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Kogan F, Yoon D, Teeter MG, Chaudhari AJ, Hales L, Barbieri M, Gold GE, Vainberg Y, Goyal A, Watkins L. Multimodal positron emission tomography (PET) imaging in non-oncologic musculoskeletal radiology. Skeletal Radiol 2024; 53:1833-1846. [PMID: 38492029 DOI: 10.1007/s00256-024-04640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
Musculoskeletal (MSK) disorders are associated with large impacts on patient's pain and quality of life. Conventional morphological imaging of tissue structure is limited in its ability to detect pain generators, early MSK disease, and rapidly assess treatment efficacy. Positron emission tomography (PET), which offers unique capabilities to evaluate molecular and metabolic processes, can provide novel information about early pathophysiologic changes that occur before structural or even microstructural changes can be detected. This sensitivity not only makes it a powerful tool for detection and characterization of disease, but also a tool able to rapidly assess the efficacy of therapies. These benefits have garnered more attention to PET imaging of MSK disorders in recent years. In this narrative review, we discuss several applications of multimodal PET imaging in non-oncologic MSK diseases including arthritis, osteoporosis, and sources of pain and inflammation. We also describe technical considerations and recent advancements in technology and radiotracers as well as areas of emerging interest for future applications of multimodal PET imaging of MSK conditions. Overall, we present evidence that the incorporation of PET through multimodal imaging offers an exciting addition to the field of MSK radiology and will likely prove valuable in the transition to an era of precision medicine.
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Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - Daehyun Yoon
- Department of Radiology, University of California-San Francisco, San Francisco, CA, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Western University, London, ON, Canada
| | | | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Marco Barbieri
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Yael Vainberg
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Ananya Goyal
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Lauren Watkins
- Department of Radiology, Stanford University, Stanford, CA, USA
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Sun H, Huang Y, Hu D, Hong X, Salimi Y, Lv W, Chen H, Zaidi H, Wu H, Lu L. Artificial intelligence-based joint attenuation and scatter correction strategies for multi-tracer total-body PET. EJNMMI Phys 2024; 11:66. [PMID: 39028439 PMCID: PMC11264498 DOI: 10.1186/s40658-024-00666-8] [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: 12/26/2023] [Accepted: 07/04/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Low-dose ungated CT is commonly used for total-body PET attenuation and scatter correction (ASC). However, CT-based ASC (CT-ASC) is limited by radiation dose risks of CT examinations, propagation of CT-based artifacts and potential mismatches between PET and CT. We demonstrate the feasibility of direct ASC for multi-tracer total-body PET in the image domain. METHODS Clinical uEXPLORER total-body PET/CT datasets of [18F]FDG (N = 52), [18F]FAPI (N = 46) and [68Ga]FAPI (N = 60) were retrospectively enrolled in this study. We developed an improved 3D conditional generative adversarial network (cGAN) to directly estimate attenuation and scatter-corrected PET images from non-attenuation and scatter-corrected (NASC) PET images. The feasibility of the proposed 3D cGAN-based ASC was validated using four training strategies: (1) Paired 3D NASC and CT-ASC PET images from three tracers were pooled into one centralized server (CZ-ASC). (2) Paired 3D NASC and CT-ASC PET images from each tracer were individually used (DL-ASC). (3) Paired NASC and CT-ASC PET images from one tracer ([18F]FDG) were used to train the networks, while the other two tracers were used for testing without fine-tuning (NFT-ASC). (4) The pre-trained networks of (3) were fine-tuned with two other tracers individually (FT-ASC). We trained all networks in fivefold cross-validation. The performance of all ASC methods was evaluated by qualitative and quantitative metrics using CT-ASC as the reference. RESULTS CZ-ASC, DL-ASC and FT-ASC showed comparable visual quality with CT-ASC for all tracers. CZ-ASC and DL-ASC resulted in a normalized mean absolute error (NMAE) of 8.51 ± 7.32% versus 7.36 ± 6.77% (p < 0.05), outperforming NASC (p < 0.0001) in [18F]FDG dataset. CZ-ASC, FT-ASC and DL-ASC led to NMAE of 6.44 ± 7.02%, 6.55 ± 5.89%, and 7.25 ± 6.33% in [18F]FAPI dataset, and NMAE of 5.53 ± 3.99%, 5.60 ± 4.02%, and 5.68 ± 4.12% in [68Ga]FAPI dataset, respectively. CZ-ASC, FT-ASC and DL-ASC were superior to NASC (p < 0.0001) and NFT-ASC (p < 0.0001) in terms of NMAE results. CONCLUSIONS CZ-ASC, DL-ASC and FT-ASC demonstrated the feasibility of providing accurate and robust ASC for multi-tracer total-body PET, thereby reducing the radiation hazards to patients from redundant CT examinations. CZ-ASC and FT-ASC could outperform DL-ASC for cross-tracer total-body PET AC.
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Affiliation(s)
- Hao Sun
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva 4, Switzerland
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
| | - Yanchao Huang
- Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital Southern Medical University, Guangzhou, 510515, China
| | - Debin Hu
- Department of Medical Engineering, Nanfang Hospital Southern Medical University, Guangzhou, 510515, China
| | - Xiaotong Hong
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva 4, Switzerland
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China
| | - Yazdan Salimi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva 4, Switzerland
| | - Wenbing Lv
- Department of Electronic Engineering, Information School, Yunnan University, Kunming, 650091, China
| | - Hongwen Chen
- Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital Southern Medical University, Guangzhou, 510515, China
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva 4, Switzerland
| | - Hubing Wu
- Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital Southern Medical University, Guangzhou, 510515, China.
| | - Lijun Lu
- School of Biomedical Engineering, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China.
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China.
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, 1023 Shatai Road, Guangzhou, 510515, China.
- Pazhou Lab, Guangzhou, 510330, China.
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Pan T, Luo D. Data-driven gated positron emission tomography/computed tomography for radiotherapy. Phys Imaging Radiat Oncol 2024; 31:100601. [PMID: 39040434 PMCID: PMC11261283 DOI: 10.1016/j.phro.2024.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Purpose Software-based data-driven gated (DDG) positron emission tomography/computed tomography (PET/CT) has replaced hardware-based 4D PET/CT. The purpose of this article was to review DDG PET/CT, which could improve the accuracy of treatment response assessment, tumor motion evaluation, and target tumor contouring with whole-body (WB) PET/CT for radiotherapy (RT). Material and methods This review covered the topics of 4D PET/CT with hardware gating, advancements in PET instrumentation, DDG PET, DDG CT, and DDG PET/CT based on a systematic literature review. It included a discussion of the large axial field-of-view (AFOV) PET detector and a review of the clinical results of DDG PET and DDG PET/CT. Results DDG PET matched or outperformed 4D PET with hardware gating. DDG CT was more compatible with DDG PET than 4D CT, which required hardware gating. DDG CT could replace 4D CT for RT. DDG PET and DDG CT for DDG PET/CT can be incorporated in a WB PET/CT of less than 15 min scan time on a PET/CT scanner of at least 25 cm AFOV PET detector. Conclusions DDG PET/CT could correct the misregistration and tumor motion artifacts in a WB PET/CT and provide the quantitative PET and tumor motion information of a registered PET/CT for RT.
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Affiliation(s)
- Tinsu Pan
- Department of Imaging Physics, M.D. Anderson Cancer Center, University of Texas, United States
| | - Dershan Luo
- Department of Radiation Physics, M.D. Anderson Cancer Center, University of Texas, United States
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Sheppard AJ, Theng EH, Paravastu SS, Wojnowski NM, Farhadi F, Morris MA, Hartley IR, Rachel IG, Roszko KL, Collins MT, Saboury B. Spatial Atlas for Mapping Vascular Microcalcification Using 18F-NaF PET/CT: Application in Hyperphosphatemic Familial Tumoral Calcinosis. Arterioscler Thromb Vasc Biol 2024; 44:1432-1446. [PMID: 38660800 PMCID: PMC11111330 DOI: 10.1161/atvbaha.123.320455] [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: 12/18/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Vascular calcification causes significant morbidity and occurs frequently in diseases of calcium/phosphate imbalance. Radiolabeled sodium fluoride positron emission tomography/computed tomography has emerged as a sensitive and specific method for detecting and quantifying active microcalcifications. We developed a novel technique to quantify and map total vasculature microcalcification to a common space, allowing simultaneous assessment of global disease burden and precise tracking of site-specific microcalcifications across time and individuals. METHODS To develop this technique, 4 patients with hyperphosphatemic familial tumoral calcinosis, a monogenic disorder of FGF23 (fibroblast growth factor-23) deficiency with a high prevalence of vascular calcification, underwent radiolabeled sodium fluoride positron emission tomography/computed tomography imaging. One patient received serial imaging 1 year after treatment with an IL-1 (interleukin-1) antagonist. A radiolabeled sodium fluoride-based microcalcification score, as well as calcification volume, was computed at all perpendicular slices, which were then mapped onto a standardized vascular atlas. Segment-wise mCSmean and mCSmax were computed to compare microcalcification score levels at predefined vascular segments within subjects. RESULTS Patients with hyperphosphatemic familial tumoral calcinosis had notable peaks in microcalcification score near the aortic bifurcation and distal femoral arteries, compared with a control subject who had uniform distribution of vascular radiolabeled sodium fluoride uptake. This technique also identified microcalcification in a 17-year-old patient, who had no computed tomography-defined calcification. This technique could not only detect a decrease in microcalcification score throughout the patient treated with an IL-1 antagonist but it also identified anatomic areas that had increased responsiveness while there was no change in computed tomography-defined macrocalcification after treatment. CONCLUSIONS This technique affords the ability to visualize spatial patterns of the active microcalcification process in the peripheral vasculature. Further, this technique affords the ability to track microcalcifications at precise locations not only across time but also across subjects. This technique is readily adaptable to other diseases of vascular calcification and may represent a significant advance in the field of vascular biology.
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Affiliation(s)
- Aaron J Sheppard
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Louisiana State University Health Shreveport, School of Medicine, Shreveport, LA, 71103
| | - Elizabeth H Theng
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Department of Radiology, Stanford School of Medicine, Stanford, CA, 94304
| | - Sriram S Paravastu
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- University of Missouri – Kansas City School of Medicine, Kansas City, MO, 64108
| | - Natalia M Wojnowski
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, 20892
- Geisel School of Medicine, Dartmouth, Hanover, NH, 03755
- Institute of Nuclear Medicine, Bethesda, MD, USA
| | | | - Iris R Hartley
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - I Gafni Rachel
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Kelly L Roszko
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Michael T Collins
- National Institutes of Dental and Craniofacial Research, NIH, Bethesda, MD, 20892
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD, 20892
- Institute of Nuclear Medicine, Bethesda, MD, USA
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Chen W, Li Y, Li Z, Jiang Y, Cui Y, Zeng J, Mo Y, Tang S, Li S, Liu L, Zhao Y, Hu Y, Fan W. Advantages and Challenges of Total-Body PET/CT at a Tertiary Cancer Center: Insights from Sun Yat-sen University Cancer Center. J Nucl Med 2024; 65:54S-63S. [PMID: 38719233 DOI: 10.2967/jnumed.123.266948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/31/2024] [Indexed: 07/16/2024] Open
Abstract
In recent decades, researchers worldwide have directed their efforts toward enhancing the quality of PET imaging. The detection sensitivity and image resolution of conventional PET scanners with a short axial field of view have been constrained, leading to a suboptimal signal-to-noise ratio. The advent of long-axial-field-of-view PET scanners, exemplified by the uEXPLORER system, marked a significant advancement. Total-body PET imaging possesses an extensive scan range of 194 cm and an ultrahigh detection sensitivity, and it has emerged as a promising avenue for improving image quality while reducing the administered radioactivity dose and shortening acquisition times. In this review, we elucidate the application of the uEXPLORER system at the Sun Yat-sen University Cancer Center, including the disease distribution, patient selection workflow, scanning protocol, and several enhanced clinical applications, along with encountered challenges. We anticipate that this review will provide insights into routine clinical practice and ultimately improve patient care.
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Affiliation(s)
- Wanqi Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Yinghe Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Zhijian Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Yongluo Jiang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Yingpu Cui
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Jiling Zeng
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Yiwen Mo
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Si Tang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Shatong Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Lei Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Yumo Zhao
- United Imaging Healthcare Co. Ltd., Shanghai, China
| | - Yingying Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China;
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China;
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; and
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Cook GJR, Thorpe MP. Bone Metastases. Cancer J 2024; 30:202-209. [PMID: 38753755 DOI: 10.1097/ppo.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Bone metastases occur frequently in common malignancies such as breast and prostate cancer. They are responsible for considerable morbidity and skeletal-related events. Fortunately, there are now several systemic, focal, and targeted therapies that can improve quality and length of life, including radionuclide therapies. It is therefore important that bone metastases can be detected as early as possible and that treatment can be accurately and sensitively monitored. Several bone-specific and tumor-specific single-photon emission computed tomography and positron emission tomography molecular imaging agents are available, for detection and monitoring response to systemic therapeutics, as well as theranostic agents to confirm target expression and predict response to radionuclide therapies.
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Affiliation(s)
- Gary J R Cook
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Matthew P Thorpe
- Division of Nuclear Radiology, Department of Radiology, Mayo Clinic, Rochester, MN
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Sun Y, Cheng Z, Qiu J, Lu W. Performance and application of the total-body PET/CT scanner: a literature review. EJNMMI Res 2024; 14:38. [PMID: 38607510 PMCID: PMC11014840 DOI: 10.1186/s13550-023-01059-1] [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: 10/08/2023] [Accepted: 12/14/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The total-body positron emission tomography/computed tomography (PET/CT) system, with a long axial field of view, represents the state-of-the-art PET imaging technique. Recently, the total-body PET/CT system has been commercially available. The total-body PET/CT system enables high-resolution whole-body imaging, even under extreme conditions such as ultra-low dose, extremely fast imaging speed, delayed imaging more than 10 h after tracer injection, and total-body dynamic scan. The total-body PET/CT system provides a real-time picture of the tracers of all organs across the body, which not only helps to explain normal human physiological process, but also facilitates the comprehensive assessment of systemic diseases. In addition, the total-body PET/CT system may play critical roles in other medical fields, including cancer imaging, drug development and immunology. MAIN BODY Therefore, it is of significance to summarize the existing studies of the total-body PET/CT systems and point out its future direction. This review collected research literatures from the PubMed database since the advent of commercially available total-body PET/CT systems to the present, and was divided into the following sections: Firstly, a brief introduction to the total-body PET/CT system was presented, followed by a summary of the literature on the performance evaluation of the total-body PET/CT. Then, the research and clinical applications of the total-body PET/CT were discussed. Fourthly, deep learning studies based on total-body PET imaging was reviewed. At last, the shortcomings of existing research and future directions for the total-body PET/CT were discussed. CONCLUSION Due to its technical advantages, the total-body PET/CT system is bound to play a greater role in clinical practice in the future.
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Affiliation(s)
- Yuanyuan Sun
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China
| | - Zhaoping Cheng
- Department of PET-CT, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, 250014, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271016, China
| | - Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, 271000, China.
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Shiyam Sundar LK, Gutschmayer S, Maenle M, Beyer T. Extracting value from total-body PET/CT image data - the emerging role of artificial intelligence. Cancer Imaging 2024; 24:51. [PMID: 38605408 PMCID: PMC11010281 DOI: 10.1186/s40644-024-00684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 04/13/2024] Open
Abstract
The evolution of Positron Emission Tomography (PET), culminating in the Total-Body PET (TB-PET) system, represents a paradigm shift in medical imaging. This paper explores the transformative role of Artificial Intelligence (AI) in enhancing clinical and research applications of TB-PET imaging. Clinically, TB-PET's superior sensitivity facilitates rapid imaging, low-dose imaging protocols, improved diagnostic capabilities and higher patient comfort. In research, TB-PET shows promise in studying systemic interactions and enhancing our understanding of human physiology and pathophysiology. In parallel, AI's integration into PET imaging workflows-spanning from image acquisition to data analysis-marks a significant development in nuclear medicine. This review delves into the current and potential roles of AI in augmenting TB-PET/CT's functionality and utility. We explore how AI can streamline current PET imaging processes and pioneer new applications, thereby maximising the technology's capabilities. The discussion also addresses necessary steps and considerations for effectively integrating AI into TB-PET/CT research and clinical practice. The paper highlights AI's role in enhancing TB-PET's efficiency and addresses the challenges posed by TB-PET's increased complexity. In conclusion, this exploration emphasises the need for a collaborative approach in the field of medical imaging. We advocate for shared resources and open-source initiatives as crucial steps towards harnessing the full potential of the AI/TB-PET synergy. This collaborative effort is essential for revolutionising medical imaging, ultimately leading to significant advancements in patient care and medical research.
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Affiliation(s)
| | - Sebastian Gutschmayer
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Vienna, Austria
| | - Marcel Maenle
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- Quantitative Imaging and Medical Physics (QIMP) Team, Medical University of Vienna, Vienna, Austria
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Liu Y, Li L, Qin Y, Chen Z, Zhao H, Wang X, Chen R. Total-body PET/CT with half-dose [ 68 Ga]Ga-PSMA-11 for biochemical recurrent prostate cancer: comparable diagnostic value to short axial field-of-view PET/CT with full-dose [ 68 Ga]Ga-PSMA-11. Eur J Nucl Med Mol Imaging 2024; 51:581-589. [PMID: 37819451 DOI: 10.1007/s00259-023-06466-z] [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: 07/26/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE The objective of this study was to evaluate the diagnostic performance and image quality of total-body positron emission tomography/computed tomography (PET/CT) imaging using a half-dose of [68 Ga]Ga-prostate specific membrane antigen ([68 Ga]Ga-PSMA) radiotracer, compared to conventional short axial field-of-view PET/CT imaging using a full dose of [68 Ga]Ga-PSMA. METHODS This retrospective study enrolled 52 patients with biochemical recurrent (BCR) prostate cancer after radical prostatectomy who underwent total-body PET/CT with a half-dose (0.9-1.1 MBq/kg) of [68 Ga]Ga-PSMA. These patients were matched by baseline characteristics to another 52 BCR patients after prostatectomy who underwent conventional PET/CT with a full dose (1.8-2.2 MBq/kg) of [68 Ga]Ga-PSMA. The half-dose group was further divided into 5-min (G5) and 2-min (G2) acquisition subgroups. Image quality was assessed through subjective analysis using a 5-point scale and objective measurements of standard uptake value maximum (SUVmax), standard uptake value mean (SUVmean), background variation (BV) of the liver, blood pool, and parotid glands. Additionally, SUVmax and tumor-to-background ratio (TBR) were calculated for lesions. RESULTS No significant difference in subjective image quality was found between the G2 and full-dose groups (p > 0.05). PET/CT image quality was significantly higher for the G5 versus G2 (p < 0.001) and full-dose groups (p < 0.001). TBR did not differ between the G2 and full-dose groups (4.23 ± 5.21 vs 4.22 ± 3.97, p = 0.99). Liver BV was significantly lower for G2 versus full-dose groups (0.16 ± 0.03 vs 0.20 ± 0.05, p < 0.001). CONCLUSIONS Total-body PET/CT with a half-dose [68 Ga]Ga-PSMA yields image quality superior or comparable to that of conventional PET/CT. The utilization of total-body [68 Ga]Ga-PSMA PET/CT meets the diagnostic demands of BCR patients, particularly those who exhibit reduced tolerance to prolonged horizontal positioning and scan durations, while simultaneously reducing radiation exposure for the subjects.
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Affiliation(s)
- Yuheng Liu
- Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China
| | - Lianghua Li
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Yanyu Qin
- Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China
| | - Zijun Chen
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Haitao Zhao
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Xinlu Wang
- Department of Nuclear Medicine, the First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China.
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.
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Jin SO, Mérida I, Stavropoulos I, Elwes RDC, Lam T, Guedj E, Girard N, Costes N, Hammers A. Characterisation of a novel [ 18F]FDG brain PET database and combination with a second database for optimising detection of focal abnormalities, using focal cortical dysplasia as an example. EJNMMI Res 2023; 13:98. [PMID: 37964137 PMCID: PMC10645721 DOI: 10.1186/s13550-023-01023-z] [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: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Brain [18F]FDG PET is used clinically mainly in the presurgical evaluation for epilepsy surgery and in the differential diagnosis of neurodegenerative disorders. While scans are usually interpreted visually on an individual basis, comparison against normative cohorts allows statistical assessment of abnormalities and potentially higher sensitivity for detecting abnormalities. Little work has been done on out-of-sample databases (acquired differently to the patient data). Combination of different databases would potentially allow better power and discrimination. We fully characterised an unpublished healthy control brain [18F]FDG PET database (Marseille, n = 60, ages 21-78 years) and compared it to another publicly available database (MRXFDG, n = 37, ages 23-65 years). We measured and then harmonised spatial resolution and global values. A collection of patient scans (n = 34, 13-48 years) with histologically confirmed focal cortical dysplasias (FCDs) obtained on three generations of scanners was used to estimate abnormality detection rates using standard software (statistical parametric mapping, SPM12). RESULTS Regional SUVs showed similar patterns, but global values and resolutions were different as expected. Detection rates for the FCDs were 50% for comparison with the Marseille database and 53% for MRXFDG. Simply combining both databases worsened the detection rate to 41%. After harmonisation of spatial resolution, using a full factorial design matrix to accommodate global differences, and leaving out controls older than 60 years, we achieved detection rates of up to 71% for both databases combined. Detection rates were similar across the three scanner types used for patients, and high for patients whose MRI had been normal (n = 10/11). CONCLUSIONS As expected, global and regional data characteristics are database specific. However, our work shows the value of increasing database size and suggests ways in which database differences can be overcome. This may inform analysis via traditional statistics or machine learning, and clinical implementation.
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Affiliation(s)
- Sameer Omer Jin
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London & Guy's and St Thomas' PET Centre, London, UK
| | - Inés Mérida
- Centre d'Etude et de Recherche Multimodale et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Lyon, France
| | - Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Robert D C Elwes
- Department of Clinical Neurophysiology, King's College Hospital, London, UK
| | - Tanya Lam
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, Marseille, France
| | - Nadine Girard
- Department of Neuroradiology, APHM, CRMBM, UMR CNRS 7339, Timone Hospital, Aix Marseille University, Marseille, France
| | - Nicolas Costes
- Centre d'Etude et de Recherche Multimodale et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Lyon, France
| | - Alexander Hammers
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- King's College London & Guy's and St Thomas' PET Centre, London, UK.
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11
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Dimitrakopoulou-Strauss A, Pan L, Sachpekidis C. Long axial field of view (LAFOV) PET-CT: implementation in static and dynamic oncological studies. Eur J Nucl Med Mol Imaging 2023; 50:3354-3362. [PMID: 37079129 PMCID: PMC10541341 DOI: 10.1007/s00259-023-06222-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
Long axial field of view (LAFOV) PET-CT scanners have been recently developed and are already in clinical use in few centers worldwide. Although still limited, the hitherto acquired experience with these novel systems highlights an increased sensitivity as their main advantage, which results in an increased lesion detectability. This attribute, alternatively, allows a reduction in PET acquisition time and/or administered radiotracer dose, while it renders delayed scanning of satisfying diagnostic accuracy possible. Another potential advantage of the new generation scanners is CT-less approaches for attenuation correction with the impact of marked reduction of radiation exposure, which may in turn lead to greater acceptance of longitudinal PET studies in the oncological setting. Further, the possibility for the first time of whole-body dynamic imaging, improved compartment modeling, and whole-body parametric imaging represent unique characteristics of the LAFOV PET-CT scanners. On the other hand, the advent of the novel LAFOV scanners is linked to specific challenges, such as the high purchase price and issues related to logistics and their optimal operation in a nuclear medicine department. Moreover, with regard to its research applications in oncology, the full potential of the new scanners can only be reached if different radiopharmaceuticals, both short and long-lived ones, as well as novel tracers, are available for use, which would, in turn, require the appropriate infrastructure in the area of radiochemistry. Although the novel LAFOV scanners are not yet widely used, this development represents an important step in the evolution of molecular imaging. This review presents the advantages and challenges of LAFOV PET-CT imaging for oncological applications with respect to static and dynamic acquisition protocols as well as to new tracers, while it provides an overview of the literature in the field.
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Affiliation(s)
- Antonia Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany.
| | - Leyun Pan
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
| | - Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120, Heidelberg, Germany
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12
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Hameed M, Taylor SA. Small bowel imaging in inflammatory bowel disease: updates for 2023. Expert Rev Gastroenterol Hepatol 2023; 17:1117-1134. [PMID: 37902040 DOI: 10.1080/17474124.2023.2274926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Cross-sectional imaging techniques including MR and CT enterography and ultrasound are integral to Crohn's disease management, accurate, responsive, and well tolerated. They assess the full thickness of the bowel wall, perienteric environment, and distant complications. As we strive toward tighter disease control, imaging's role will expand further with transmural healing becoming an increasingly important therapeutic target. AREAS COVERED MEDLINE and Web of Science were searched from 2012 to 2023 inclusive. We review the evidence for cross-sectional imaging in assessing disease activity, phenotyping, and therapeutic response assessment. Emerging novel imaging applications such as quantifying enteric motility and fibrosis, prognostication, and potential utility of artificial intelligence will be covered. Recent international consensus statements highlight the need for standardized imaging reporting and definitions of transmural healing and remission. We will discuss how recent advances may be best integrated into patient care and highlight key outstanding research questions. EXPERT OPINION Cross-sectional imaging is established in Crohn's disease management. Research emphasis should be placed on optimal integration of imaging modalities in clinical care pathways, workforce training, definitions, and evidence for use of imaging based therapeutic targets such as transmural healing, better phenotyping of stricturing disease, and developing novel techniques, including integration of artificial intelligence.
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Affiliation(s)
- Maira Hameed
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
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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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Llosá G, Rafecas M. Hybrid PET/Compton-camera imaging: an imager for the next generation. EUROPEAN PHYSICAL JOURNAL PLUS 2023; 138:214. [PMID: 36911362 PMCID: PMC9990967 DOI: 10.1140/epjp/s13360-023-03805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Compton cameras can offer advantages over gamma cameras for some applications, since they are well suited for multitracer imaging and for imaging high-energy radiotracers, such as those employed in radionuclide therapy. While in conventional clinical settings state-of-the-art Compton cameras cannot compete with well-established methods such as PET and SPECT, there are specific scenarios in which they can constitute an advantageous alternative. The combination of PET and Compton imaging can benefit from the improved resolution and sensitivity of current PET technology and, at the same time, overcome PET limitations in the use of multiple radiotracers. Such a system can provide simultaneous assessment of different radiotracers under identical conditions and reduce errors associated with physical factors that can change between acquisitions. Advances are being made both in instrumentation developments combining PET and Compton cameras for multimodal or three-gamma imaging systems, and in image reconstruction, addressing the challenges imposed by the combination of the two modalities or the new techniques. This review article summarizes the advances made in Compton cameras for medical imaging and their combination with PET.
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Affiliation(s)
- Gabriela Llosá
- Instituto de Física Corpuscular (IFIC), CSIC-UV, Catedrático Beltrán, 2., 46980 Paterna, Valencia, Spain
| | - Magdalena Rafecas
- Institute of Medical Engineering (IMT), Universität zu Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Godoy LA, Chen J, Ma W, Lally J, Toomey KA, Rajappa P, Sheridan R, Mahajan S, Stollenwerk N, Phan CT, Cheng D, Knebel RJ, Li T. Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives. Biomark Res 2023; 11:7. [PMID: 36650586 PMCID: PMC9847175 DOI: 10.1186/s40364-022-00444-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.
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Affiliation(s)
- Luis A Godoy
- Division of Thoracic Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Joy Chen
- Medical Student, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Weijie Ma
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Jag Lally
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Kyra A Toomey
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Prabhu Rajappa
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Roya Sheridan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Shirish Mahajan
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Nicholas Stollenwerk
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Chinh T Phan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
- Medical Service, Pulmonology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Danny Cheng
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Robert J Knebel
- Department of Radiology, Interventional Radiology, Veterans Affairs Northern California Health Care System, Mather, CA, USA
| | - Tianhong Li
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis School of Medicine, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.
- Medical Service, Hematology and Oncology, Veterans Affairs Northern California Health Care System, Mather, CA, USA.
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16
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Calabro’ A, Abdelhafez YG, Triumbari EKA, Spencer BA, Chen MS, Albano D, Cassim CR, Bertagna F, Dondi F, Cherry SR, Badawi RD, Sen F, Nardo L. 18F-FDG gallbladder uptake: observation from a total-body PET/CT scanner. BMC Med Imaging 2023; 23:9. [PMID: 36627570 PMCID: PMC9832624 DOI: 10.1186/s12880-022-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Total-body positron emission tomography/computed tomography (PET/CT) scanners are characterized by higher signal collection efficiency and greater spatial resolution compared to conventional scanners, allowing for delayed imaging and improved image quality. These advantages may also lead to better detection of physiological processes that diagnostic imaging professionals should be aware of. The gallbladder (GB) is not usually visualized as an 18F-2-fluorodeoxyglucose (18F-FDG)-avid structure in routine clinical PET/CT studies; however, with the total-body PET/CT, we have been increasingly visualizing GB activity without it being involved in an inflammatory or neoplastic process. The aim of this study was to report visualization rates and characteristics of GB 18F-FDG uptake observed in both healthy and oncological subjects scanned on a total-body PET/CT system. MATERIALS AND METHODS Scans from 73 participants (48 healthy and 25 with newly diagnosed lymphoma) who underwent 18F-FDG total-body PET/CT were retrospectively reviewed. Subjects were scanned at multiple timepoints up to 3 h post-injection. Gallbladder 18F-FDG activity was graded using liver uptake as a reference, and the pattern was qualified as present in the wall, lumen, or both. Participants' characteristics, such as age, sex, body-mass index, blood glucose, and other clinical parameters, were collected to assess for any significant correlation with GB 18F-FDG uptake. RESULTS All 73 subjects showed GB uptake at one or more imaging timepoints. An increase in uptake intensity overtime was observed up until the 180-min scan, and the visualization rate of GB 18F-FDG uptake was 100% in the 120- and 180-min post-injection scans. GB wall uptake was detected in a significant number of patients (44/73, 60%), especially at early timepoint scans, whereas luminal activity was detected in 71/73 (97%) subjects, especially at later timepoint scans. No significant correlation was found between GB uptake intensity/pattern and subjects' characteristics. CONCLUSION The consistent observation of GB 18F-FDG uptake recorded in this study in healthy participants and subjects with a new oncological diagnosis indicates that this is a normal physiologic finding rather than representing an exception.
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Affiliation(s)
- Anna Calabro’
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
| | - Yasser G. Abdelhafez
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.252487.e0000 0000 8632 679XNuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Asyut, Egypt
| | - Elizabeth K. A. Triumbari
- grid.414603.4Nuclear Medicine Unit, TracerGLab, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benjamin A. Spencer
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Moon S. Chen
- grid.27860.3b0000 0004 1936 9684Department of Internal Medicine, University of California Davis, Davis, CA USA
| | - Domenico Albano
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Christopher R. Cassim
- Department of Radiology, Sangre Grande Hospital, Eastern Regional Health Authority, Sangre Grande, Trinidad and Tobago
| | - Francesco Bertagna
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Dondi
- grid.7637.50000000417571846Nuclear Medicine Department, University of Brescia and ASST Spedali Civili di Brescia, Brescia, Italy
| | - Simon R. Cherry
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Ramsey D. Badawi
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA ,grid.27860.3b0000 0004 1936 9684Department of Biomedical Engineering, University of California Davis, Davis, CA USA
| | - Fatma Sen
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
| | - Lorenzo Nardo
- grid.27860.3b0000 0004 1936 9684Department of Radiology, EXPLORER Molecular Imaging Center, University of California, Davis, 3195 Folsom Blvd, Davis, Sacramento, CA 95816 USA
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Bouchelouche K, Sathekge MM. Letter from the Editors. Semin Nucl Med 2022; 52:263-265. [DOI: 10.1053/j.semnuclmed.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Abdelhafez YG, McBride K, Leung EK, Hunt H, Spencer BA, Lopez JE, Atsina K, Li EJ, Wang G, Cherry SR, Badawi RD, Sen F, Nardo L. Blanching Defects at the Pressure Points: Observations from Dynamic Total-Body PET/CT Studies. J Nucl Med Technol 2022; 50:jnmt.122.263905. [PMID: 35440473 PMCID: PMC9745988 DOI: 10.2967/jnmt.122.263905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/26/2023] Open
Abstract
Total-body PET/CT allows simultaneous acquisition of all the body parts in a single bed position during the radiotracer uptake phase. Dynamic imaging protocols employing total-body PET could demonstrate findings that may not have been previously visualized or described using conventional PET/CT scanners. We examined the characteristics of blanching defects, areas of markedly reduced (partial defect) or absent (complete defect) radiotracer uptake seen at the skin/subcutaneous tissues opposite the bony prominences at pressure points. Methods: In this observational study, 77 participants underwent dynamic total-body PET/CT imaging using 18F-FDG (Group 1, N = 47, 60-min dynamic, arms-down, divided into 3 subgroups according to the injected dose) or 18F-fluciclovine (Group 2, N = 30, 25-min dynamic, arms above the head). 40 out of 47 participants in Group 1 were re-imaged at 90 min after being allowed off the scanning table. Blanching defects, partial or complete, were characterized opposite the bony prominences at 7 pressure points (the skull, scapula, and calcaneus bilaterally, as well as the sacrum). Association of the blanching defects with different clinical and technical characteristics were analyzed using uni- and multi-variate analyses. Results: A total of 124 blanching defects were seen in 68 out of 77 (88%) participants at one or more pressure points. Blanching defects were higher, on average, in Group 2 participants (3.5±1.7) compared to Group 1 (2.1±1.4; P <0.001), but it did not vary within Group 1 for different 18F-FDG dose subgroups. All defects resumed normal pattern on delayed static (90-min) images except for 14 partial defects. No complete blanching defects were seen on the 90-min images. By multivariate analysis, arm positioning above the head was associated with skull defects; scapular and sacral defects were significantly more encountered in men and with lower BMI, while calcaneal defects could not be associated to any factor. Conclusion: Blanching defects opposite the bony pressure points are common on dynamic total-body PET/CT images using different radiopharmaceuticals and injection doses. Their appearance should not be immediately interpreted as an abnormality. The current findings warrant further exploration in a prospective setting and may be utilized to study various mechano-pathologic conditions, such as pressure ulcers.
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Affiliation(s)
- Yasser G. Abdelhafez
- Department of Radiology, University of California, Davis, California
- Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Kristin McBride
- Department of Radiology, University of California, Davis, California
| | - Edwin K. Leung
- Department of Radiology, University of California, Davis, California
- Biomedical Engineering, University of California, Davis, California
- UIH America, Inc., Houston, Texas
| | - Heather Hunt
- Department of Radiology, University of California, Davis, California
| | | | - Javier E. Lopez
- Department of Internal Medicine, University of California, Davis, California; and
- Cardiovascular Research Institute, University of California, Davis, California
| | - Kwame Atsina
- Department of Internal Medicine, University of California, Davis, California; and
- Cardiovascular Research Institute, University of California, Davis, California
| | - Elizabeth J. Li
- Biomedical Engineering, University of California, Davis, California
| | - Guobao Wang
- Department of Radiology, University of California, Davis, California
| | - Simon R. Cherry
- Department of Radiology, University of California, Davis, California
- Biomedical Engineering, University of California, Davis, California
| | - Ramsey D. Badawi
- Department of Radiology, University of California, Davis, California
- Biomedical Engineering, University of California, Davis, California
| | - Fatma Sen
- Department of Radiology, University of California, Davis, California
| | - Lorenzo Nardo
- Department of Radiology, University of California, Davis, California
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