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Wumener X, Zhang Y, Zang Z, Ye X, Zhao J, Zhao J, Liang Y. The value of net influx constant based on FDG PET/CT dynamic imaging in the differential diagnosis of metastatic from non-metastatic lymph nodes in lung cancer. Ann Nucl Med 2024:10.1007/s12149-024-01964-y. [PMID: 39078558 DOI: 10.1007/s12149-024-01964-y] [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: 05/27/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVES This study aims to evaluate the value of the dynamic and static quantitative metabolic parameters derived from 18F-fluorodeoxyglucose (FDG)-positron emission tomography/CT (PET/CT) in the differential diagnosis of metastatic from non-metastatic lymph nodes (LNs) in lung cancer and to validate them based on the results of a previous study. METHODS One hundred and twenty-one patients with lung nodules or masses detected on chest CT scan underwent 18F-FDG PET/CT dynamic + static imaging with informed consent. A retrospective collection of 126 LNs in 37 patients with lung cancer was pathologically confirmed. Static image analysis parameters include LN-SUVmax and LN-SUVmax/primary tumor SUVmax (LN-SUVmax/PT-SUVmax). Dynamic metabolic parameters including the net influx rate (Ki) and the surrogate of perfusion (K1) and of each LN were obtained by applying the irreversible two-tissue compartment model using in-house Matlab software. Ki/K1 was then calculated as a separate marker. Based on the pathological findings, we divided into a metastatic group and a non-metastatic group. The χ2 test was used to evaluate the agreement of the individual and combined diagnosis of each metabolic parameter with the gold standard. The receiver-operating characteristic (ROC) analysis was performed for each parameter to determine the diagnostic efficacy in differentiating non-metastatic from metastatic LNs with high FDG-avid. P < 0.05 was considered statistically significant. RESULTS Among the 126 FDG-avid LNs confirmed by pathology, 70 LNs were metastatic, and 56 LNs were non-metastatic. For ROC analysis, in separate assays, the dynamic metabolic parameter Ki [sensitivity (SEN) of 84.30%, specificity (SPE) of 94.60%, accuracy of 88.89%, and AUC of 0.895] had a better diagnostic value than the static metabolic parameter SUVmax (SEN of 82.90%, SPE of 62.50%, accuracy of 74.60%, and AUC of 0.727) in differentiating between metastatic from non-metastatic LNs groups, respectively. In the combined diagnosis group, the combined SUVmax + Ki diagnosis had a better diagnostic value in the differential diagnosis of metastatic from non-metastatic LNs, with SEN, SPE, accuracy, and AUC of 84.3%, 94.6%, 88.89%, and 0.907, respectively. CONCLUSIONS When the cutoff value of Ki was 0.022 ml/g/min, it had a high diagnostic value in the differential diagnosis between metastasis and non-metastasis in FDG-avid LNs of lung cancer, especially in improving the specificity. The combination of SUVmax and Ki is expected to be a reliable metabolic parameter for N-staging of lung cancer.
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Affiliation(s)
- Xieraili Wumener
- Department of Graduate School, Dalian Medical University, Dalian, China
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Yarong Zhang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | | | - Xiaoxing Ye
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Jiuhui Zhao
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital Tongji University, Shanghai, China.
| | - Ying Liang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China.
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Wumener X, Zhang Y, Zang Z, Du F, Ye X, Zhang M, Liu M, Zhao J, Sun T, Liang Y. The value of dynamic FDG PET/CT in the differential diagnosis of lung cancer and predicting EGFR mutations. BMC Pulm Med 2024; 24:227. [PMID: 38730287 PMCID: PMC11088023 DOI: 10.1186/s12890-024-02997-9] [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: 09/04/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used for the differential diagnosis of cancer. Semi-quantitative standardized uptake value (SUV) is known to be affected by multiple factors and may make it difficult to differentiate between benign and malignant lesions. It is crucial to find reliable quantitative metabolic parameters to further support the diagnosis. This study aims to evaluate the value of the quantitative metabolic parameters derived from dynamic FDG PET/CT in the differential diagnosis of lung cancer and predicting epidermal growth factor receptor (EGFR) mutation status. METHODS We included 147 patients with lung lesions to perform FDG PET/CT dynamic plus static imaging with informed consent. Based on the results of the postoperative pathology, the patients were divided into benign/malignant groups, adenocarcinoma (AC)/squamous carcinoma (SCC) groups, and EGFR-positive (EGFR+)/EGFR-negative (EGFR-) groups. Quantitative parameters including K1, k2, k3, and Ki of each lesion were obtained by applying the irreversible two-tissue compartmental modeling using an in-house Matlab software. The SUV analysis was performed based on conventional static scan data. Differences in each metabolic parameter among the group were analyzed. Wilcoxon rank-sum test, independent-samples T-test, and receiver-operating characteristic (ROC) analysis were performed to compare the diagnostic effects among the differentiated groups. P < 0.05 were considered statistically significant for all statistical tests. RESULTS In the malignant group (N = 124), the SUVmax, k2, k3, and Ki were higher than the benign group (N = 23), and all had-better performance in the differential diagnosis (P < 0.05, respectively). In the AC group (N = 88), the SUVmax, k3, and Ki were lower than in the SCC group, and such differences were statistically significant (P < 0.05, respectively). For ROC analysis, Ki with cut-off value of 0.0250 ml/g/min has better diagnostic specificity than SUVmax (AUC = 0.999 vs. 0.70). In AC group, 48 patients further underwent EGFR testing. In the EGFR (+) group (N = 31), the average Ki (0.0279 ± 0.0153 ml/g/min) was lower than EGFR (-) group (N = 17, 0.0405 ± 0.0199 ml/g/min), and the difference was significant (P < 0.05). However, SUVmax and k3 did not show such a difference between EGFR (+) and EGFR (-) groups (P>0.05, respectively). For ROC analysis, the Ki had a cut-off value of 0.0350 ml/g/min when predicting EGFR status, with a sensitivity of 0.710, a specificity of 0.588, and an AUC of 0.674 [0.523-0.802]. CONCLUSION Although both techniques were specific, Ki had a greater specificity than SUVmax when the cut-off value was set at 0.0250 ml/g/min for the differential diagnosis of lung cancer. At a cut-off value of 0.0350 ml/g/min, there was a 0.710 sensitivity for EGFR status prediction. If EGFR testing is not available for a patient, dynamic imaging could be a valuable non-invasive screening method.
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Affiliation(s)
- Xieraili Wumener
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Yarong Zhang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | | | - Fen Du
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Xiaoxing Ye
- Department of pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Maoqun Zhang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Ming Liu
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Jiuhui Zhao
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Ying Liang
- Department of Nuclear Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College/Shenzhen Clinical Research Center for Cancer, Shenzhen, China.
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Lu Z, Chen G, Jiang H, Sun J, Lin KH, Mok GSP. SPECT and CT misregistration reduction in [ 99mTc]Tc-MAA SPECT/CT for precision liver radioembolization treatment planning. Eur J Nucl Med Mol Imaging 2023; 50:2319-2330. [PMID: 36877236 DOI: 10.1007/s00259-023-06149-9] [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: 10/20/2022] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Respiration and body movement induce misregistration between static [99mTc]Tc-MAA SPECT and CT, causing lung shunting fraction (LSF) and tumor-to-normal liver ratio (TNR) errors for 90Y radioembolization planning. We aim to alleviate the misregistration between [99mTc]Tc-MAA SPECT and CT using two registration schemes on simulation and clinical data. METHODS In the simulation study, 70 XCAT phantoms were modeled. The SIMIND Monte Carlo program and OS-EM algorithm were used for projection generation and reconstruction, respectively. Low-dose CT (LDCT) at end-inspiration was simulated for attenuation correction (AC), lungs and liver segmentation, while contrast-enhanced CT (CECT) was simulated for tumor and perfused liver segmentation. In the clinical study, 16 patient data including [99mTc]Tc-MAA SPECT/LDCT and CECT with observed SPECT and CT mismatch were analyzed. Two liver-based registration schemes were studied: SPECT registered to LDCT/CECT and vice versa. Mean count density (MCD) of different volumes-of-interest (VOIs), normalized mutual information (NMI), LSF, TNR, and maximum injected activity (MIA) based on the partition model before and after registration were compared. Wilcoxon signed-rank test was performed. RESULTS In the simulation study, compared to before registration, registrations significantly reduced estimation errors of MCD of all VOIs, LSF (Scheme 1: - 100.28%, Scheme 2: - 101.59%), and TNR (Scheme 1: - 7.00%, Scheme 2: - 5.67%), as well as MIA (Scheme 1: - 3.22%, Scheme 2: - 2.40%). In the clinical study, Scheme 1 reduced 33.68% LSF and increased 14.75% TNR, while Scheme 2 reduced 38.88% LSF and increased 6.28% TNR compared to before registration. One patient may change from 90Y radioembolization untreatable to treatable and other patients may change the MIA up to 25% after registration. NMI between SPECT and CT was significantly increased after registrations in both studies. CONCLUSION Registration between static [99mTc]Tc-MAA SPECT and corresponding CTs is feasible to reduce their spatial mismatch and improve dosimetric estimation. The improvement of LSF is larger than TNR. Our method can potentially improve patient selection and personalized treatment planning for liver radioembolization.
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Affiliation(s)
- Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
- Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau SAR, China
| | - Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Han Jiang
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Jingzhang Sun
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Ko-Han Lin
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China.
- Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau SAR, China.
- Ministry of Education Frontiers Science Center for Precision Oncology, Faculty of Health Science, University of Macau, Taipa, Macau SAR, China.
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Lyu Y, Chen G, Lu Z, Chen Y, Mok GSP. The effects of mismatch between SPECT and CT images on quantitative activity estimation - A simulation study. Z Med Phys 2023; 33:54-69. [PMID: 35644776 PMCID: PMC10082378 DOI: 10.1016/j.zemedi.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Quantitative activity estimation is essential in nuclear medicine imaging. Mismatch between SPECT and CT images at the same imaging time point due to patient movement degrades accuracy in both diagnostic studies and target radionuclide therapy dosimetry. This work aims to study the mismatch effects between CT and SPECT data on attenuation correction (AC), volume-of-interest (VOI) delineation, and registration for activity estimation. METHODS Nine 4D XCAT phantoms were generated at 1, 24, and 144 h post In-111 Zevalin injection, varying in activity distributions, body sizes, and organ sizes. Realistic noisy SPECT projections were generated by an analytical projector and reconstructed with a quantitative OS-EM method. CT images were shifted, corresponding to SPECT images at each imaging time point, from -5 to 5 voxels and also according to a clinical reference. The effect of mismatched AC maps was evaluated using mismatched CT images for AC in SPECT reconstruction while VOIs were mapped out from matched CTs. The effect of mismatched VOI drawings was evaluated using mismatched CTs to map out target organs while using matched CTs for AC. The effect of mismatched CT images for registration was evaluated by registering sequential mismatched CTs to align corresponding SPECT images, with no AC and VOI mismatch. Bi-exponential curve fitting was performed to obtain time-integrated activity (TIA). Organ activity errors (%OAE) and TIA errors (%TIAE) were calculated. RESULTS According to the clinical reference, %OAE was larger for organs near ribs for AC effect. For VOI effect, %OAE was larger for small and low uptake organs. For registration effect, %TIAE were larger when mismatch existed in more numbers of SPECT/CT images, while no substantial difference was observed when using mismatched CT at different imaging time points as registration reference. %TIAE was highest for VOI, followed by registration and AC, e.g., 20.62%±8.61%, 9.33%±4.66% and 1.13%±0.90% respectively for kidneys. CONCLUSIONS The mismatch between CT and SPECT images poses a significant impact on the accuracy of quantitative activity estimation, attributed particularly from VOI delineation errors. It is recommended to perform registration between emission and transmission images at the same time point to ensure diagnostic and dosimetric accuracy.
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Affiliation(s)
- Yingqing Lyu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No. 25, Taiping St., Luzhou, Sichuan, China.
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China; Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau SAR, China; Ministry of Education Frontiers Science Center for Precision Oncology, Faculty of Health Science, University of Macau, Taipa, Macau SAR, China.
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Wumener X, Zhang Y, Wang Z, Zhang M, Zang Z, Huang B, Liu M, Huang S, Huang Y, Wang P, Liang Y, Sun T. Dynamic FDG-PET imaging for differentiating metastatic from non-metastatic lymph nodes of lung cancer. Front Oncol 2022; 12:1005924. [PMID: 36439506 PMCID: PMC9686335 DOI: 10.3389/fonc.2022.1005924] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES 18F-fluorodeoxyglucose (FDG) PET/CT has been widely used in tumor diagnosis, staging, and response evaluation. To determine an optimal therapeutic strategy for lung cancer patients, accurate staging is essential. Semi-quantitative standardized uptake value (SUV) is known to be affected by multiple factors and may fail to differentiate between benign and malignant lesions. Lymph nodes (LNs) in the mediastinal and pulmonary hilar regions with high FDG uptake due to granulomatous lesions such as tuberculosis, which has a high prevalence in China, pose a diagnostic challenge. This study aims to evaluate the diagnostic value of the quantitative metabolic parameters derived from dynamic 18F-FDG PET/CT in differentiating metastatic and non-metastatic LNs in lung cancer. METHODS One hundred and eight patients with pulmonary nodules were enrolled to perform 18F-FDG PET/CT dynamic + static imaging with informed consent. One hundred and thirty-five LNs in 29 lung cancer patients were confirmed by pathology. Static image analysis parameters including LN-SUVmax, LN-SUVmax/primary tumor SUVmax (LN-SUVmax/PT-SUVmax), mediastinal blood pool SUVmax (MBP-SUVmax), LN-SUVmax/MBP-SUVmax, and LN-SUVmax/short diameter. Quantitative parameters including K1, k2, k3 and Ki and of each LN were obtained by applying the irreversible two-tissue compartment model using in-house Matlab software. Ki/K1 was computed subsequently as a separate marker. We further divided the LNs into mediastinal LNs (N=82) and pulmonary hilar LNs (N=53). Wilcoxon rank-sum test or Independent-samples T-test and receiver-operating characteristic (ROC) analysis was performed on each parameter to compare the diagnostic efficacy in differentiating lymph node metastases from inflammatory uptake. P<0.05 were considered statistically significant. RESULTS Among the 135 FDG-avid LNs confirmed by pathology, 49 LNs were non-metastatic, and 86 LNs were metastatic. LN-SUVmax, MBP-SUVmax, LN-SUVmax/MBP-SUVmax, and LN-SUVmax/short diameter couldn't well differentiate metastatic from non-metastatic LNs (P>0.05). However, LN-SUVmax/PT-SUVmax have good performance in the differential diagnosis of non-metastatic and metastatic LNs (P=0.039). Dynamic metabolic parameters in addition to k3, the parameters including K1, k2, Ki, and Ki/K1, on the other hand, have good performance in the differential diagnosis of metastatic and non-metastatic LNs (P=0.045, P=0.001, P=0.001, P=0.001, respectively). For ROC analysis, the metabolic parameters Ki (AUC of 0.672 [0.579-0.765], sensitivity 0.395, specificity 0.918) and Ki/K1 (AUC of 0.673 [0.580-0.767], sensitivity 0.570, specificity 0.776) have good performance in the differential diagnosis of metastatic from non-metastatic LNs than SUVmax (AUC of 0.596 [0.498-0.696], sensitivity 0.826, specificity 0.388), included the mediastinal region and pulmonary hilar region. CONCLUSION Compared with SUVmax, quantitative parameters such as K1, k2, Ki and Ki/K1 showed promising results for differentiation of metastatic and non-metastatic LNs with high uptake. The Ki and Ki/K1 had a high differential diagnostic value both in the mediastinal region and pulmonary hilar region.
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Affiliation(s)
- Xieraili Wumener
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yarong Zhang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhenguo Wang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Maoqun Zhang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | | | - Bin Huang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Ming Liu
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Shengyun Huang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yong Huang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Peng Wang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Ying Liang
- Department of Nuclear Medicine, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Tao Sun
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Lu Z, Chen G, Lyu Y, Chen Y, Mok GSP. Technical Note: Respiratory impacts on static and respiratory gated 99m Tc-MAA SPECT/CT for liver radioembolization- A simulation study. Med Phys 2022; 49:5330-5339. [PMID: 35446448 DOI: 10.1002/mp.15682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We aimed to evaluate respiratory impacts on static and respiratory gated (RG) 99m Tc-MAA SPECT in terms of respiratory motion (RM) blur, attenuation correction (AC) and volume-of-interest (VOI) segmentation on lung shunt faction (LSF) and tumor-to-normal liver ratio (TNR) estimation for liver radioembolization therapy planning. METHODS The XCAT phantom was used to simulate a population of 300 phantoms, modelling various anatomical variations, tumor characteristics, respiratory motion amplitudes, LSFs and TNRs. One hundred and twenty noisy projections of average activity maps near end-expiration (End-EX) and whole respiratory cycle were simulated analytically, modeling attenuation and geometric collimator-detector-response (GCDR). The OS-EM algorithm was employed for reconstruction, modeling AC and GCDR. RM effect was evaluated for static SPECT, while AC and VOI mismatch effects were investigated independently and together for static and RG SPECT utilizing one gate, i.e., End-EX. LSF and TNR errors were measured based on the ground truth. Lesions with different characteristics were also investigated for static and RG SPECT. RESULTS RM overestimates LSF and underestimates TNR. The VOI mismatch caused the largest errors in both RG and static SPECT for LSF and TNR estimation, reaching 160% and -52% correspondingly with extremely mismatched VOIs for RG SPECT, even larger than those for static SPECT. With matched AC and VOIs, RG SPECT has better performance than static SPECT. Larger TNR errors are associated with tumors of smaller sizes and higher TNR for static SPECT. CONCLUSIONS The VOI segmentation mismatch has a stronger impact, followed by RM and AC in static 99m Tc-MAA SPECT/CT. This effect is more pronounced for RG SPECT. When VOI masks are derived from a matched CT, RG SPECT is generally superior to static SPECT for LSF and TNR estimation. The performance of RG SPECT could be worse than static SPECT when a mismatched CT is used for segmentation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Yingqing Lyu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, China
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Taipa, Macau SAR, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Taipa, Macau SAR, China.,Ministry of Education Frontiers Science Center for Precision Oncology, Faculty of Health Science, University of Macau, Taipa, Macau SAR, China
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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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Lu Z, Chen G, Lin KH, Wu TH, Mok GSP. Evaluation of different CT maps for attenuation correction and segmentation in static 99m Tc-MAA SPECT/CT for 90 Y radioembolization treatment planning: A simulation study. Med Phys 2021; 48:3842-3851. [PMID: 34013551 DOI: 10.1002/mp.14991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Conventional 99m Tc-macroaggregated albumin (99m Tc-MAA) planar scintigraphy overestimates lung shunt fraction (LSF) compared to SPECT/CT. However, the respiratory motion artifact due to the temporal mismatch between static SPECT and helical CT (HCT) may compromise the SPECT quantitation accuracy by incorrect attenuation correction (AC) and volume-of-interest (VOI) segmentation. This study aims to evaluate AC and VOI segmentation effects systematically and to propose a CT map for LSF and tumor-to-normal liver ratio (TNR) estimation in static 99m Tc-MAA SPECT/CT. METHODS The 4D XCAT phantom was used to simulate a phantom population of 120 phantoms, modeling 10 different anatomical variations, nine TNRs (2-13.2), nine tumor sizes (2-6.7 cm diameter), eight tumor locations, three axial motion amplitudes of 1, 1.5, and 2 (cm), and four LSFs of 5%, 10%, 15%, and 20%. An analytical projector for low-energy high-resolution parallel-hole collimator was used to simulate 60 noisy projections over 360°, modeling attenuation and geometric collimator-detector response (GCDR). AC and VOI mismatch effects were investigated independently and together, using cine average CT (CACT), HCT at end-inspiration (HCT-IN), mid-respiration (HCT-MID), and end-expiration (HCT-EX) respectively as attenuation and segmentation maps. SPECT images without motion, AC, and VOI errors were also generated as reference. LSF and TNR errors were measured as compared to the ground truth. RESULTS HCT-MID has slightly better performance for AC effect compared with other CT maps in LSF and TNR estimation, while HCT-EX and HCT-MID perform better for VOI effect. For a respiratory motion amplitude of 1.5 cm and a LSF of 5%, the LSF errors are 19.56 ± 4.58%, -6.79 ± 1.74%, 77.29 ± 14.74%, and 111.25 ± 18.29% corresponding to HCT-MID, HCT-EX, HCT-IN, and CACT in static SPECT. The TNR errors are -12.38 ± 6.42%, -20.55 ± 11.25%, -20.89 ± 9.98%, and -22.89 ± 14.38% respectively. HCT-MID has the best performance for LSF estimation for LSF > 10% and TNR estimation, followed by HCT-EX, HCT-IN, and CACT. CONCLUSIONS The HCT-MID is recommended for AC and segmentation to alleviate respiratory artifacts and improve quantitation accuracy in 90 Y radioembolization treatment planning. HCT-EX would also be a recommended choice if HCT-MID is not available.
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Affiliation(s)
- Zhonglin Lu
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Gefei Chen
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Kuan-Heng Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Industrial PhD Program of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Greta S P Mok
- Biomedical Imaging Laboratory (BIG), Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China.,Center for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
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Zhang Q, Zhang D, Mok GSP. Comparison of Different Attenuation Correction Methods for Dual Gating Myocardial Perfusion SPECT/CT. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2019. [DOI: 10.1109/trpms.2019.2899066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Zhang D, Ghaly M, Mok GSP. InterpolatedCTfor attenuation correction on respiratory gating cardiacSPECT/CT— A simulation study. Med Phys 2019; 46:2621-2628. [DOI: 10.1002/mp.13513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Duo Zhang
- Biomedical Imaging Laboratory (BIG) Department of Electrical and Computer Engineering Faculty of Science and Technology University of Macau Macau SAR China
| | - Michael Ghaly
- Russell H Morgan Department of Radiology and Radiological Science Johns Hopkins University Baltimore MD USA
- Radiopharmaceutical Imaging and Dosimetry (RAPID), LLC Baltimore MD USA
| | - Greta S. P. Mok
- Biomedical Imaging Laboratory (BIG) Department of Electrical and Computer Engineering Faculty of Science and Technology University of Macau Macau SAR China
- Faculty of Health Sciences University of Macau Macau SAR China
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Zhang D, Yang BH, Wu NY, Mok GSP. Respiratory average CT for attenuation correction in myocardial perfusion SPECT/CT. Ann Nucl Med 2016; 31:172-180. [PMID: 28000164 DOI: 10.1007/s12149-016-1144-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cine average CT (CACT) and interpolated average CT (IACT) have been proposed to improve attenuation correction (AC) for PET/CT in oncologic and cardiac studies. This study aims to evaluate their effectiveness on myocardial perfusion SPECT/CT using computer simulation and physical phantom experiments. METHODS We first simulated normal male with 99mTc-sestamibi distribution using digital XCAT phantom with respiratory motion amplitudes of 2, 3, and 4 cm. Average activity and attenuation maps represented static SPECT and CACT, while the attenuation maps of end-inspiration and end-expiration represented two helical CTs (HCTs), respectively. Sixty noise-free and noisy projections were simulated over 180° using an analytical parallel-hole projector. We then filled 673 MBq 99mTc into an anthropomorphic torso phantom with normal heart or heart with a defect which placed on a programmable respiratory platform to model various respiratory amplitudes. Sixty projections were acquired over 180° using a clinical SPECT/CT scanner. The CACT, standard HCT, and 2 HCTs at extreme phases were acquired. Interpolated CT phases were generated between them using affine plus b-spline registration, and IACT was obtained by averaging the interpolated phases and the 2 original extreme phases for both simulation and phantom experiments. Projections were reconstructed with AC using CACT, IACT, and HCTs, respectively. Polar and 17-segment plots were analyzed by relative difference (RD) of the uptake. Two regions-of-interest (ROI) were drawn on the defect and background area to obtain the intensity ratio (IR). RESULTS No substantial difference was observed on the polar plots generated from different AC methods, while the quantitative RD measurements showed that SPECTCACT were most similar to the original phantom, followed by SPECTIACT, with RDmax <8 and <10% in the simulation study. The RD of SPECTHCTs deviated from the original phantom and SPECTCACT in various segments, with RDmax of 19.76 and 16.68% in the simulation and phantom experiment, respectively. The IR of SPECTHCTs fluctuated more from the truth for higher motion amplitude. CONCLUSIONS Both CACT-AC and IACT-AC reduced respiratory artifacts and improved quantitation in myocardial perfusion SPECT as compared to HCT-AC. The use of IACT further reduced the radiation dose.
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Affiliation(s)
- Duo Zhang
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China
| | - Bang-Hung Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Nuclear Medicine, National PET/Cyclotron Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nien Yun Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Nuclear Medicine, National PET/Cyclotron Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Greta Seng Peng Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau SAR, China.
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Mok GSP, Ho CYT, Yang BH, Wu TH. Interpolated average CT for cardiac PET/CT attenuation correction. J Nucl Cardiol 2016; 23:1072-1079. [PMID: 25933679 DOI: 10.1007/s12350-015-0140-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previously, we proposed interpolated averaged CT (IACT) for improved attenuation correction (AC) in thoracic PET/CT. This study aims to evaluate its feasibility and effectiveness on cardiac PET/CT. METHODS We simulated (18)F-FDG distribution using the XCAT phantom with normal and abnormal cardiac uptake. Average activity and attenuation maps represented static PET and respiration average CT (ACT), respectively, while the attenuation maps of end-inspiration/expiration represented 2 helical CTs (HCT). IACT was obtained by averaging the 2 extreme phases and the interpolated phases generated between them. Later, we recruited 4 patients who were scanned 1 hr post 315-428 MBq (18)F-FDG injection. Simulated and clinical PET sinograms were reconstructed with AC using (1) HCT, (2) IACT, and (3) ACT. Polar plots and the 17-segment plots were analyzed. Two regions-of-interest were drawn on lesion and background area to obtain the intensity ratio (IR). RESULTS Polar plots of PETIACT-AC were more similar to PETACT-AC in both simulation and clinical data. Artifacts were observed in various segments in PETHCT-AC. IR differences of HCT as compared to the phantom were up to ~20%. CONCLUSIONS IACT-AC reduced respiratory artifacts and improved PET/CT matching similarly to ACT-AC. It is a promising low-dose alternate of ACT for cardiac PET/CT.
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Affiliation(s)
- Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, China.
| | - Cobie Y T Ho
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, China
| | - Bang-Hung Yang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
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Interpolated average CT for PET attenuation correction in different lesion characteristics. Nucl Med Commun 2016; 37:297-306. [DOI: 10.1097/mnm.0000000000000435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Respiratory motion reduction in PET/CT using abdominal compression for lung cancer patients. PLoS One 2014; 9:e98033. [PMID: 24837352 PMCID: PMC4024027 DOI: 10.1371/journal.pone.0098033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/14/2014] [Indexed: 12/25/2022] Open
Abstract
Purpose Respiratory motion causes substantial artifacts in reconstructed PET images when using helical CT as the attenuation map in PET/CT imaging. In this study, we aimed to reduce the respiratory artifacts in PET/CT images of patients with lung tumors using an abdominal compression device. Methods Twelve patients with lung cancer located in the middle or lower lobe of the lung were recruited. The patients were injected with 370 MBq of 18F-FDG. During PET, the patients assumed two bed positions for 1.5 min/bed. After conducting free-breathing imaging, we obtained images of the patients with abdominal compression by applying the same setup used in the free-breathing scan. The differences in the standardized uptake value (SUV)max, SUVmean, tumor volume, and the centroid of the tumors between PET and various CT schemes were measured. Results The SUVmax and SUVmean derived from PET/CT imaging using an abdominal compression device increased for all the lesions, compared with those obtained using the conventional approach. The percentage increases were 18.1% ±14% and 17% ±16.8% for SUVmax and SUVmean, respectively. PET/CT imaging combined with abdominal compression generally reduced the tumor mismatch between CT and the corresponding attenuation corrected PET images, with an average decrease of 1.9±1.7 mm over all the cases. Conclusions PET/CT imaging combined with abdominal compression reduces respiratory artifacts and PET/CT misregistration, and enhances quantitative SUV in tumor. Abdominal compression is easy to set up and is an effective method used in PET/CT imaging for clinical oncology, especially in the thoracic region.
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