficients. RESULTS High correlations were found in the blinded analyses (r ≥ 0.87, P < 0.0001 for all). AUC for detecting increased LVM and WT (> 12 mm and > 15 mm) was ≥ 0.95 (P < 0.0001 for all). Reproducibility was excellent (ICC ≥ 0.93, P < 0.0001). CONCLUSION 15O-water PET might detect LV hypertrophy with high accuracy and precision.
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Affiliation(s)
- Jens Sörensen
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden.
- PET Center, Entrance 86, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Jonny Nordström
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
| | - Tomasz Baron
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Sven-Olof Granstam
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Tolbod
- Nuclear Medicine and PET, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeffrey van den Berg
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden
- Cardiology Research Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hendrik J Harms
- Department of Surgical Sciences, Radiology & Nuclear Medicine, Uppsala University, Uppsala, Sweden
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Nordström J, Harms HJ, Kero T, Sörensen J, Lubberink M. Influence of patient motion on quantitative accuracy in cardiac 15O-water positron emission tomography. J Nucl Cardiol 2022; 29:1742-1752. [PMID: 33655448 PMCID: PMC9345798 DOI: 10.1007/s12350-021-02550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/18/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patient motion is a common problem during cardiac PET. The purpose of the present study was to investigate to what extent motions influence the quantitative accuracy of cardiac 15O-water PET/CT and to develop a method for automated motion detection. METHOD Frequency and magnitude of motion was assessed visually using data from 50 clinical 15O-water PET/CT scans. Simulations of 4 types of motions with amplitude of 5 to 20 mm were performed based on data from 10 scans. An automated motion detection algorithm was evaluated on clinical and simulated motion data. MBF and PTF of all simulated scans were compared to the original scan used as reference. RESULTS Patient motion was detected in 68% of clinical cases by visual inspection. All observed motions were small with amplitudes less than half the LV wall thickness. A clear pattern of motion influence was seen in the simulations with a decrease of myocardial blood flow (MBF) in the region of myocardium to where the motion was directed. The perfusable tissue fraction (PTF) trended in the opposite direction. Global absolute average deviation of MBF was 3.1% ± 1.8% and 7.3% ± 6.3% for motions with maximum amplitudes of 5 and 20 mm, respectively. Automated motion detection showed a sensitivity of 90% for simulated motions ≥ 10 mm but struggled with the smaller (≤ 5 mm) simulated (sensitivity 45%) and clinical motions (accuracy 48%). CONCLUSION Patient motion can impair the quantitative accuracy of MBF. However, at typically occurring levels of patient motion, effects are similar to or only slightly larger than inter-observer variability, and downstream clinical effects are likely negligible.
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Affiliation(s)
- Jonny Nordström
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden.
- Centre for Research and Development, Uppsala/Gävleborg County, Gävle, Sweden.
| | - Hendrik J Harms
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- MedTrace Pharma A/S, Lyngby, Denmark
| | - Tanja Kero
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Mark Lubberink
- Department of Surgical Sciences/Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
- Medical Physics, Uppsala University Hospital, Uppsala, Sweden
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7
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Lee BC. Cardiac 15O-water PET: Does mismatched attenuation correction not matter? J Nucl Cardiol 2022; 29:1129-1131. [PMID: 33751477 DOI: 10.1007/s12350-021-02573-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Benjamin C Lee
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY, USA.
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Abstract
PET/CT has become a preferred imaging modality over PET-only scanners in clinical practice. However, along with the significant improvement in diagnostic accuracy and patient throughput, pitfalls on PET/CT are reported as well. This review provides a general overview on the potential influence of the limitations with respect to PET/CT instrumentation and artifacts associated with the modality integration on the image appearance and quantitative accuracy of PET. Approaches proposed in literature to address the limitations or minimize the artifacts are discussed as well as their current challenges for clinical applications. Although the CT component can play an important role in assisting clinical diagnosis, we concentrate on the imaging scenarios where CT is used to provide auxiliary information for attenuation compensation and scatter correction in PET.
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Affiliation(s)
- Yu-Jung Tsai
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT.
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