A multifractal approach to space-filling recovery for PET quantification.

Purpose: A new image-based methodology is developed for estimating the apparent space-filling properties of an object of interest in PET imaging without need for a robust segmentation step and used to recover accurate estimates of total lesion activity (TLA). Methods: A multifractal approach and the fractal dimension are proposed to recover the apparent space-filling index of a lesion (tumor volume, TV) embedded in nonzero background. A practical implementation is proposed, and the index is subsequently used with mean standardized uptake value (SUVmean) to correct TLA estimates obtained from approximate lesion contours. The methodology is illustrated on fractal and synthetic objects contaminated by partial volume effects (PVEs), validated on realistic 18F-fluorodeoxyglucose PET simulations and tested for its robustness using a clinical 18F-fluorothymidine PET test-retest dataset. Results: TLA estimates were stable for a range of resolutions typical in PET oncology (4-6 mm). By contrast, the space-filling index and intensity estimates were resolution dependent. TLA was generally recovered within 15% of ground truth on postfiltered PET images affected by PVEs. Volumes were recovered within 15% variability in the repeatability study. Results indicated that TLA is a more robust index than other traditional metrics such as SUVmean or TV measurements across imaging protocols. Conclusions: The fractal procedure reported here is proposed as a simple and effective computational alternative to existing methodologies which require the incorporation of image preprocessing steps (i.e., partial volume correction and automatic segmentation) prior to quantification

Impact of motion compensation and partial volume correction for ¹⁸F-NaF PET/CT imaging of coronary plaque

Recent studies have suggested that ¹⁸F-NaF-PET enables visualization and quantification of plaque micro-calcification in the coronary tree. However, PET imaging of plaque calcification in the coronary arteries is challenging because of the respiratory and cardiac motion as well as partial volume effects. The objective of this work is to implement an image reconstruction framework, which incorporates compensation for respiratory as well as cardiac motion (MoCo) and partial volume correction (PVC), for cardiac ¹⁸F-NaF PET imaging in PET/CT. We evaluated the effect of MoCo and PVC on the quantification of vulnerable plaques in the coronary arteries. Realistic simulations (Biograph TPTV, Biograph mCT) and phantom acquisitions (Biograph mCT) were used for these evaluations. Different uptake values in the calcified plaques were evaluated in the simulations, while three "plaque-type" lesions of 36, 31 and 18 mm³ were included in the phantom experiments. After validation, the MoCo and PVC methods were applied in four pilot NaF-PET patient studies. In all cases, the MoCo-based image reconstruction was performed using the STIR software. The PVC was obtained from a local projection (LP) method, previously evaluated in preclinical and clinical PET. The results obtained show a significant increase of the measured lesion-to-background ratios (LBR) in the MoCo+PVC images. These ratios were further enhanced when using directly the tissue-activities from the LP method, making this approach more suitable for the quantitative evaluation of coronary plaques. When using the LP method on the MoCo images, LBR increased between 200% and 1119% in the simulated data, between 212% and 614% in the phantom experiments and between 46% and 373% in the plaques with positive uptake observed in the pilot patients. In conclusion, we have built and validated a STIR framework incorporating MoCo and PVC for ¹⁸NaF PET imaging of coronary plaques. First results indicate an improved quantification of plaque-type lesions

Hybrid PET-MR list-mode kernelized expectation maximization reconstruction

The recently introduced kernelized expectation maximization (KEM) method has shown promise across varied applications. These studies have demonstrated the benefits and drawbacks of the technique when the kernel matrix is estimated from separate anatomical information, for example from magnetic resonance (MR), or from a preliminary PET reconstruction. The contribution of this work is to propose and investigate a list-mode-hybrid KEM (LM-HKEM) reconstruction algorithm with the aim of maintaining the benefits of the anatomically-guided methods and overcome their limitations by incorporating synergistic information iteratively. The HKEM is designed to reduce negative bias associated with low-counts, the problem of PET unique feature suppression reported in the previously mentioned studies using only the MR-based kernel, and to improve contrast of lesions at different count levels. The proposed algorithm is validated using a simulation study, a phantom dataset and two clinical datasets. For each of the real datasets high and low count-levels were investigated. The reconstructed images are assessed and compared with different LM algorithms implemented in STIR. The findings obtained using simulated and real datasets show that anatomically-guided techniques provide reduced partial volume effect and higher contrast compared to standard techniques, and HKEM provides even higher contrast and reduced bias in almost all the cases. This work, therefore argues that using synergistic information, via the kernel method, increases the accuracy of the PET clinical diagnostic examination. The promising quantitative features of the HKEM method give the opportunity to explore many possible clinical applications, such as cancer and inflammation

Cardiac motion compensation and resolution modeling in simultaneous PET-MR: a cardiac lesion detection study

Cardiac motion and partial volume effects (PVE) are two of the main causes of image degradation in cardiac PET. Motion generates artifacts and blurring while PVE lead to erroneous myocardial activity measurements. Newly available simultaneous PET-MR scanners offer new possibilities in cardiac imaging as MRI can assess wall contractility while collecting PET perfusion data. In this perspective, we develop a list-mode iterative reconstruction framework incorporating both tagged-MR derived non-rigid myocardial wall motion and position dependent detector point spread function (PSF) directly into the PET system matrix. In this manner, our algorithm performs both motion 'deblurring' and PSF deconvolution while reconstructing images with all available PET counts. The proposed methods are evaluated in a beating non-rigid cardiac phantom whose hot myocardial compartment contains small transmural and non-transmural cold defects. In order to accelerate imaging time, we investigate collecting full and half k-space tagged MR data to obtain tagged volumes that are registered using non-rigid B-spline registration to yield wall motion information. Our experimental results show that tagged-MR based motion correction yielded an improvement in defect/myocardium contrast recovery of 34-206% as compared to motion uncorrected studies. Likewise, lesion detectability improved by respectively 115-136% and 62-235% with MR-based motion compensation as compared to gating and no motion correction and made it possible to distinguish non-transmural from transmural defects, which has clinical significance given the inherent limitations of current single modality imaging in identifying the amount of residual ischemia. The incorporation of PSF modeling within the framework of MR-based motion compensation significantly improved defect/myocardium contrast recovery (5.1-8.5%, p < 0.01) and defect detectability (39-56%, p < 0.01). No statistical difference was found in PET contrast and lesion detectability based on motion fields obtained with half and full k-space tagged data.close10

Advanced kinetic modelling strategies: Towards adoption in clinical PET imaging

Positron emission tomography (PET) is a highly quantitative imaging modality that can probe a number of functional and biological processes, depending on the radio-labelled tracer used. Static imaging, followed by analysis using semi-quantitative indices, such as the standardised uptake value, is used in the majority of clinical assessments in which PET has a role. However, considerably more information can be extracted from dynamic image acquisition protocols, followed by application of appropriate image reconstruction and tracer kinetic modelling techniques, but the latter approaches have mainly been restricted to drug development and clinical research applications due to their complexity in terms of both protocol design and parameter estimation methodology. To make dynamic imaging more feasible and valuable in routine clinical imaging, novel research outcomes are needed. Research areas include non-invasive input function extraction, protocol design for whole-body imaging application, and kinetic parameter estimation methods using spatiotemporal (4D) image reconstruction algorithms. Furthermore, with the advent of sequential and simultaneous PET/magnetic resonance (MR) data acquisition, strategies for obtaining synergistic benefits in kinetic modelling are emerging and potentially enhancing the role and clinical importance of PET/MR imaging. In this article, we review and discuss various advances in kinetic modelling both from a protocol design and a methodological development perspective. Moreover, we discuss future trends and potential outcomes, which could facilitate more routine use of tracer kinetic modelling techniques in clinical practice