Effect of Time-of-Flight and Regularized Reconstructions on Quantitative Measurements and Qualitative Assessments in Newly Diagnosed Prostate Cancer With 18F-Fluorocholine Dual Time Point PET/MRI.

Recent technical advances in positron emission tomography/magnetic resonance imaging (PET/MRI) technology allow much improved time-of-flight (TOF) and regularized iterative PET reconstruction regularized iterative reconstruction (RIR) algorithms. We evaluated the effect of TOF and RIR on standardized uptake values (maximum and peak SUV [SUVmax and SUVpeak]) and their metabolic tumor volume dependencies and visual image quality for 18F-fluorocholine PET/MRI in patients with newly diagnosed prostate cancer. Fourteen patients were administered with 3 MBq/kg of 18F-fluorocholine and scanned dynamically for 30 minutes. Positron emission tomography images were divided to early and late time points (1-6 minutes summed and 7-30 minutes summed). The values of the different SUVs were documented for dominant PET-avid lesions, and metabolic tumor volume was estimated using a 50% isocontour and SUV threshold of 2.5. Image quality was assessed via visual acuity scoring (VAS). We found that incorporation of TOF or RIR increased lesion SUVs. The lesion to background ratio was not improved by TOF reconstruction, while RIR improved the lesion to background ratio significantly ( P < .05). The values of the different VAS were all significantly higher ( P < .05) for RIR images over TOF, RIR over non-TOF, and TOF over non-TOF. In conclusion, our data indicate that TOF or RIR should be incorporated into current protocols when available

NEMA NU 2-2007 performance characteristics of GE Signa integrated PET/MR for different PET isotopes

BackgroundFully integrated PET/MR systems are being used frequently in clinical research and routine. National Electrical Manufacturers Association (NEMA) characterization of these systems is generally done with F-18 which is clinically the most relevant PET isotope. However, other PET isotopes, such as Ga-68 and Y-90, are gaining clinical importance as they are of specific interest for oncological applications and for follow-up of Y-90-based radionuclide therapy. These isotopes have a complex decay scheme with a variety of prompt gammas in coincidence. Ga-68 and Y-90 have higher positron energy and, because of the larger positron range, there may be interference with the magnetic field of the MR compared to F-18. Therefore, it is relevant to determine the performance of PET/MR for these clinically relevant and commercially available isotopes.MethodsNEMA NU 2-2007 performance measurements were performed for characterizing the spatial resolution, sensitivity, image quality, and the accuracy of attenuation and scatter corrections for F-18, Ga-68, and Y-90. Scatter fraction and noise equivalent count rate (NECR) tests were performed using F-18 and Ga-68. All phantom data were acquired on the GE Signa integrated PET/MR system, installed in UZ Leuven, Belgium.Results(18)F, Ga-68, and Y-90 NEMA performance tests resulted in substantially different system characteristics. In comparison with F-18, the spatial resolution is about 1mm larger in the axial direction for Ga-68 and no significative effect was found for Y-90. The impact of this lower resolution is also visible in the recovery coefficients of the smallest spheres of Ga-68 in image quality measurements, where clearly lower values are obtained. For Y-90, the low number of counts leads to a large variability in the image quality measurements. The primary factor for the sensitivity change is the scale factor related to the positron emission fraction. There is also an impact on the peak NECR, which is lower for Ga-68 than for F-18 and appears at higher activities.ConclusionsThe system performance of GE Signa integrated PET/MR was substantially different, in terms of NEMA spatial resolution, image quality, and NECR for Ga-68 and Y-90 compared to F-18. But these differences are compensated by the PET/MR scanner technologies and reconstructions methods

Approaches Toward Combining Positron Emission Tomography with Magnetic Resonance Imaging

Positron emission tomography (PET) and magnetic resonance imaging (MRI) provide complementary information, and there has been a great deal of research effort to combine these two modalities. A major engineering hurdle is that photomultiplier tubes (PMT), used in conventional PET detectors, are sensitive to magnetic field. This thesis explores the design considerations of different ways of combining small animal PMT-based PET systems with MRI through experimentation, modelling and Monte Carlo simulation. A proof-of-principle hybrid PET and field-cycled MRI system was built and the first multimodality images are shown. A Siemens Inveon PET was exposed to magnetic fields of different strengths and the performance is characterized as a function of field magnitude. The results of this experiment established external magnetic field limits and design studies are shown for wide range of approaches to combining the PET system with various configurations of field-cycled MRI and superconducting MRI systems. A sophisticated Monte Carlo PET simulation workflow based on the GATE toolkit was developed to model the Siemens Inveon PET. Simulated PET data were converted to the raw Siemens list-mode format and were processed and reconstructed using the same processing chain as the data measured on the actual scanner. A general GATE add-on was developed to rapidly generate attenuation correction sinograms using the precise detector geometry and attenuation coefficients built into the emission simulation. Emission simulations and the attenuation correction add-on were validated against measured data. Simulations were performed to study the impact of radiofrequency coil components on PET image quality and to test the suitability of various MR-compatible materials for a dual-modality animal bed

Improved correction for the tissue fraction effect in lung PET/CT imaging

Recently, there has been an increased interest in imaging different pulmonary disorders using PET techniques. Previous work has shown, for static PET/CT, that air content in the lung influences reconstructed image values and that it is vital to correct for this 'tissue fraction effect' (TFE). In this paper, we extend this work to include the blood component and also investigate the TFE in dynamic imaging. CT imaging and PET kinetic modelling are used to determine fractional air and blood voxel volumes in six patients with idiopathic pulmonary fibrosis. These values are used to illustrate best and worst case scenarios when interpreting images without correcting for the TFE. In addition, the fractional volumes were used to determine correction factors for the SUV and the kinetic parameters. These were then applied to the patient images. The kinetic parameters K1 and Ki along with the static parameter SUV were all found to be affected by the TFE with both air and blood providing a significant contribution to the errors. Without corrections, errors range from 34-80% in the best case and 29-96% in the worst case. In the patient data, without correcting for the TFE, regions of high density (fibrosis) appeared to have a higher uptake than lower density (normal appearing tissue), however this was reversed after air and blood correction. The proposed correction methods are vital for quantitative and relative accuracy. Without these corrections, images may be misinterpreted

Developments in PET-MRI for Radiotherapy Planning Applications

The hybridization of magnetic resonance imaging (MRI) and positron emission tomography (PET) provides the benefit of soft-tissue contrast and specific molecular information in a simultaneous acquisition. The applications of PET-MRI in radiotherapy are only starting to be realised. However, quantitative accuracy of PET relies on accurate attenuation correction (AC) of, not only the patient anatomy but also MRI hardware and current methods, which are prone to artefacts caused by dense materials. Quantitative accuracy of PET also relies on full characterization of patient motion during the scan. The simultaneity of PET-MRI makes it especially suited for motion correction. However, quality assurance (QA) procedures for such corrections are lacking. Therefore, a dynamic phantom that is PET and MR compatible is required. Additionally, respiratory motion characterization is needed for conformal radiotherapy of lung. 4D-CT can provide 3D motion characterization but suffers from poor soft-tissue contrast. In this thesis, I examine these problems, and present solutions in the form of improved MR-hardware AC techniques, a PET/MRI/CT-compatible tumour respiratory motion phantom for QA measurements, and a retrospective 4D-PET-MRI technique to characterise respiratory motion. Chapter 2 presents two techniques to improve upon current AC methods that use a standard helical CT scan for MRI hardware in PET-MRI. One technique uses a dual-energy computed tomography (DECT) scan to construct virtual monoenergetic image volumes and the other uses a tomotherapy linear accelerator to create CT images at megavoltage energies (1.0 MV) of the RF coil. The DECT-based technique reduced artefacts in the images translating to improved μ-maps. The MVCT-based technique provided further improvements in artefact reduction, resulting in artefact free μ-maps. This led to more AC of the breast coil. In chapter 3, I present a PET-MR-CT motion phantom for QA of motion-correction protocols. This phantom is used to evaluate a clinically available real-time dynamic MR images and a respiratory-triggered PET-MRI protocol. The results show the protocol to perform well under motion conditions. Additionally, the phantom provided a good model for performing QA of respiratory-triggered PET-MRI. Chapter 4 presents a 4D-PET/MRI technique, using MR sequences and PET acquisition methods currently available on hybrid PET/MRI systems. This technique is validated using the motion phantom presented in chapter 3 with three motion profiles. I conclude that our 4D-PET-MRI technique provides information to characterise tumour respiratory motion while using a clinically available pulse sequence and PET acquisition method

Diagnostic value of nuclear cardiology in coronary artery disease

This thesis investigates the diagnostic value of cardiac positron emission tomography when compared to single photon emission computed tomography for detection of coronary artery disease. This prospective study involves comparison of myocardial perfusion single photon emission computed tomography with coronary calcium scores; optimization of nuclear cardiac protocols in cardiac phantom experiments; and determination of diagnostic performance of cardiac positron emission tomography in the evaluation of myocardial viability in patients with significant coronary disease

PET/MRI attenuation estimation in the lung: A review of past, present, and potential techniques

Positron emission tomography/magnetic resonance imaging (PET/MRI) potentially offers several advantages over positron emission tomography/computed tomography (PET/CT), for example, no CT radiation dose and soft tissue images from MR acquired at the same time as the PET. However, obtaining accurate linear attenuation correction (LAC) factors for the lung remains difficult in PET/MRI. LACs depend on electron density and in the lung, these vary significantly both within an individual and from person to person. Current commercial practice is to use a single-valued population-based lung LAC, and better estimation is needed to improve quantification. Given the under-appreciation of lung attenuation estimation as an issue, the inaccuracy of PET quantification due to the use of single-valued lung LACs, the unique challenges of lung estimation, and the emerging status of PET/MRI scanners in lung disease, a review is timely. This paper highlights past and present methods, categorizing them into segmentation, atlas/mapping, and emission-based schemes. Potential strategies for future developments are also presented