Reconstructed spatial resolution and contrast recovery with Bayesian penalized likelihood reconstruction (Q.Clear) for FDG-PET compared to time-of-flight (TOF) with point spread function (PSF)

BACKGROUND: Bayesian penalized likelihood reconstruction for PET (e.g., GE Q.Clear) aims at improving convergence of lesion activity while ensuring sufficient signal-to-noise ratio (SNR). This study evaluated reconstructed spatial resolution, maximum/peak contrast recovery (CRmax/CRpeak) and SNR of Q.Clear compared to time-of-flight (TOF) OSEM with and without point spread function (PSF) modeling. METHODS: The NEMA IEC Body phantom was scanned five times (3 min scan duration, 30 min between scans, background, 1.5-3.9 kBq/ml F18) with a GE Discovery MI PET/CT (3-ring detector) with spheres filled with 8-, 4-, or 2-fold the background activity concentration (SBR 8:1, 4:1, 2:1). Reconstruction included Q.Clear (beta, 150/300/450), "PSF+TOF4/16" (iterations, 4; subsets, 16; in-plane filter, 2.0 mm), "OSEM+TOF4/16" (identical parameters), "PSF+TOF2/17" (2 it, 17 ss, 2.0 mm filter), "OSEM+TOF2/17" (identical), "PSF+TOF4/8" (4 it, 8 ss, 6.4 mm), and "OSEM+TOF2/8" (2 it, 8 ss, 6.4 mm). Spatial resolution was derived from 3D sphere activity profiles. RC as (sphere activity concentration [AC]/true AC). SNR as (background mean AC/background AC standard deviation). RESULTS: Spatial resolution of Q.Clear150 was significantly better than all conventional algorithms at SBR 8:1 and 4:1 (Wilcoxon, each p < 0.05). At SBR 4:1 and 2:1, the spatial resolution of Q.Clear300/450 was similar or inferior to PSF+TOF4/16 and OSEM+TOF4/16. Small sphere CRpeak generally underestimated true AC, and it was similar for Q.Clear150/300/450 as with PSF+TOF4/16 or PSF+TOF2/17 (i.e., relative differences < 10%). Q.Clear provided similar or higher CRpeak as OSEM+TOF4/16 and OSEM+TOF2/17 resulting in a consistently better tradeoff between CRpeak and SNR with Q.Clear. Compared to PSF+TOF4/8/OSEM+TOF2/8, Q.Clear150/300/450 showed lower SNR but higher CRpeak. CONCLUSIONS: Q.Clear consistently improved reconstructed spatial resolution at high and medium SBR compared to PSF+TOF and OSEM+TOF, but only with beta = 150. However, this is at the cost of inferior SNR with Q.Clear150 compared to Q.Clear300/450 and PSF+TOF4/16/PSF+TOF2/17 while CRpeak for the small spheres did not improve considerably. This suggests that Q.Clear300/450 may be advantageous for the 3-ring detector configuration because the tradeoff between CR and SNR with Q.Clear300/450 was superior to PSF+TOF4/16, OSEM+TOF4/16, and OSEM+TOF2/17. However, it requires validation by systematic evaluation in patients at different activity and acquisition protocols

An optimized imaging protocol for [99mTc]Tc-DPD scintigraphy and SPECT/CT quantification in cardiac transthyretin (ATTR) amyloidosis

Background: In [(99)mTc]Tc-DPD scintigraphy for myocardial ATTR amyloidosis, planar images 3 hour p.i. and SPECT/CT acquisition in L-mode are recommended. This study investigated if earlier planar images (1 hour p.i.) are beneficial and if SPECT/CT acquisition should be preferred in H-mode (180 degrees detector angle) or L-mode (90 degrees). Methods: In SPECT/CT phantom measurements (NaI cameras, N = 2; CZT, N = 1), peak contrast recovery (CRpeak) was derived from sphere inserts or myocardial insert (cardiac phantom; signal-to-background ratio [SBR], 10:1 or 5:1). In 25 positive and 38 negative patients reference: endomyocardial biopsy or clinical diagnosis), Perugini scores and heart-to-contralateral (H/CL) count ratios were derived from planar images 1 hour and 3 hour p.i. Results: In phantom measurements, accuracy of myocardial CRpeak at SBR 10:1 (H-mode, 0.95-0.99) and reproducibility at 5:1 (H-mode, 1.02-1.14) was comparable for H-mode and L-mode. However, L-mode showed higher variability of background counts and sphere CRpeak throughout the field of view than H-mode. In patients, sensitivity/specificity were >= 95% for H/CL ratios at both time points and visual scoring 3 hour. At 1 hour, visual scores showed specificity of 89% and reduced reader's confidence. Conclusions: Early DPD images provided no additional value for visual scoring or H/CL ratios. In SPECT/CT, H-mode is preferred over L-mode, especially if quantification is applied apart from the myocardium

Asphericity of tumor FDG uptake in non-small cell lung cancer: reproducibility and implications for harmonization in multicenter studies

Background: Asphericity (ASP) of the primary tumor's metabolic tumor volume (MTV) in FDG-PET/CT is independently predictive for survival in patients with non-small cell lung cancer (NSCLC). However, comparability between PET systems may be limited. Therefore, reproducibility of ASP was evaluated at varying image reconstruction and acquisition times to assess feasibility of ASP assessment in multicenter studies. Methods: This is a retrospective study of 50 patients with NSCLC (female 20; median age 69 years) undergoing pretherapeutic FDG-PET/CT (median 3.7 MBq/kg; 180 s/bed position). Reconstruction used OSEM with TOF4/16 (iterations 4; subsets 16; in-plane filter 2.0, 6.4 or 9.5 mm), TOF4/8 (4 it; 8 ss; filter 2.0/6.0/9.5 mm), PSF + TOF2/17 (2 it; 17 ss; filter 2.0/7.0/10.0 mm) or Bayesian-penalized likelihood (Q.Clear; beta, 600/1750/4000). Resulting reconstructed spatial resolution (FWHM) was determined from hot sphere inserts of a NEMA IEC phantom. Data with approx. 5-mm FWHM were retrospectively smoothed to achieve 7-mm FWHM. List mode data were rebinned for acquisition times of 120/90/60 s. Threshold-based delineation of primary tumor MTV was followed by evaluation of relative ASP/SUVmax/MTV differences between datasets and resulting proportions of discordantly classified cases. Results: Reconstructed resolution for narrow/medium/wide in-plane filter (or low/medium/high beta) was approx. 5/7/9 mm FWHM. Comparing different pairs of reconstructed resolution between TOF4/8, PSF + TOF2/17, Q.Clear and the reference algorithm TOF4/16, ASP differences was lowest at FWHM of 7 versus 7 mm. Proportions of discordant cases (ASP > 19.5% vs. ≤ 19.5%) were also lowest at 7 mm (TOF4/8, 2%; PSF + TOF2/17, 4%; Q.Clear, 10%). Smoothing of 5-mm data to 7-mm FWHM significantly reduced discordant cases (TOF4/8, 38% reduced to 2%; PSF + TOF2/17, 12% to 4%; Q.Clear, 10% to 6%), resulting in proportions comparable to original 7-mm data. Shorter acquisition time only increased proportions of discordant cases at < 90 s. Conclusions: ASP differences were mainly determined by reconstructed spatial resolution, and multicenter studies should aim at comparable FWHM (e.g., 7 mm; determined by in-plane filter width). This reduces discordant cases (high vs. low ASP) to an acceptable proportion for TOF and PSF + TOF of < 5% (Q.Clear: 10%). Data with better resolution (i.e., lower FWHM) could be retrospectively smoothed to the desired FWHM, resulting in a comparable number of discordant cases

Optimization of SPECT/CT imaging protocols for quantitative and qualitative 99mTc SPECT

Background!#!The introduction of hybrid SPECT/CT devices enables quantitative imaging in SPECT, providing a methodological setup for quantitation using SPECT tracers comparable to PET/CT. We evaluated a specific quantitative reconstruction algorithm for SPECT data using a !##!Results!#!The reconstructed activity concentration (AC!##!Conclusion!#!Quantitative SPECT imaging is feasible with the used reconstruction algorithm and hybrid SPECT/CT, and its consistent implementation in diagnostics may provide perspectives for quantification in routine clinical practice (e.g., assessment of bone metabolism). When combining quantitative analysis and diagnostic imaging, we recommend using two different reconstruction protocols with task-specific optimized setups (quantitative vs. qualitative reconstruction). Furthermore, individual scatter correction significantly improves both quantitative and qualitative results

Selective Internal Radiation Therapy in Breast Cancer Liver Metastases: Outcome Assessment Applying a Prognostic Score

Selective internal radiation therapy (SIRT) is a therapy option in patients with breast cancer liver metastasis (BCLM). This analysis aimed at identifying a prognostic score regarding overall survival (OS) after SIRT using routine pretherapeutic parameters. Retrospective analysis of 38 patients (age, 59 (39–84) years) with BCLM and 42 SIRT procedures. Cox regression for OS included clinical factors (age, ECOG and prior treatments), laboratory parameters, hepatic tumor load and dose reduction due to hepatopulmonary shunt. Elevated baseline ALT and/or AST was present if CTCAE grade ≥ 2 was fulfilled (&gt;3 times the upper limit of normal). Median OS after SIRT was 6.4 months. In univariable Cox, ECOG ≥ 1 (hazard ratio (HR), 3.8), presence of elevated baseline ALT/AST (HR, 3.8), prior liver surgery (HR, 10.2), and dose reduction of 40% (HR, 8.1) predicted shorter OS (each p &lt; 0.05). Multivariable Cox confirmed ECOG ≥ 1 (HR, 2.34; p = 0.012) and elevated baseline ALT/AST (HR, 4.16; p &lt; 0.001). Combining both factors, median OS decreased from 19.2 months (0 risk factors; n = 14 procedures) to 5.9 months (1 factor; n = 20) or 2.2 months (2 factors; n = 8; p &lt; 0.001). The proposed score may facilitate pretherapeutic identification of patients with unfavorable OS after SIRT. This may help to balance potential life prolongation with the hazards of invasive treatment and hospitalization

SEAwise Report on consistency of existing targets and limits for indicators in an ecosystem context

The SEAwise project works to deliver a fully operational tool that will allow fishers, managers, and policy makers to easily apply Ecosystem Based Fisheries Management (EBFM) in their fisheries. This SEAwise report investigates the consistency of existing targets and limits from the Common Fisheries Policy (CFP) and the Marine Strategy Framework Directive (MSFD). Trade-offs between different objectives (ecological, economic, social), targets and limits are highlighted. A wide range of model types (from bio-economic to full ecosystem models) has been applied to various case study areas accross the North East Atlantic and Mediterranean. Although model predictions are by nature uncertain, this study provides important information on likely inconsistencies between existing targets and limits and trade-offs expected under ecosystem- based fisheries management (EBFM). The scenarios investigated include the current range of management applied in terms of the Maximum Sustainable Yield (MSY) concept (i.e. strict MSY approach vs. Pretty Good Yield (PGY) approach allowing sustainable deviations from single species point estimates). The landing obligation is a key aspect of current fisheries management and was fully considered, in particular for mixed demersal fisheries.Maintaining current fishing effort without further management measures was the least sustainable option in nearly all cases studies. This approach led to increased risk of stocks falling below critical biomass limits. Although the fishing effort adaptions needed is highly case specific, this indicates that further management measures are likely to be needed to ensure a sustainable exploitation of all stocks.Scenarios applying a strict MSY approach in combination with the landing obligation as upper limit with fisheries ending when the first stock reaches in most case studies led to the lowest fishing effort. This had positive effects on MSFD related indicators such as bycatch of Protected, Endangered and Threatened (PET) species, benthic impact and the Large Fish Indicator as well as global indicators such as CO emission or ecosystem-based indicators like catch per . However, this scenario often led to the lowest catches from mixed demersal fisheries due to strong choke effects because fleets had to stop when their first quota was exhausted. This reduces social indicators such as food security, employment and wages. In terms of economic performance, the gains and loses were highly case specific. Scenarios applying the Pretty Good Yield concept and allowing sustainable deviations from the point estimate when stocks are in a healthy state often outperformed the scenarios applying as strict upper limit. Such scenarios, applying a more flexible interpretation of the MSY concept, led to reduced fishing effort compared to the status quo effort, but relaxed choke situations in mixed demersal fisheries to some extent leading to higher gross profits and in some case studies also to higher catches. Hence, they may constitute a compromise between the need to attain social as well as ecological objectives. Whether the associated effort levels lead to conflicts with MSFD objectives must be analysed when more internationally agreed thresholds become available for e.g., bycatch of PET species or benthic impact.The majority of case studies exceeded suggested thresholds for the global ecosystem indicators catch per km or primary production even under scenarios with high effort reductions. This can be explained to some extent by the fact that these indices are mainly driven by pelagic and industrial fisheries not always part of the models applied. Nevertheless, it indicates potential conflicts with such more holistic ecosystem indicators in their current form.Additional trade-offs in terms of yield were identified within the food web if e.g., demersal piscivorous predators feed on small pelagic fish and both groups are fished. Further, in case studies where small-scale fisheries (SSF) play an important role (e.g., Eastern Ionian Sea) additional trade-offs became apparent as different scenarios led to different ratios between revenues from small scale fisheries and revenues from large-scale fisheries. This adds another level of complexity when such aspects need to be taken more into account in future fisheries management under EBFM.The modelling assumed current selectivities and catchabilities will be maintained in the future. Especially trade-offs arising from fleets having to stop fishing when their first quota is exhausted or when e.g., a threshold for bycatch of PET species is reached may be resolved by improving selectivities via technical measures (e.g., closed areas or innovative gears) in the future. Deliverable 6.8 in month 36 will test such scenarios. Furthermore, the list of indicators and their targets and limits will be updated based on research within and outside SEAwise. Predictive capability of models will be enhanced by incorporating improved biological and economic sub-models in relation to environmental change. Climate change scenarios will be run and new harvest control rules (HCRs), proposed by SEAwise, will be tested. Finally, consistent targets and limits will be proposed for implementing EBFM