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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [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] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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2
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Gao F. Integrated Positron Emission Tomography/Magnetic Resonance Imaging in clinical diagnosis of Alzheimer's disease. Eur J Radiol 2021; 145:110017. [PMID: 34826792 DOI: 10.1016/j.ejrad.2021.110017] [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: 05/11/2021] [Revised: 08/30/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022]
Abstract
Alzheimer's disease (AD), a progressive neurodegenerative disease which seriously endangers the health of the aged, is the most common etiology of senile dementia. With the increasing progress of neuroimaging technology, more and more imaging methods have been applied to study Alzheimer's disease. The emergence of integrated PET/MRI (Positron Emission Tomography/Magnetic Resonance Imaging) is a major advance in multimodal molecular imaging with many advantages on the structure of resolution and contrast of image over computed tomography (CT), PET and MRI. PET/MRI is now used stepwise in neurodegenerative diseases, and also has broad prospect of application in the early diagnosis of AD. In this review, we emphatically introduce the imaging advances of AD including functional imaging and molecular imaging, the advantages of PET/MRI over other imaging methods and prospects of PET/MRI in AD clinical diagnosis, especially in early diagnosis, clinical assessment and prediction on AD.
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Affiliation(s)
- Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
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Brancato V, Borrelli P, Alfano V, Picardi M, Mascalchi M, Nicolai E, Salvatore M, Aiello M. The impact of MR-based attenuation correction in spinal cord FDG-PET/MR imaging for neurological studies. Med Phys 2021; 48:5924-5934. [PMID: 34369590 PMCID: PMC9293017 DOI: 10.1002/mp.15149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/30/2021] [Accepted: 07/24/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Positron emission tomography (PET) attenuation correction (AC) in positron emission tomography‐magnetic resonance (PET/MR) scanners constitutes a critical and barely explored issue in spinal cord investigation, mainly due to the limitations in accounting for highly attenuating bone structures which surround the spinal canal. Our study aims at evaluating the clinical suitability of MR‐driven AC (MRAC) for 18‐fluorodeoxy‐glucose positron emission tomography (18F‐FDG‐PET) in spinal cord. Methods Thirty‐six patients, undergoing positron emission tomography‐computed tomography (PET/CT) and PET/MR in the same session for oncological examination, were retrospectively analyzed. For each patient, raw PET data from PET/MR scanner were reconstructed with 4‐ and 5‐class MRAC maps, generated by hybrid PET/MR system (PET_MRAC4 and PET_MRAC5, respectively, where PET_MRAC is PET images reconstructed using MR‐based attenuation correction map), and an AC map derived from CT data after a custom co‐registration pipeline (PET_rCTAC, where PET_rCTAC is PET images reconstructed using CT‐based attenuation correction map), which served as reference. Mean PET standardized uptake values (SUVm) were extracted from the three reconstructed PET images by regions of interest (ROIs) identified on T2‐weighted MRI, in the spinal cord, lumbar cerebrospinal fluid (CSF), and vertebral marrow at five levels (C2, C5, T6, T12, and L3). SUVm values from PET_MRAC4 and PET_MRAC5 were compared with each other and with the reference by means of paired t‐test, and correlated using Pearson's correlation (r) to assess their consistency. Cohen's d was calculated to assess the magnitude of differences between PET images. Results SUVmvalues from PET_MRAC4 were lower than those from PET_MRAC5 in almost all analyzed ROIs, with a mean difference ranging from 0.03 to 0.26 (statistically significant in the vertebral marrow at C2 and C5, spinal cord at T6 and T2, and CSF at L3). This was also confirmed by the effect size, with highest values at low spinal levels (d = 0.45 at T12 in spinal cord, d = 0.95 at L3 in CSF). SUVm values from PET_MRAC4 and PET_MRAC5 showed a very good correlation (0.81 < r < 0.97, p < 0.05) in all spinal ROIs. Underestimation of SUVm between PET_MRAC4 and PET_rCTAC was observed at each level, with a mean difference ranging from 0.02 to 0.32 (statistically significant in the vertebral marrow at C2 and T6, and CSF at L3). Although PET_MRAC5 underestimates PET_rCTAC (mean difference ranging from 0.02 to 0.3), an overall decrease in effect size could be observed for PET_MRAC5, mainly at lower spinal levels (T12, L3). SUVm from both PET_MRAC4 and PET_MRAC5 methods showed r value from good to very good with respect to PET_rCTAC (0.67 < r < 0.9 and 0.73 < r < 0.94, p < 0.05, respectively). Conclusions Our results showed that neglecting bones in AC can underestimate the FDG uptake measurement of the spinal cord. The inclusion of bones in MRAC is far from negligible and improves the AC in spinal cord, mainly at low spinal levels. Therefore, care must be taken in the spinal canal region, and the use of AC map reconstruction methods accounting for bone structures could be beneficial.
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Affiliation(s)
| | | | | | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Mario Mascalchi
- «Mario Serio» Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
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4
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Tiepolt S, Luthardt J, Patt M, Hesse S, Hoffmann KT, Weise D, Gertz HJ, Sabri O, Barthel H. Early after Administration [11C]PiB PET Images Correlate with Cognitive Dysfunction Measured by the CERAD Test Battery. J Alzheimers Dis 2020; 68:65-76. [PMID: 30636731 DOI: 10.3233/jad-180217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Amyloid-β (Aβ) and [18F]FDG PET are established as amyloid pathology and neuronal injury biomarkers. Early after administration Aβ PET images have the potential to replace [18F]FDG PET images allowing dual biomarker delivery by the administration of a single tracer. For [18F]FDG PET data, a correlation with cognitive performance is known. OBJECTIVE The aim of this study was to investigate whether early after administration [11C]PiB PET data also correlate with cognitive performance. METHODS The early after administration [11C]PiB PET data of 31 patients with cognitive impairment were evaluated. CERAD subtests were summarized to five cognitive domains. The resulting z scores were correlated with the PET data on a voxel- and VOI-based approach. Additional subgroup analyses (MCI versus dementia, Aβ-positive versus Aβ-negative subjects) were performed. RESULTS Significant correlations between cognitive performance and early after administration [11C]PiB PET data were found between left temporo-parietal SUVR and language domain, bilateral occipital as well as left temporal SUVR and executive function, left pre- and postcentral SUVRs, and visuospatial abilities. For the episodic and immediate memory domains, the analysis at the high significance level did not show any correlated cluster, however, the exploratory analysis did. CONCLUSION Our study revealed correlations between deficits in different cognitive domains and regional early after administration [11C]PiB PET data similar to those known from [18F]FDG PET studies. Thus, our data support the assumption that early [11C]PiB PET data have a potential as neuronal injury biomarker. Head-to-head double-tracer studies of larger cohorts are needed to confirm this assumption.
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Affiliation(s)
- Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
| | - Julia Luthardt
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
| | | | - David Weise
- Department of Psychiatry, University of Leipzig, Leipzig, Germany.,Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, University of Leipzig, Leipzig, Germany
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5
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Øen SK, Keil TM, Berntsen EM, Aanerud JF, Schwarzlmüller T, Ladefoged CN, Karlberg AM, Eikenes L. Quantitative and clinical impact of MRI-based attenuation correction methods in [ 18F]FDG evaluation of dementia. EJNMMI Res 2019; 9:83. [PMID: 31446507 PMCID: PMC6708519 DOI: 10.1186/s13550-019-0553-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/15/2019] [Indexed: 01/03/2023] Open
Abstract
Background Positron emission tomography/magnetic resonance imaging (PET/MRI) is a promising diagnostic imaging tool for the diagnosis of dementia, as PET can add complementary information to the routine imaging examination with MRI. The purpose of this study was to evaluate the influence of MRI-based attenuation correction (MRAC) on diagnostic assessment of dementia with [18F]FDG PET. Quantitative differences in both [18F]FDG uptake and z-scores were calculated for three clinically available (DixonNoBone, DixonBone, UTE) and two research MRAC methods (UCL, DeepUTE) compared to CT-based AC (CTAC). Furthermore, diagnoses based on visual evaluations were made by three nuclear medicine physicians and one neuroradiologist (PETCT, PETDeepUTE, PETDixonBone, PETUTE, PETCT + MRI, PETDixonBone + MRI). In addition, pons and cerebellum were compared as reference regions for normalization. Results The mean absolute difference in z-scores were smallest between MRAC and CTAC with cerebellum as reference region: 0.15 ± 0.11 σ (DeepUTE), 0.15 ± 0.12 σ (UCL), 0.23 ± 0.20 σ (DixonBone), 0.32 ± 0.28 σ (DixonNoBone), and 0.54 ± 0.40 σ (UTE). In the visual evaluation, the diagnoses agreed with PETCT in 74% (PETDeepUTE), 67% (PETDixonBone), and 70% (PETUTE) of the patients, while PETCT + MRI agreed with PETDixonBone + MRI in 89% of the patients. Conclusion The MRAC research methods performed close to that of CTAC in the quantitative evaluation of [18F]FDG uptake and z-scores. Among the clinically implemented MRAC methods, DixonBone should be preferred for diagnostic assessment of dementia with [18F]FDG PET/MRI. However, as artifacts occur in DixonBone attenuation maps, they must be visually inspected to assure proper quantification. Electronic supplementary material The online version of this article (10.1186/s13550-019-0553-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silje Kjærnes Øen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postbox 8905, N-7491, Trondheim, Norway.
| | - Thomas Morten Keil
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postbox 8905, N-7491, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Joel Fredrik Aanerud
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Schwarzlmüller
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Claes Nøhr Ladefoged
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Maria Karlberg
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postbox 8905, N-7491, Trondheim, Norway.,Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postbox 8905, N-7491, Trondheim, Norway
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6
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Kaltoft NS, Marner L, Larsen VA, Hasselbalch SG, Law I, Henriksen OM. Hybrid FDG PET/MRI vs. FDG PET and CT in patients with suspected dementia - A comparison of diagnostic yield and propagated influence on clinical diagnosis and patient management. PLoS One 2019; 14:e0216409. [PMID: 31048902 PMCID: PMC6497285 DOI: 10.1371/journal.pone.0216409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/21/2019] [Indexed: 12/03/2022] Open
Abstract
Background Both 18F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET), computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used in the evaluation of memory clinic patients. Hybrid PET/MR systems now allow simultaneous PET and MRI imaging within the duration of the PET emission scan. Purpose To compare the diagnostic yield of PET/MRI using an abbreviated MR protocol with that of separate PET and CT in a mixed memory clinic population, and the propagated influences on clinical diagnosis and patient management. Material and methods Consecutive memory clinic patients (n = 78) undergoing both CT and hybrid FDG PET/MRI scans were identified retrospectively. MRI and CT were separately evaluated for vascular and structural pathology. PET scans were classified according to the presence of neurodegenerative or vascular disease using CT or MRI, respectively, for anatomical guiding. A memory clinic expert assessed the clinical impact of the additional findings and/or change of PET classification achieved by MRI anatomical guiding as compared to CT guiding. Results MRI lead to significantly higher Fazekas scores, higher medial temporal and global cortical atrophy scores, and identified more patients with infarcts (28 vs 8, p<0.001) compared to CT. MRI changed PET classification in 13 (17%) patients. Addition of MRI to CT had minor clinical impact in 4/78 (5%) and major clinical impact in 13/78 (17%) of patients. Conclusion The study demonstrates the capabilities of PET/MRI systems for routine clinical imaging of memory clinic patients, and that even an abbreviated hybrid PET/MRI protocol provides significant additional information influencing clinical diagnosis and patient management in a substantial fraction of patients when compared to separate PET and CT.
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Affiliation(s)
- Nicolai Stefan Kaltoft
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Andree Larsen
- Department of Radiology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Danish Dementia Research Centre, Dept. of Neurology, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
| | - Otto Mølby Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Blegdamsvej, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
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7
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Mainta IC, Vargas MI, Trombella S, Frisoni GB, Unschuld PG, Garibotto V. Hybrid PET-MRI in Alzheimer's Disease Research. Methods Mol Biol 2019; 1750:185-200. [PMID: 29512073 DOI: 10.1007/978-1-4939-7704-8_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Multiple factors, namely amyloid, tau, inflammation, metabolic, and perfusion changes, contribute to the cascade of neurodegeneration and functional decline occurring in Alzheimer's disease (AD). These molecular and cellular processes and related functional and morphological changes can be visualized in vivo by two imaging modalities, namely positron emission tomography (PET) and magnetic resonance imaging (MRI). These imaging biomarkers are now part of the diagnostic algorithm and of particular interest for patient stratification and targeted drug development.In this field the availability of hybrid PET/MR systems not only offers a comprehensive evaluation in a single imaging session, but also opens new possibilities for the integration of the two imaging information. Here, we cover the clinical protocols and practical details of FDG, amyloid, and tau PET/MR imaging as applied in our institutions.
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Affiliation(s)
- Ismini C Mainta
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland. .,Faculty of Medicine, Nuclear Medicine Department, Geneva University Medical Center, University of Geneva, Geneva, Switzerland.
| | - Maria I Vargas
- Faculty of Medicine, Nuclear Medicine Department, Geneva University Medical Center, University of Geneva, Geneva, Switzerland.,Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sara Trombella
- Faculty of Medicine, Nuclear Medicine Department, Geneva University Medical Center, University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Faculty of Medicine, Nuclear Medicine Department, Geneva University Medical Center, University of Geneva, Geneva, Switzerland.,Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Paul G Unschuld
- Institute for Regenerative Medicine and Hospital for Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Nuclear Medicine Department, Geneva University Medical Center, University of Geneva, Geneva, Switzerland
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8
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Franceschi AM, Abballe V, Raad RA, Nelson A, Jackson K, Babb J, Vahle T, Fenchel M, Zhan Y, Valadez GH, Shepherd TM, Friedman KP. Visual detection of regional brain hypometabolism in cognitively impaired patients is independent of positron emission tomography-magnetic resonance attenuation correction method. World J Nucl Med 2018; 17:188-194. [PMID: 30034284 PMCID: PMC6034547 DOI: 10.4103/wjnm.wjnm_61_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Fluorodeoxyglucose (FDG) positron emission tomography-magnetic resonance (PET/MR) is useful for the evaluation of cognitively-impaired patients. This study aims to assess two different attenuation correction (AC) methods (Dixon-MR and atlas-based) versus index-standard computed tomography (CT) AC for the visual interpretation of regional hypometabolism in patients with cognitive impairment. Two board-certified nuclear medicine physicians blindly scored brain region FDG hypometabolism as normal versus hypometabolic using two-dimensional (2D) and 3D FDG PET/MR images generated by MIM software. Regions were quantitatively assessed as normal versus mildly, moderately, or severely hypometabolic. Hypometabolism scores obtained using the different methods of AC were compared, and interreader, as well as intra-reader agreement, was assessed. Regional hypometabolism versus normal metabolism was correctly classified in 16 patients on atlas-based and Dixon-based AC map PET reconstructions (vs. CT reference AC) for 94% (90%–96% confidence interval [CI]) and 93% (89%–96% CI) of scored regions, respectively. The averaged sensitivity/specificity for detection of any regional hypometabolism was 95%/94% (P = 0.669) and 90%/91% (P = 0.937) for atlas-based and Dixon-based AC maps. Interreader agreement for detection of regional hypometabolism was high, with similar outcome assessments when using atlas- and Dixon-corrected PET data in 93% (Κ =0.82) and 93% (Κ =0.84) of regions, respectively. Intrareader agreement for detection of regional hypometabolism was high, with concordant outcome assessments when using atlas- and Dixon-corrected data in 93%/92% (Κ =0.79) and 92/93% (Κ =0.78). Despite the quantitative advantages of atlas-based AC in brain PET/MR, routine clinical Dixon AC yields comparable visual ratings of regional hypometabolism in the evaluation of cognitively impaired patients undergoing brain PET/MR and is similar in performance to CT-based AC. Therefore, Dixon AC is acceptable for the routine clinical evaluation of dementia syndromes.
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Affiliation(s)
- Ana M Franceschi
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | - Valentino Abballe
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | - Roy A Raad
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | | | - Kimberly Jackson
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | - James Babb
- Department of Radiology, New York University Medical Center, New York, NY, USA
| | | | | | | | | | - Timothy M Shepherd
- Department of Radiology, New York University Medical Center, New York, NY, USA.,Center for Advanced Imaging Innovation and Research, New York, NY, USA
| | - Kent P Friedman
- Department of Radiology, New York University Medical Center, New York, NY, USA
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9
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Jena A, Taneja S, Jha A, Damesha NK, Negi P, Jadhav GK, Verma SM, Sogani SK. Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous 18F-FDG-PET/MRI: A Single-Institution Retrospective Study. AJNR Am J Neuroradiol 2017; 38:899-907. [PMID: 28341716 DOI: 10.3174/ajnr.a5124] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence. MATERIALS AND METHODS Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard. RESULTS Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBVmean (mean relative CBV), ADCmean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADCmean and Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy. CONCLUSIONS Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.
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Affiliation(s)
- A Jena
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - S Taneja
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - A Jha
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - N K Damesha
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - P Negi
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - G K Jadhav
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S M Verma
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S K Sogani
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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