Individual refinement of attenuation correction maps for hybrid PET/MR based on multi-resolution regional learning.

PET/MR is an emerging hybrid imaging modality. However, attenuation correction (AC) remains challenging for hybrid PET/MR in generating accurate PET images. Segmentation-based methods on special MR sequences are most widely recommended by vendors. However, their accuracy is usually not high. Individual refinement of available certified attenuation maps may be helpful for further clinical applications. In this study, we proposed a multi-resolution regional learning (MRRL) scheme to utilize the internal consistency of the patient data. The anatomical and AC MR sequences of the same subject were employed to guide the refinement of the provided AC maps. The developed algorithm was tested on 9 patients scanned consecutively with PET/MR and PET/CT (7 [18F]FDG and 2 [18F]FET). The preliminary results showed that MRRL can improve the accuracy of segmented attenuation maps and consequently the accuracy of PET reconstructions.

Evaluation of 18F-fluoride PET/MR and PET/CT in patients with foot pain of unclear cause.

UNLABELLED: Our objective was to compare the quality and diagnostic performance of (18)F-fluoride PET/MR imaging with that of (18)F-fluoride PET/CT imaging in patients with foot pain of unclear cause. METHODS: Twenty-two patients (9 men, 13 women; mean age, 48 ± 18 y; range, 20-78 y) were prospectively included in this study and underwent a single-injection dual-imaging protocol with (18)F-fluoride PET/CT and PET/MR. At a minimum, the PET/MR protocol included T1-weighted spin echo and proton-density fat-saturated sequences in 2 planes each with simultaneous acquisition of PET over 20 min. PET/CT included a native isotropic (0.6 mm) diagnostic CT scan (80 kV, 165 mAs) and a subsequent PET scan (2 min per bed position). By consensus, 2 masked interpreters randomly assessed both PET datasets for image quality (3-point scale) and for the presence of focal lesions with increased (18)F-fluoride uptake (maximum of 4 lesions). For each dataset (PET/CT vs. PET/MR), the diagnoses were defined using both PET and a morphologic dataset. Standardized uptake values (SUVs) from the 2 devices were compared using linear correlation and Bland-Altman plots. Moreover, we estimated the potential for dose reduction for PET/MR compared with PET/CT considering the longer acquisition time of PET/MR analyzing count rate statistics. RESULTS: Image quality was rated diagnostic for both PET datasets. However, with a mean rating of 3.0/3 for PET/MR and 2.3/3 for PET/CT, image quality was significantly superior for PET/MR (P < 0.0001). The sensitivity of the PET datasets in PET/MR and PET/CT was equivalent, with the same 42 lesions showing focal (18)F-fluoride uptake. In PET/MR, the mean SUVmean was 10.4 (range, 2.0-67.7) and the mean SUVmax was 15.6 (range, 2.9-94.1). In PET/CT, the corresponding mean SUVmean of PET/CT was 10.2 (range, 1.8-55.6) and the mean SUVmax was 16.3 (range, 2.5-117.5), resulting in a high linear correlation coefficient (r = 0.96, P < 0.0001, for SUVmean and for SUVmax). A final consensus interpretation revealed the most frequent main diagnoses to be osteoarthritis, stress fracture, and bone marrow edema. PET/CT was more precise in visualizing osteoarthritis, whereas PET/MR was more specific in nondegenerative pathologies because of the higher soft-tissue and bone marrow contrast. The longer acquisition time of MR compared with CT would potentially allow (18)F-fluoride dose reduction using hybrid (18)F-fluoride PET/MR imaging of at least 50% according to the counting rate analysis. CONCLUSION: In patients with foot pain of unclear cause, (18)F-fluoride PET/MR is technically feasible and is more robust in terms of image quality and SUV quantification than (18)F-fluoride PET/CT. In most patients, (18)F-fluoride PET/MR provided more diagnostic information at a higher diagnostic certainty than did PET/CT. Thus, PET/MR combines the high sensitivity of (18)F-fluoride PET to pinpoint areas with the dominant disease activity and the specificity of MR imaging for the final diagnosis with the potential for a substantial dose reduction compared with PET/CT.

Motion correction strategies for integrated PET/MR.

UNLABELLED: Integrated whole-body PET/MR facilitates the implementation of a broad variety of respiratory motion correction strategies, taking advantage of the strengths of both modalities. The goal of this study was the quantitative evaluation with clinical data of different MR- and PET-data-based motion correction strategies for integrated PET/MR. METHODS: The PET and MR data of 20 patients were simultaneously acquired for 10 min on an integrated PET/MR system after administration of (18)F-FDG or (68)Ga-DOTANOC. Respiratory traces recorded with a bellows were compared against MR self-gating signals and signals extracted from PET raw data with the sensitivity method, by applying principal component analysis (PCA) or Laplacian eigenmaps and by using a novel variation combining the former and either of the latter two. Gated sinograms and MR images were generated accordingly, followed by image registration to derive MR motion models. Corrected PET images were reconstructed by incorporating this information into the reconstruction. An optical flow algorithm was applied for PET-based motion correction. Gating and motion correction were evaluated by quantitative analysis of apparent tracer uptake, lesion volume, displacement, contrast, and signal-to-noise ratio. RESULTS: The correlation between bellows- and MR-based signals was 0.63 ± 0.19, and that between MR and the sensitivity method was 0.52 ± 0.26. Depending on the PET raw-data compression, the average correlation between MR and PCA ranged from 0.25 ± 0.30 to 0.58 ± 0.33, and the range was 0.25 ± 0.30 to 0.42 ± 0.34 if Laplacian eigenmaps were applied. By combining the sensitivity method and PCA or Laplacian eigenmaps, the maximum average correlation to MR could be increased to 0.74 ± 0.21 and 0.70 ± 0.19, respectively. The selection of the best PET-based signal for each patient yielded an average correlation of 0.80 ± 0.13 with MR. Using the best PET-based respiratory signal for gating, mean tracer uptake increased by 17 ± 19% for gating, 13 ± 10% for MR-based motion correction, and 18 ± 15% for PET-based motion correction, compared with the static images. Lesion volumes were 76 ± 31%, 83 ± 18%, and 74 ± 22% of the sizes in the static images for gating, MR-based motion correction, and PET-based motion correction, respectively. CONCLUSION: Respiratory traces extracted from MR and PET data are comparable to those based on external sensors. The proposed PET-driven gating method improved respiratory signals and overall stability. Consistent results from MR- and PET-based correction methods enable more flexible PET/MR scan protocols while achieving higher PET image quality.

Self-gated MRI motion modeling for respiratory motion compensation in integrated PET/MRI.

Accurate localization and uptake quantification of lesions in the chest and abdomen using PET imaging is challenged by respiratory motion occurring during the exam. This work describes how a stack-of-stars MRI acquisition on integrated PET/MRI systems can be used to derive a high-resolution motion model, how many respiratory phases need to be differentiated, how much MRI scan time is required, and how the model is employed for motion-corrected PET reconstruction. MRI self-gating is applied to perform respiratory gating of the MRI data and simultaneously acquired PET raw data. After gated PET reconstruction, the MRI motion model is used to fuse the individual gates into a single, motion-compensated volume with high signal-to-noise ratio (SNR). The proposed method is evaluated in vivo for 15 clinical patients. The gating requires 5-7 bins to capture the motion to an average accuracy of 2mm. With 5 bins, the motion-modeling scan can be shortened to 3-4 min. The motion-compensated reconstructions show significantly higher accuracy in lesion quantification in terms of standardized uptake value (SUV) and different measures of lesion contrast compared to ungated PET reconstruction. Furthermore, unlike gated reconstructions, the motion-compensated reconstruction does not lead to SNR loss.

An SPM8-based approach for attenuation correction combining segmentation and nonrigid template formation: application to simultaneous PET/MR brain imaging.

UNLABELLED: We present an approach for head MR-based attenuation correction (AC) based on the Statistical Parametric Mapping 8 (SPM8) software, which combines segmentation- and atlas-based features to provide a robust technique to generate attenuation maps (µ maps) from MR data in integrated PET/MR scanners. METHODS: Coregistered anatomic MR and CT images of 15 glioblastoma subjects were used to generate the templates. The MR images from these subjects were first segmented into 6 tissue classes (gray matter, white matter, cerebrospinal fluid, bone, soft tissue, and air), which were then nonrigidly coregistered using a diffeomorphic approach. A similar procedure was used to coregister the anatomic MR data for a new subject to the template. Finally, the CT-like images obtained by applying the inverse transformations were converted to linear attenuation coefficients to be used for AC of PET data. The method was validated on 16 new subjects with brain tumors (n = 12) or mild cognitive impairment (n = 4) who underwent CT and PET/MR scans. The µ maps and corresponding reconstructed PET images were compared with those obtained using the gold standard CT-based approach and the Dixon-based method available on the Biograph mMR scanner. Relative change (RC) images were generated in each case, and voxel- and region-of-interest-based analyses were performed. RESULTS: The leave-one-out cross-validation analysis of the data from the 15 atlas-generation subjects showed small errors in brain linear attenuation coefficients (RC, 1.38% ± 4.52%) compared with the gold standard. Similar results (RC, 1.86% ± 4.06%) were obtained from the analysis of the atlas-validation datasets. The voxel- and region-of-interest-based analysis of the corresponding reconstructed PET images revealed quantification errors of 3.87% ± 5.0% and 2.74% ± 2.28%, respectively. The Dixon-based method performed substantially worse (the mean RC values were 13.0% ± 10.25% and 9.38% ± 4.97%, respectively). Areas closer to the skull showed the largest improvement. CONCLUSION: We have presented an SPM8-based approach for deriving the head µ map from MR data to be used for PET AC in integrated PET/MR scanners. Its implementation is straightforward and requires only the morphologic data acquired with a single MR sequence. The method is accurate and robust, combining the strengths of both segmentation- and atlas-based approaches while minimizing their drawbacks.

An integrated bioimpedance--ECG gating technique for respiratory and cardiac motion compensation in cardiac PET.

Respiratory motion may degrade image quality in cardiac PET imaging. Since cardiac PET studies often involve cardiac gating by ECG, a separate respiratory monitoring system is required increasing the logistic complexity of the examination, in case respiratory gating is also needed. Thus, we investigated the simultaneous acquisition of both respiratory and cardiac gating signals using II limb lead mimicking electrode configuration during cardiac PET scans of 11 patients. In addition to conventional static and ECG-gated images, bioimpedance technique was utilized to generate respiratory- and dual-gated images. The ability of the bioimpedance technique to monitor intrathoracic respiratory motion was assessed estimating cardiac displacement between end-inspiration and -expiration. The relevance of dual gating was evaluated in left ventricular volume and myocardial wall thickness measurements. An average 7.6 ± 3.3 mm respiratory motion was observed in the study population. Dual gating showed a small but significant increase (4 ml, p = 0.042) in left ventricular myocardial volume compared to plain cardiac gating. In addition, a thinner myocardial wall was observed in dual-gated images (9.3 ± 1.3 mm) compared to cardiac-gated images (11.3 ± 1.3 mm, p = 0.003). This study shows the feasibility of bioimpedance measurements for dual gating in a clinical setting. The method enables simultaneous acquisition of respiratory and cardiac gating signals using a single device with standard ECG electrodes.

Systematic Comparison of the Performance of Integrated Whole-Body PET/MR Imaging to Conventional PET/CT for ¹8F-FDG Brain Imaging in Patients Examined for Suspected Dementia.

UNLABELLED: Technologic specifications of recently introduced integrated PET/MR instrumentation, such as MR-based attenuation correction, may particularly affect brain imaging procedures. To evaluate the qualitative performance of PET/MR in clinical neuroimaging, we systematically compared results obtained with integrated PET/MR with conventional PET/CT in the same patients examined for assessment of cognitive impairment. METHODS: Thirty patients underwent a single-injection ((18)F-FDG), dual-imaging protocol including PET/CT and integrated PET/MR imaging in randomized order. Attenuation and scatter correction were performed using low-dose CT for the PET/CT and segmented Dixon MR imaging data for the PET/MR. Differences between PET/MR and PET/CT were assessed via region-of-interest (ROI)-based and voxel-based statistical group comparison. Analyses involved attenuation-corrected (AC) and non-attenuation-corrected (NAC) data. Individual PET/MR and PET/CT datasets were compared versus a predefined independent control population, using 3-dimensional stereotactic surface projections. RESULTS: Generally, lower measured PET signal values were obtained throughout the brain in ROI-based quantification of the PET signal for PET/MR as compared with PET/CT in AC and NAC data, independently of the scan order. After elimination of global effects, voxel-based and ROI-based group comparison still revealed significantly lower relative tracer signal in PET/MR images in frontoparietal portions of the neocortex but significantly higher relative signal in subcortical and basal regions of the brain than the corresponding PET/CT images of the AC data. In the corresponding NAC images, the discrepancies in frontoparietal portions of the neocortex were diminished, but the subcortical overestimation of tracer intensity by PET/MR persisted. CONCLUSION: Considerable region-dependent differences were observed between brain imaging data acquired on the PET/MR, compared with corresponding PET/CT images, in patients evaluated for neurodegenerative disorders. These findings may only in part be explained by inconsistencies in the attenuation-correction procedures. The observed differences may interfere with semiquantitative evaluation and with individual qualitative clinical assessment and they need to be considered, for example, for clinical trials. Improved attenuation-correction algorithms and a PET/MR-specific healthy control database are recommended for reliable and consistent application of PET/MR for clinical neuroimaging.

PET/MR imaging in the detection and characterization of pulmonary lesions: technical and diagnostic evaluation in comparison to PET/CT.

UNLABELLED: Fully integrated PET/MR imaging holds great promise as a novel hybrid imaging modality in oncology and might offer advantages to PET/CT in many instances, especially because of the superior soft-tissue contrast of MR imaging, compared with CT. However, lung metastases are a frequent finding in oncologic patients, and for imaging of the lung CT is still the modality of choice. Thus, we prospectively evaluated differences in quality, detection rate, size, and radiotracer uptake of pulmonary lesions in (18)F-FDG PET/CT and PET/MR imaging. METHODS: Institutional review board approval and informed consent were obtained. Forty patients (23 men, 17 women; mean age ± SD, 53.2 ± 13.1 y) underwent a single-injection dual-imaging protocol with (18)F-FDG PET/CT and PET/MR imaging. Pulse sequences for the lung included T1-weighted VIBE (volumetric interpolated breath-hold examination) Dixon for attenuation correction and contrast-enhanced VIBE pulse sequences. All patients underwent a diagnostic CT of the chest in deep inspiration, which also served as a standard of reference. Two masked readers assessed in consensus all images randomly concerning quality, detection, standardized uptake value (SUV), and size of pulmonary nodules. Correlations were performed using linear correlation. RESULTS: Overall, 47 pulmonary lesions (mean size ± SD, 10.0 ± 11.4 mm; range, 2-60 mm) in 25 of 40 patients were detected. The PET datasets of PET/MR imaging and PET/CT revealed 22 of 47 pulmonary lesions with focal (18)F-FDG uptake. SUVs of lung lesions in PET/MR imaging and PET/CT correlated significantly (R = 0.9; P = 0.0001) and showed no significant difference (mean SUV PET/MR imaging, 6.3; PET/CT, 5.1; P = 0.388). There was a significantly lower image quality comparing Dixon and VIBE sequence with CT whereas PET from PET/CT and PET from PET/MR imaging showed the same results (2.8). Dixon images detected 15 of 47 lung lesions whereas VIBE images detected 32 of 47 lesions, respectively. The detection rates for small lung lesions less than 1 cm in diameter (n = 33) of MR imaging was significantly lower, with a detection rate of 9 of 33 for the Dixon sequence and 15 of 33 for the VIBE sequence (P < 0.0001 for VIBE and Dixon sequence). There was a high correlation of pulmonary lesion size of CT versus VIBE (R = 0.97). CONCLUSION: PET image quality and detection rate of (18)F-FDG-positive lung lesions in PET/MR imaging is equivalent to PET/CT despite differences in attenuation-correction techniques. Additionally, a high linear correlation coefficient in the SUVs for the PET images from PET/CT and PET/MR imaging was found. The detection rate of lung lesions can be significantly improved by adding a diagnostic contrast-enhanced VIBE sequence to the PET/MR imaging protocol. However, the detection rate of small lung lesions is still inferior, compared with PET/CT with diagnostic CT of the chest.

Performance of whole-body integrated 18F-FDG PET/MR in comparison to PET/CT for evaluation of malignant bone lesions.

UNLABELLED: Because of its higher soft-tissue contrast, whole-body integrated PET/MR offers potential advantages over PET/CT for evaluation of bone lesions. However, unlike PET/CT, PET/MR ignores the contribution of cortical bone in the attenuation map. Thus, the aims of this study were to evaluate the diagnostic performance of whole-body integrated (18)F-FDG PET/MR specifically for bone lesions and to analyze differences in standardized uptake value (SUV) quantification between PET/MR and PET/CT. METHODS: One hundred nineteen patients with (18)F-FDG-avid primary malignancies underwent a single-injection, dual-imaging protocol using (18)F-FDG on a PET/CT scanner and a subsequent PET/MR scan with a T1-weighted volumetric interpolated breath-hold examination (VIBE) Dixon sequence for attenuation correction and an unenhanced coronal T1-weighted turbo spin-echo (TSE) sequence for bone analysis. Three sets of images (CT with PET [from PET/CT; set A], T1-weighted VIBE Dixon with PET [set B], and T1-weighted TSE with PET [both from PET/MR; set C]) were analyzed. Two readers rated every lesion using a 4-point scale for lesion conspicuity on PET, a 4-point scale for anatomic allocation of PET-positive lesions, and a 5-point scale for the nature of every lesion based on its appearance on morphologic imaging and uptake on PET. For all lesions and for representative regions of normal bone, SUV analysis was performed for PET/MR and PET/CT. RESULTS: In total, 98 bone lesions were identified in 33 of 119 patients, and 630 regions of normal bone were analyzed. Visual lesion conspicuity on PET was comparable for PET/CT (mean rating, 2.82 ± 0.45) and PET/MR (2.75 ± 0.51; P = 0.3095). Anatomic delineation and allocation of suggestive lesions was significantly superior with T1-weighted TSE MRI (mean rating, 2.84 ± 0.42) compared with CT (2.57 ± 0.54, P = 0.0001) or T1-weighted VIBE Dixon MRI (2.57 ± 0.54, P = 0.0002). No significant difference in correct classification of malignant bone lesions was found among sets A (85/90), B (84/90), and C (86/90). For bone lesions and regions of normal bone, a highly significant correlation existed between the mean SUVs for PET/MR and PET/CT (R = 0.950 and 0.917, respectively, each P < 0.001). However, substantially lower mean SUVs were found for PET/MR than for PET/CT both for bone lesions (12.4% ± 15.5%) and for regions of normal bone (30.1% ± 27.5%). CONCLUSION: Compared with PET/CT, fully integrated whole-body (18)F-FDG PET/MR is technically and clinically robust for evaluation of bone lesions despite differences in attenuation correction. PET/MR, including diagnostic T1-weighted TSE sequences, was superior to PET/CT for anatomic delineation and allocation of bone lesions. This finding might be of clinical relevance in selected cases--for example, primary bone tumors, early bone marrow infiltration, and tumors with low uptake on PET. Thus, a diagnostic T1-weighted TSE sequence is recommended as a routine protocol for oncologic PET/MR.

Comparison of integrated whole-body [11C]choline PET/MR with PET/CT in patients with prostate cancer.

PURPOSE: To evaluate the performance of conventional [(11)C]choline PET/CT in comparison to that of simultaneous whole-body PET/MR. METHODS: The study population comprised 32 patients with prostate cancer who underwent a single-injection dual-imaging protocol with PET/CT and subsequent PET/MR. PET/CT scans were performed applying standard clinical protocols (5 min after injection of 793 ± 69 MBq [(11)C]choline, 3 min per bed position, intravenous contrast agent). Subsequently (52 ± 15 min after injection) PET/MR was performed (4 min per bed position). PET images were reconstructed iteratively (OSEM 3D), scatter and attenuation correction of emission data and regional allocation of [(11)C]choline foci were performed using CT data for PET/CT and segmented Dixon MR, T1 and T2 sequences for PET/MR. Image quality of the respective PET scans and PET alignment with the respective morphological imaging modality were compared using a four point scale (0-3). Furthermore, number, location and conspicuity of the detected lesions were evaluated. SUVs for suspicious lesions, lung, liver, spleen, vertebral bone and muscle were compared. RESULTS: Overall 80 lesions were scored visually in 29 of the 32 patients. There was no significant difference between the two PET scans concerning number or conspicuity of the detected lesions (p not significant). PET/MR with T1 and T2 sequences performed better than PET/CT in anatomical allocation of lesions (2.87 ± 0.3 vs. 2.72 ± 0.5; p = 0.005). The quality of PET/CT images (2.97 ± 0.2) was better than that of the respective PET scan of the PET/MR (2.69 ± 0.5; p = 0.007). Overall the maximum and mean lesional SUVs exhibited high correlations between PET/CT and PET/MR (ρ = 0.87 and ρ = 0.86, respectively; both p < 0.001). CONCLUSION: Despite a substantially later imaging time-point, the performance of simultaneous PET/MR was comparable to that of PET/CT in detecting lesions with increased [(11)C]choline uptake in patients with prostate cancer. Anatomical allocation of lesions was better with simultaneous PET/MR than with PET/CT, especially in the bone and pelvis. These promising findings suggest that [(11)C]choline PET/MR might have a diagnostic benefit compared to PET/CT in patients with prostate cancer, and now needs to be further evaluated in prospective trials.

PET/MR in prostate cancer: technical aspects and potential diagnostic value.

PET/MR is a new multimodal imaging technique that is expected to improve diagnostic performance of imaging in conditions in which assessment of changes in soft tissue is important such as prostate cancer. Despite substantial changes in PET technology compared to PET/CT, initial studies have demonstrated that integrated PET/MR provides comparable image quality to that of PET/CT, retaining PET quantification efficacy. In this review we briefly describe technological changes compared to PET/CT that made integrated PET/MR possible, propose acquisition protocols for evaluation of prostate cancer with this new multimodal approach, present initial results concerning the application of PET/MR in prostate cancer, and outline the potential for further clinical applications, focusing on potential incremental value compared to present diagnostic performance.

PET/MR: a paradigm shift.

More than a decade ago, multimodality imaging was introduced into clinical routine with the development of the positron emission tomography (PET)/computed tomography (CT) technique. Since then, PET/CT has been widely accepted in clinical imaging and has emerged as one of the main cancer imaging modalities. With the recent development of combined PET/magnetic resonance (MR) systems for clinical use, a promising new hybrid imaging modality is now becoming increasingly available. The combination of functional information delivered by PET with the morphologic and functional imaging of MR imaging (e.g., diffusion-weighted imaging, dynamic contrast-enhanced MR imaging and MR spectroscopy) offers exciting possibilities for clinical applications as well as basic research. However, the differences between CT and MR imaging are fundamental. This also leads to distinct differences between PET/CT and PET/MR not only regarding image interpretation but also concerning data acquisition, data processing and image reconstruction. This article provides an overview of the principal differences between PET/CT and PET/MR in terms of scanner design and technology, attenuation correction, speed, acquisition protocols, radiation exposure and safety aspects. PET/MR is expected to show advantages over PET/CT in clinical applications in which MR is known to be superior to CT due to its high intrinsic soft tissue contrast. However, as of now, only assumptions can be made about the future clinical role of PET/MR, as data about the performance of PET/MR in the clinical setting are still limited. The possible future clinical use of PET/MR in oncology, neurology and neurooncology, cardiology and imaging of inflammation is discussed.

Evaluation of feasibility and image quality of 68Ga-DOTATOC positron emission tomography/magnetic resonance in comparison with positron emission tomography/computed tomography in patients with neuroendocrine tumors.

OBJECTIVES: The primary aims of this study were to evaluate the feasibility of simultaneous 68(DOTA(0)-Phe(1)-Tyr(3))octreotide positron emission tomography (PET)/magnetic resonance (MR) acquisition on a fully integrated PET/MR scanner in patients and to compare the quality of PET images acquired with a PET/MR device with those acquired with a PET/computed tomography (CT) scanner. PATIENTS AND METHODS: Sequential PET/CT and PET/MR imaging was performed in 24 patients with neuroendocrine tumors using a single-injection/dual-imaging protocol. After intravenous injection of 68Ga-DOTATOC (mean, 120 MBq), PET/CT imaging including low-dose CT was performed at a mean time of 17 minutes post injection, and subsequently, PET/MR imaging including a Dixon sequence for attenuation correction was started at a mean time of 82 minutes post injection. The PET/CT and PET/MR images were analyzed visually using a 4-point scale for quality, coregistration, anatomical correlation, and lesion conspicuity. The standardized uptake value of background organs and focal lesions was measured and compared between the PET/CT and PET/MR acquisitions. RESULTS: 68Ga-DOTATOC PET acquired on the PET/MR delivered images with a good diagnostic quality (average visual rating PET/CT, 2.83; PET/MR, 2.08; P <; 0.01). The standardized uptake value of focal lesions did not differ between the PET/CT and PET/MR acquisitions (P >; 0.3) and correlated in a linear fashion (correlation coefficient ρ = 0.90). Lesion conspicuity was slightly, but significantly, higher on the PET/CT acquisitions (PET/CT, 2.71; PET/MR, 2.62; P = 0.01). Positron emission tomography/MR detected 153 of 157 lesions identified by PET/CT; however, there was no difference in sensitivity on a patient basis or organ system basis. Anatomical correlates for focal PET lesions could significantly more often be delineated using MR Dixon images compared with low-dose CT (average visual rating PET/CT, 1.78; PET/MR, 2.30; P <; 0.01). Coregistration of functional and morphological data was better on PET/MR compared with PET/CT, which, however, did not reach significance (average visual rating PET/CT, 2.17; PET/MR, 2.46; P = 0.10). CONCLUSIONS: 68Ga-DOTATOC PET/MR imaging is feasible in patients, with good image quality, and detectability of focal PET lesions was equivalent to PET/CT on a patient basis and organ system basis. Now, the clinical value of 68Ga-DOTATOC PET/MR with additional diagnostic MR protocols has to be evaluated against PET/CT with multiphase contrast-enhanced CT protocols in future studies.

Self-gated radial MRI for respiratory motion compensation on hybrid PET/MR systems.

Accurate localization and uptake quantification of lesions in the chest and abdomen using PET imaging is challenging due to the respiratory motion during the exam. The advent of hybrid PET/MR systems offers new ways to compensate for respiratory motion without exposing the patient to additional radiation. The use of self-gated reconstructions of a 3D radial stack-of-stars GRE acquisition is proposed to derive a high-resolution MRI motion model. The self-gating signal is used to perform respiratory binning of the simultaneously acquired PET raw data. Matching mu-maps are generated for every bin, and post-reconstruction registration is performed in order to obtain a motion-compensated PET volume from the individual gates. The proposed method is demonstrated in-vivo for three clinical patients. Motion-corrected reconstructions are compared against ungated and gated PET reconstructions. In all cases, motion-induced blurring of lesions in the liver and lung was substantially reduced, without compromising SNR as it is the case for gated reconstructions.

First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses.

UNLABELLED: The recently introduced first integrated whole-body PET/MR scanner allows simultaneous acquisition of PET and MRI data in humans and, thus, may offer new opportunities, particularly regarding diagnostics in oncology. This scanner features major technologic differences from conventional PET/CT devices, including the replacement of photomultipliers with avalanche photodiodes and the need for MRI-based attenuation correction. The aim of this study was to evaluate the comparability of clinical performance between conventional PET/CT and PET/MR in patients with oncologic diseases. METHODS: Thirty-two patients with different oncologic diagnoses underwent a single-injection, dual-imaging protocol consisting of a PET/CT and subsequent PET/MR scan. PET/CT scans were performed according to standard clinical protocols (86 ± 8 min after injection of 401 ± 42 MBq of (18)F-FDG, 2 min/bed position). Subsequently (140 ± 24 min after injection), PET/MR was performed (4 min/bed position). PET images of both modalities were reconstructed iteratively. Attenuation and scatter correction as well as regional allocation of PET findings were performed using low-dose CT data for PET/CT and Dixon MRI sequences for PET/MR. PET/MR and PET/CT were compared visually by 2 teams of observers by rating the number and location of lesions suspicious for malignancy, as well as image quality and alignment. For quantitative comparison, standardized uptake values (SUVs) of the detected lesions and of different tissue types were assessed. RESULTS: Simultaneous PET/MR acquisition was feasible with high quality in short acquisition time (≤ 20 min). No significant difference was found between the numbers of suspicious lesions (n = 80) or lesion-positive patients (n = 20) detected with PET/MR or PET/CT. Anatomic allocation of PET/MR findings by means of the Dixon MRI sequence was comparable to allocation of PET/CT findings by means of low-dose CT. Quantitative evaluation revealed a high correlation between mean SUVs measured with PET/MR and PET/CT in lesions (ρ = 0.93) and background tissue (ρ = 0.92). CONCLUSION: This study demonstrates, for what is to our knowledge the first time, that integrated whole-body PET/MR is feasible in a clinical setting with high quality and in a short examination time. The reliability of PET/MR was comparable to that of PET/CT in allowing the detection of hypermetabolic lesions suspicious for malignancy in patients with oncologic diagnoses. Despite different attenuation correction approaches, tracer uptake in lesions and background correlated well between PET/MR and PET/CT. The Dixon MRI sequences acquired for attenuation correction were found useful for anatomic allocation of PET findings obtained by PET/MR in the entire body. These encouraging results may form the foundation for future studies aiming to define the added value of PET/MR over PET/CT.

Performance measurements of the Siemens mMR integrated whole-body PET/MR scanner.

UNLABELLED: The recently released Biograph mMR is the first commercially available integrated whole-body PET/MR scanner. There are considerable advantages to integrating both modalities in a single scanner that enables truly simultaneous acquisition. However, there are also concerns about the possible degradation of both PET and MR performance in an integrated system. This paper evaluates the performance of the Biograph mMR during independent and simultaneous acquisition of PET and morphologic MR data. METHODS: The NEMA NU 2-2007 protocol was followed for studying the PET performance. The following measurements were performed: spatial resolution; scatter fraction, count losses, and randoms; sensitivity; accuracy of the correction for count losses and randoms; and image quality. The quality control manual of the American College of Radiology was followed for studying the MR performance. The following measurements were performed: geometric accuracy, spatial resolution, low-contrast detectability, signal-to-noise ratio, static field (B(0)) homogeneity, radiofrequency field (B(1)) homogeneity, and radiofrequency noise. RESULTS: An average spatial resolution of 4.3 mm in full width at half maximum was measured at 1 cm offset from the center of the field of view. The system sensitivity was 15.0 kcps/MBq along the center of the scanner. The scatter fraction was 37.9%, and the peak noise-equivalent count rate was 184 kcps at 23.1 kBq/mL. The maximum absolute value of the relative count rate error due to dead-time losses and randoms was 5.5%. The average residual error in scatter and attenuation correction was 12.1%. All MR parameters were within the tolerances defined by the American College of Radiology. B(0) inhomogeneities below 1 ppm were measured in a 120-mm radius. B(1) homogeneity and signal-to-noise ratio were equivalent to those of a standard MR scanner. No radiofrequency interference was detected. CONCLUSION: These results compare favorably with other state-of-the-art PET/CT and PET/MR scanners, indicating that the integration of the PET detectors in the MR scanner and their operation within the magnetic field do not have a perceptible impact on the overall performance. The MR subsystem performs essentially like a standalone system. However, further work is necessary to evaluate the more advanced MR applications, such as functional imaging and spectroscopy.

Image-guided tumor-selective radioiodine therapy of liver cancer after systemic nonviral delivery of the sodium iodide symporter gene.

We reported the induction of tumor-selective iodide uptake and therapeutic efficacy of (131)I in a hepatocellular carcinoma (HCC) xenograft mouse model, using novel polyplexes based on linear polyethylenimine (LPEI), shielded by polyethylene glycol (PEG), and coupled with the epidermal growth factor receptor-specific peptide GE11 (LPEI-PEG-GE11). The aim of the current study in the same HCC model was to evaluate the potential of biodegradable nanoparticle vectors based on pseudodendritic oligoamines (G2-HD-OEI) for systemic sodium iodide symporter (NIS) gene delivery and to compare efficiency and tumor specificity with LPEI-PEG-GE11. Transfection of HCC cells with NIS cDNA, using G2-HD-OEI, resulted in a 44-fold increase in iodide uptake in vitro as compared with a 22-fold increase using LPEI-PEG-GE11. After intravenous application of G2-HD-OEI/NIS HCC tumors accumulated 6-11% ID/g (123)I (percentage of the injected dose per gram tumor tissue) with an effective half-life of 10 hr (tumor-absorbed dose, 281 mGy/MBq) as measured by (123)I scintigraphic gamma camera or single-photon emission computed tomography computed tomography (SPECT CT) imaging, as compared with 6.5-9% ID/g with an effective half-life of only 6 hr (tumor-absorbed dose, 47 mGy/MBq) for LPEI-PEG-GE11. After only two cycles of G2-HD-OEI/NIS/(131)I application, a significant delay in tumor growth was observed with markedly improved survival. A similar degree of therapeutic efficacy had been observed after four cycles of LPEI-PEG-GE11/(131)I. These results clearly demonstrate that biodegradable nanoparticles based on OEI-grafted oligoamines show increased efficiency for systemic NIS gene transfer in an HCC model with similar tumor selectivity as compared with LPEI-PEG-GE11, and therefore represent a promising strategy for NIS-mediated radioiodine therapy of HCC.