Respiratory motion correction of PET using MR-constrained PET-PET registration

BACKGROUND: Respiratory motion in positron emission tomography (PET) is an unavoidable source of error in the measurement of tracer uptake, lesion position and lesion size. The introduction of PET-MR dual modality scanners opens a new avenue for addressing this issue. Motion models offer a way to estimate motion using a reduced number of parameters. This can be beneficial for estimating motion from PET, which can otherwise be difficult due to the high level of noise of the data. METHOD: We propose a novel technique that makes use of a respiratory motion model, formed from initial MR scan data. The motion model is used to constrain PET-PET registrations between a reference PET gate and the gates to be corrected. For evaluation, PET with added FDG-avid lesions was simulated from real, segmented, ultrashort echo time MR data obtained from four volunteers. Respiratory motion was included in the simulations using motion fields derived from real dynamic 3D MR volumes obtained from the same volunteers. RESULTS: Performance was compared to an MR-derived motion model driven method (which requires constant use of the MR scanner) and to unconstrained PET-PET registration of the PET gates. Without motion correction, a median drop in uncorrected lesion [Formula: see text] intensity to [Formula: see text] and an increase in median head-foot lesion width, specified by a minimum bounding box, to [Formula: see text] was observed relative to the corresponding measures in motion-free simulations. The proposed method corrected these values to [Formula: see text] ([Formula: see text] ) and [Formula: see text] ([Formula: see text] ) respectively, with notably improved performance close to the diaphragm and in the liver. Median lesion displacement across all lesions was observed to be [Formula: see text] without motion correction, which was reduced to [Formula: see text] ([Formula: see text] ) with motion correction. DISCUSSION: This paper presents a novel technique for respiratory motion correction of PET data in PET-MR imaging. After an initial 30 second MR scan, the proposed technique does not require use of the MR scanner for motion correction purposes, making it suitable for MR-intensive studies or sequential PET-MR. The accuracy of the proposed technique was similar to both comparative methods, but robustness was improved compared to the PET-PET technique, particularly in regions with higher noise such as the liver

Scapula fractures: interobserver reliability of classification and treatment

OBJECTIVES:There is substantial variation in the classification and the management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO and the New International Classification of scapula fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment. DESIGN:: Web-based reliability study SETTING:: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey. PARTICIPANTS:One-hundred and three orthopaedic surgeons evaluated 35 movies of 3DCT-reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns. MAIN OUTCOME MEASUREMENTS:Fleiss' kappa (κ) was used to assess the reliability of agreement between the surgeons. RESULTS:: The overall agreement on the OTA/AO Classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) as well as for the nine groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intra-articular extension of the fracture (Fossa (F), κ = 0.79) was substantial, the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53), however PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA. CONCLUSIONS:The New International Classification was more reliable. Body and process fractures generated more disagreement than intra-articular fractures and need further clear definitions