Aortic valve imaging using 18F-sodium fluoride: impact of triple motion correction

BACKGROUND: Current (18)F-NaF assessments of aortic valve microcalcification using (18)F-NaF PET/CT are based on evaluations of end-diastolic or cardiac motion-corrected (ECG-MC) images, which are affected by both patient and respiratory motion. We aimed to test the impact of employing a triple motion correction technique (3 × MC), including cardiorespiratory and gross patient motion, on quantitative and qualitative measurements. MATERIALS AND METHODS: Fourteen patients with aortic stenosis underwent two repeat 30-min PET aortic valve scans within (29 ± 24) days. We considered three different image reconstruction protocols; an end-diastolic reconstruction protocol (standard) utilizing 25% of the acquired data, an ECG-gated (four ECG gates) reconstruction (ECG-MC), and a triple motion-corrected (3 × MC) dataset which corrects for both cardiorespiratory and patient motion. All datasets were compared to aortic valve calcification scores (AVCS), using the Agatston method, obtained from CT scans using correlation plots. We report SUV(max) values measured in the aortic valve and maximum target-to-background ratios (TBR(max)) values after correcting for blood pool activity. RESULTS: Compared to standard and ECG-MC reconstructions, increases in both SUV(max) and TBR(max) were observed following 3 × MC (SUV(max): Standard = 2.8 ± 0.7, ECG-MC = 2.6 ± 0.6, and 3 × MC = 3.3 ± 0.9; TBR(max): Standard = 2.7 ± 0.7, ECG-MC = 2.5 ± 0.6, and 3 × MC = 3.3 ± 1.2, all p values ≤ 0.05). 3 × MC had improved correlations (R(2) value) to the AVCS when compared to the standard methods (SUV(max): Standard = 0.10, ECG-MC = 0.10, and 3 × MC = 0.20; TBR(max): Standard = 0.20, ECG-MC = 0.28, and 3 × MC = 0.46). CONCLUSION: 3 × MC improves the correlation between the AVCS and SUV(max) and TBR(max) and should be considered in PET studies of aortic valves using (18)F-NaF. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40658-022-00433-7

Triple-gated motion and blood pool clearance corrections improve reproducibility of coronary 18F-NaF PET

PurposeTo improve the test-retest reproducibility of coronary plaque 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) uptake measurements.MethodsWe recruited 20 patients with coronary artery disease who underwent repeated hybrid PET/CT angiography (CTA) imaging within 3 weeks. All patients had 30-min PET acquisition and CTA during a single imaging session. Five PET image-sets with progressive motion correction were reconstructed: (i) a static dataset (no-MC), (ii) end-diastolic PET (standard), (iii) cardiac motion corrected (MC), (iv) combined cardiac and gross patient motion corrected (2 × MC) and, (v) cardiorespiratory and gross patient motion corrected (3 × MC). In addition to motion correction, all datasets were corrected for variations in the background activities which are introduced by variations in the injection-to-scan delays (background blood pool clearance correction, BC). Test-retest reproducibility of PET target-to-background ratio (TBR) was assessed by Bland-Altman analysis and coefficient of reproducibility.ResultsA total of 47 unique coronary lesions were identified on CTA. Motion correction in combination with BC improved the PET TBR test-retest reproducibility for all lesions (coefficient of reproducibility: standard = 0.437, no-MC = 0.345 (27% improvement), standard + BC = 0.365 (20% improvement), no-MC + BC = 0.341 (27% improvement), MC + BC = 0.288 (52% improvement), 2 × MC + BC = 0.278 (57% improvement) and 3 × C + BC = 0.254 (72% improvement), all p < 0.001). Importantly, in a sub-analysis of 18F-NaF-avid lesions with gross patient motion > 10 mm following corrections, reproducibility was improved by 133% (coefficient of reproducibility: standard = 0.745, 3 × MC = 0.320).ConclusionJoint corrections for cardiac, respiratory, and gross patient motion in combination with background blood pool corrections markedly improve test-retest reproducibility of coronary 18F-NaF PET

Identification and functional evaluation of GRIA1 missense and truncation variants in individuals with ID: An emerging neurodevelopmental syndrome.

GRIA1 encodes the GluA1 subunit of α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptors, which are ligand-gated ion channels that act as excitatory receptors for the neurotransmitter L-glutamate (Glu). AMPA receptors (AMPARs) are homo- or heteromeric protein complexes with four subunits, each encoded by different genes, GRIA1 to GRIA4. Although GluA1-containing AMPARs have a crucial role in brain function, the human phenotype associated with deleterious GRIA1 sequence variants has not been established. Subjects with de novo missense and nonsense GRIA1 variants were identified through international collaboration. Detailed phenotypic and genetic assessments of the subjects were carried out and the pathogenicity of the variants was evaluated in vitro to characterize changes in AMPAR function and expression. In addition, two Xenopus gria1 CRISPR-Cas9 F0 models were established to characterize the in vivo consequences. Seven unrelated individuals with rare GRIA1 variants were identified. One individual carried a homozygous nonsense variant (p.Arg377Ter), and six had heterozygous missense variations (p.Arg345Gln, p.Ala636Thr, p.Ile627Thr, and p.Gly745Asp), of which the p.Ala636Thr variant was recurrent in three individuals. The cohort revealed subjects to have a recurrent neurodevelopmental disorder mostly affecting cognition and speech. Functional evaluation of major GluA1-containing AMPAR subtypes carrying the GRIA1 variant mutations showed that three of the four missense variants profoundly perturb receptor function. The homozygous stop-gain variant completely destroys the expression of GluA1-containing AMPARs. The Xenopus gria1 models show transient motor deficits, an intermittent seizure phenotype, and a significant impairment to working memory in mutants. These data support a developmental disorder caused by both heterozygous and homozygous variants in GRIA1 affecting AMPAR function

Data-Driven Gross Patient Motion Detection and Compensation: Implications for Coronary 18F-NaF PET Imaging

Patient motion degrades image quality, affecting the quantitative assessment of PET images. This problem affects studies of coronary lesions in which microcalcification processes are targeted. Coronary PET imaging protocols require scans of up to 30 min, introducing the risk of gross patient motion (GPM) during the acquisition. Here, we investigate the feasibility of an automated data-driven method for the detection of GPM during PET acquisition. Methods: Twenty-eight patients with stable coronary disease underwent a 30-min PET acquisition 1 h after the injection of 18F-sodium fluoride (18F-NaF) at 248 ± 10 MBq (mean ± SD) and then a coronary CT angiography scan. An automated data-driven GPM detection technique tracking the center of mass of the count rates for every 200 ms in the PET list-mode data was devised and evaluated. Two patient motion patterns were considered: sudden repositioning (motion of >0.5 mm within 3 s) and general repositioning (motion of >0.3 mm over 15 s or more). After the reconstruction of diastolic images, individual GPM frames with focal coronary uptake were coregistered in 3 dimensions, creating a GPM-compensated (GPMC) image series. Lesion motion was reported for all lesions with focal uptake. Relative differences in SUVmax and target-to-background ratio (TBR) between GPMC and non-GPMC (standard electrocardiogram-gated data) diastolic PET images were compared in 3 separate groups defined by the maximum motion observed in the lesion (<5, 5-10, and >10 mm). Results: A total of 35 18F-NaF-avid lesions were identified in 28 patients. An average of 3.5 ± 1.5 GPM frames were considered for each patient, resulting in an average frame duration of 7 ± 4 (range, 3-21) min. The mean per-patient motion was: 7 ± 3 mm (maximum, 13.7 mm). GPM correction increased SUVmax and TBR in all lesions with greater than 5 mm of motion. In lesions with 5-10 mm of motion (n = 15), SUVmax and TBR increased by 4.6% ± 5.6% (P = 0.02) and 5.8% ± 6.4% (P < 0.002), respectively. In lesions with greater than 10 mm of motion (n = 15), the SUVmax and TBR increased by 5.0% ± 5.3% (P = 0.009) and 11.5% ± 10.1% (P = 0.001), respectively. GPM correction led to the diagnostic reclassification of 3 patients (11%). Conclusion: GPM during coronary 18F-NaF PET imaging is common and may affect quantitative accuracy. Automated retrospective compensation of this motion is feasible and should be considered for coronary PET imaging

Observer repeatability and interscan reproducibility of 18F-sodium fluoride coronary microcalcification activity

BackgroundWe aimed to establish the observer repeatability and interscan reproducibility of coronary 18F-sodium-fluoride positron emission tomography (PET) uptake using a novel semi-automated approach, coronary microcalcification activity (CMA).MethodsPatients with multivessel coronary artery disease underwent repeated hybrid PET and computed tomography angiography (CTA) imaging (PET/CTA). CMA was defined as the integrated standardized uptake values (SUV) in the entire coronary tree exceeding 2 standard deviations above the background SUV. Coefficients of repeatability between the same observer (intraobserver repeatability), between 2 observers (interobserver repeatability) and coefficient of reproducibility between 2 scans (interscan reproducibility), were determined at vessel and patient level.ResultsIn 19 patients, CMA was assessed twice in 43 coronary vessels on two PET/CT scans performed 12 ± 5 days apart. There was excellent intraclass correlation for intraobserver and interobserver repeatability as well as interscan reproducibility (all ≥ 0.991). There was 100% intraobserver, interobserver and interscan agreement for the presence (CMA > 0) or absence (CMA = 0) of coronary18F-NaF uptake. Mean CMA was 3.12 ± 0.62 with coefficients of repeatability of ≤ 10% for all measures: intraobserver 0.24 and 0.22, interobserver 0.30 and 0.29 and interscan 0.33 and 0.32 at a per-vessel and per-patient level, respectively.ConclusionsCMA is a repeatable and reproducible global measure of coronary atherosclerotic activity