Coronary artery 18F-NaF PET analysis with the use of an elastic motion correction software.

INTRODUCTION: 18F-Sodium Fluoride Positron Emission Tomography (18F-NaF PET) is a novel molecular imaging modality with promise for use as a risk stratification tool in cardiovascular disease. There are limitations in the analysis of small and rapidly moving coronary arteries using traditional PET technology. We aimed to validate the use of a motion correction algorithm (eMoco) on coronary 18F-NaF PET outcome parameters. METHODS: Patients admitted with an acute coronary syndrome underwent 18F-NaF PET and computed tomography coronary angiography. 18F-NaF PET data were analyzed using a diastolic reconstruction, an ungated reconstruction and the eMoco reconstruction. RESULTS: Twenty patients underwent 18F-NaF PET imaging and 17 patients had at least one positive lesion that could be used to compare PET reconstruction datasets. eMoco improved noise (the coefficient of variation of the blood pool radiotracer activity) compared to the diastolic dataset (0.09 [0.07 to 0.12] vs 0.14[0.11 to 0.17], p < .001) and marginally improved coronary lesion maximum tissue-to-background ratios compared to the ungated dataset (1.33 [1.05 to 1.48]vs 1.29 [1.04 to 1.40], p = .011). CONCLUSION: In this pilot dataset, the eMoco reconstruction algorithm for motion correction appears to have potential in improving coronary analysis of 18F-NaF PET by reducing noise and increasing maximum counts. Further testing in a larger patient dataset is warranted.

Improving diagnostic precision in amyloid brain PET imaging through data-driven motion correction.

BACKGROUND: Head motion during brain positron emission tomography (PET)/computed tomography (CT) imaging degrades image quality, resulting in reduced reading accuracy. We evaluated the performance of a head motion correction algorithm using 18F-flutemetamol (FMM) brain PET/CT images. METHODS: FMM brain PET/CT images were retrospectively included, and PET images were reconstructed using a motion correction algorithm: (1) motion estimation through 3D time-domain signal analysis, signal smoothing, and calculation of motion-free intervals using a Merging Adjacent Clustering method; (2) estimation of 3D motion transformations using the Summing Tree Structural algorithm; and (3) calculation of the final motion-corrected images using the 3D motion transformations during the iterative reconstruction process. All conventional and motion-corrected PET images were visually reviewed by two readers. Image quality was evaluated using a 3-point scale, and the presence of amyloid deposition was interpreted as negative, positive, or equivocal. For quantitative analysis, we calculated the uptake ratio (UR) of 5 specific brain regions, with the cerebellar cortex as a reference region. The results of the conventional and motion-corrected PET images were statistically compared. RESULTS: In total, 108 sets of FMM brain PET images from 108 patients (34 men and 74 women; median age, 78 years) were included. After motion correction, image quality significantly improved (p < 0.001), and there were no images of poor quality. In the visual analysis of amyloid deposition, higher interobserver agreements were observed in motion-corrected PET images for all specific regions. In the quantitative analysis, the UR difference between the conventional and motion-corrected PET images was significantly higher in the group with head motion than in the group without head motion (p = 0.016). CONCLUSIONS: The motion correction algorithm provided better image quality and higher interobserver agreement. Therefore, we suggest that this algorithm be adopted as a routine post-processing protocol in amyloid brain PET/CT imaging and applied to brain PET scans with other radiotracers.

Respiratory and cardiac motion correction in positron emission tomography using elastic motion approach for simultaneous abdomen and thorax positron emission tomography-magnetic resonance imaging.

Background: Cardiac and respiratory motions in clinical positron emission tomography (PET) are a major contributor to inaccurate PET quantification and lesion characterisation. In this study, an elastic motion-correction (eMOCO) technique based on mass preservation optical flow is adapted and investigated for positron emission tomography-magnetic resonance imaging (PET-MRI) applications. Methods: The eMOCO technique was investigated in a motion management QA phantom and in twenty-four patients who underwent PET-MRI for dedicated liver imaging and nine patients for cardiac PET-MRI evaluation. Acquired data were reconstructed with eMOCO and gated motion correction techniques at cardiac, respiratory and dual gating modes, and compared to static images. Standardized uptake value (SUV), signal-to-noise ratio (SNR) of lesion activities from each gating mode and correction technique were measured and their means/standard deviation (SD) were compared using 2-ways ANOVA analysis and post-hoc Tukey's test. Results: Lesions' SNR are highly recovered from phantom and patient studies. The SD of the SUV resulted from the eMOCO technique was statistically significantly less (P<0.01) than the SD resulted from conventional gated and static SUVs at the liver, lung and heart. Conclusions: The eMOCO technique was successfully implemented in PET-MRI in a clinical setting and produced the lowest SD compared to gated and static images, and hence provided the least noisy PET images. Therefore, the eMOCO technique can potentially be used on PET-MRI for improved respiratory and cardiac motion correction.

Assessment of motion and model bias on the detection of dopamine response to behavioral challenge.

Compartmental modeling analysis of 11C-raclopride (RAC) PET data can be used to measure the dopaminergic response to intra-scan behavioral tasks. Bias in estimates of binding potential (BPND) and its dynamic changes (ΔBPND) can arise both when head motion is present and when the compartmental model used for parameter estimation deviates from the underlying biology. The purpose of this study was to characterize the effects of motion and model bias within the context of a behavioral task challenge, examining the impacts of different mitigation strategies. Seventy healthy adults were administered bolus plus constant infusion RAC during a simultaneous PET/magnetic resonance (MR) scan with a reward task experiment. BPND and ΔBPND were estimated using an extension of the Multilinear Reference Tissue Model (E-MRTM2) and a new method (DE-MRTM2) was proposed to selectively discount the contribution of the initial uptake period. Motion was effectively corrected with a standard frame-based approach, which performed equivalently to a more complex reconstruction-based approach. DE-MRTM2 produced estimates of ΔBPND in putamen and nucleus accumbens that were significantly different from those estimated from E-MRTM2, while also decoupling ΔBPND values from first-pass k2' estimation and removing skew in the spatial bias distribution of parametric ΔBPND estimates within the striatum.

Fabrication of Flexible pH-Responsive Agarose/Succinoglycan Hydrogels for Controlled Drug Release.

Agarose/succinoglycan hydrogels were prepared as pH-responsive drug delivery systems with significantly improved flexibility, thermostability, and porosity compared to agarose gels alone. Agarose/succinoglycan hydrogels were made using agarose and succinoglycan, a polysaccharide directly isolated from Sinorhizobium meliloti. Mechanical and physical properties of agarose/succinoglycan hydrogels were investigated using various instrumental methods such as rheological measurements, attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopic analysis, X-ray diffraction (XRD), and field-emission scanning electron microscopy (FE-SEM). The results showed that the agarose/succinoglycan hydrogels became flexible and stable network gels with an improved swelling pattern in basic solution compared to the hard and brittle agarose gel alone. In addition, these hydrogels showed a pH-responsive delivery of ciprofloxacin (CPFX), with a cumulative release of ~41% within 35 h at pH 1.2 and complete release at pH 7.4. Agarose/succinoglycan hydrogels also proved to be non-toxic as a result of the cell cytotoxicity test, suggesting that these hydrogels would be a potential natural biomaterial for biomedical applications such as various drug delivery system and cell culture scaffolds.

Impact of respiratory motion correction on lesion visibility and quantification in thoracic PET/MR imaging.

The impact of a method for MR-based respiratory motion correction of PET data on lesion visibility and quantification in patients with oncologic findings in the lung was evaluated. Twenty patients with one or more lesions in the lung were included. Hybrid imaging was performed on an integrated PET/MR system using 18F-FDG as radiotracer. The standard thoracic imaging protocol was extended by a free-breathing self-gated acquisition of MR data for motion modelling. PET data was acquired simultaneously in list-mode for 5-10 mins. One experienced radiologist and one experienced nuclear medicine specialist evaluated and compared the post-processed data in consensus regarding lesion visibility (scores 1-4, 4 being best), image noise levels (scores 1-3, 3 being lowest noise), SUVmean and SUVmax. Motion-corrected (MoCo) images were additionally compared with gated images. Non-motion-corrected free-breathing data served as standard of reference in this study. Motion correction generally improved lesion visibility (3.19 ± 0.63) and noise ratings (2.95 ± 0.22) compared to uncorrected (2.81 ± 0.66 and 2.95 ± 0.22, respectively) or gated PET data (2.47 ± 0.93 and 1.30 ± 0.47, respectively). Furthermore, SUVs (mean and max) were compared for all methods to estimate their respective impact on the quantification. Deviations of SUVmax were smallest between the uncorrected and the MoCo lesion data (average increase of 9.1% of MoCo SUVs), while SUVmean agreed best for gated and MoCo reconstructions (MoCo SUVs increased by 1.2%). The studied method for MR-based respiratory motion correction of PET data combines increased lesion sharpness and improved lesion activity quantification with high signal-to-noise ratio in a clinical setting. In particular, the detection of small lesions in moving organs such as the lung and liver may thus be facilitated. These advantages justify the extension of the PET/MR imaging protocol by 5-10 minutes for motion correction.

Comparison of two elastic motion correction approaches for whole-body PET/CT: motion deblurring vs gate-to-gate motion correction.

BACKGROUND: Respiratory motion in PET/CT leads to well-known image degrading effects commonly compensated using elastic motion correction approaches. Gate-to-gate motion correction techniques are promising tools for improving clinical PET data but suffer from relatively long reconstruction times. In this study, the performance of a fast elastic motion compensation approach based on motion deblurring (DEB-MC) was evaluated on patient and phantom data and compared to an EM-based fully 3D gate-to-gate motion correction method (G2G-MC) which was considered the gold standard. METHODS: Twenty-eight patients were included in this study with suspected or confirmed malignancies in the thorax or abdomen. All patients underwent whole-body [18F]FDG PET/CT examinations applying hardware-based respiratory gating. In addition, a dynamic anthropomorphic thorax phantom was studied with PET/CT simulating tumour motion under controlled but realistic conditions. PET signal recovery values were calculated from phantom scans by comparing lesion activities after motion correction to static ground truth data. Differences in standardized uptake values (SUV) and metabolic volume (MV) between both reconstruction methods as well as between motion-corrected (MC) and non motion-corrected (NOMC) results were statistically analyzed using a Wilcoxon signed-rank test. RESULTS: Phantom data analysis showed high lesion recovery values of 91% (2 cm motion) and 98% (1 cm) for G2G-MC and 83% (2 cm) and 90% (1 cm) for DEB-MC. The statistical analysis of patient data found significant differences between NOMC and MC reconstructions for SUV max, SUV mean, MV, and contrast-to-noise ratio (CNR) for both reconstruction algorithms. Furthermore, both methods showed similar increases of 11-12% in SUV max and SUV mean after MC. The statistical analysis of the MC/NOMC ratio found no significant differences between the methods. CONCLUSION: Both motion correction techniques deliver comparable improvements of SUV max, SUV mean, and CNR after MC on clinical and phantom data. The fast elastic motion compensation technique DEB-MC may thereby be a valuable alternative to state-of-the art motion correction techniques.

A fusion PET-MRI system with a high-resolution research tomograph-PET and ultra-high field 7.0 T-MRI for the molecular-genetic imaging of the brain.

We have developed a positron emission tomography (PET) and magnetic resonance imaging (MRI) fusion system for the molecular-genetic imaging (MGI) of the in vivo human brain using two high-end imaging devices: the HRRT-PET, a high-resolution research tomograph dedicated to brain imaging on the molecular level, and the 7.0 T-MRI, an ultra-high field version used for morphological imaging. HRRT-PET delivers high-resolution molecular imaging with a resolution down to 2.5 mm full width at half maximum (FWHM), which allows us to observe the brain's molecular changes using the specific reporter genes and probes. On the other front, the 7.0 T-MRI, with submillimeter resolution images of the cortical areas down to 250 mum, allows us to visualize the fine details of the brainstem areas as well as the many cortical and subcortical areas. The new PET-MRI fusion imaging system will provide many answers to the questions on neurological diseases as well as cognitive neurosciences. Some examples of the answers are the quantitative visualization of neuronal functions by clear molecular and genetic bases, as well as diagnoses of many neurological diseases such as Parkinson's and Alzheimer's. The salient point of molecular-genetic imaging and diagnosis is the fact that they precede the morphological manifestations, and hence, the early and specific diagnosis of certain diseases, such as cancers.

Ascending Aortic Endoballoon Occlusion Feasible Despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery.

OBJECTIVE: Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm. METHODS: A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia. RESULTS: From October 2011 through June 2015, 196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1-46.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure. CONCLUSIONS: Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.

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.

LSO background radiation as a transmission source using time of flight.

LSO scintillators (Lu2Sio5:Ce) have a background radiation which originates from the isotope Lu-176 that is present in natural occurring lutetium. The decay that occurs in this isotope is a beta decay that is in coincidence with cascade gamma emissions with energies of 307,202 and 88 keV. The coincidental nature of the beta decay with the gamma emissions allow for separation of emission data originating from a positron annihilation event from transmission type data from the Lu-176 beta decay. By using the time of flight information, and information of the chord length between two LSO pixels in coincidence as a result of a beta emission and emitted gamma, a second time window can be set to observe transmission events simultaneously to emission events. Using the time when the PET scanner is not actively acquiring positron emission data, a continuous blank can be acquired and used to reconstruct a transmission image. With this blank and the measured transmission data, a transmission image can be reconstructed. This reconstructed transmission image can be used to perform emission data corrections such as attenuation correction and scatter corrections or starting images for algorithms that estimate emission and attenuation simultaneously. It is observed that the flux of the background activity is high enough to create useful transmission images with an acquisition time of 10 min.

Complementary frame reconstruction: a low-biased dynamic PET technique for low count density data in projection space.

A new data handling method is presented for improving the image noise distribution and reducing bias when reconstructing very short frames from low count dynamic PET acquisition. The new method termed 'Complementary Frame Reconstruction' (CFR) involves the indirect formation of a count-limited emission image in a short frame through subtraction of two frames with longer acquisition time, where the short time frame data is excluded from the second long frame data before the reconstruction. This approach can be regarded as an alternative to the AML algorithm recently proposed by Nuyts et al, as a method to reduce the bias for the maximum likelihood expectation maximization (MLEM) reconstruction of count limited data. CFR uses long scan emission data to stabilize the reconstruction and avoids modification of algorithms such as MLEM. The subtraction between two long frame images, naturally allows negative voxel values and significantly reduces bias introduced in the final image. Simulations based on phantom and clinical data were used to evaluate the accuracy of the reconstructed images to represent the true activity distribution. Applicability to determine the arterial input function in human and small animal studies is also explored. In situations with limited count rate, e.g. pediatric applications, gated abdominal, cardiac studies, etc., or when using limited doses of short-lived isotopes such as 15O-water, the proposed method will likely be preferred over independent frame reconstruction to address bias and noise issues.

Reconstruction of scattered and unscattered PET coincidences using TOF and energy information.

In positron emission tomography (PET), a typical reconstruction algorithm relies on a method to estimate and subtract the scatter from the net trues coincidences. The remaining unscattered coincidences are then used to reconstruct an image of the original activity distribution. The introduction of time-of-flight (TOF) PET opens the possibility to change this scheme, and use the spatial information carried by the scattered events for the reconstruction. The combined knowledge of TOF difference and detected photon energy provides spatial information on the position of the source even after single scattering, and can be used for the reconstruction of scattered photons, using a 'scatter back projector' in addition to the conventional 'trues back projector'. In the scatter back projector, the scattering angle is derived from the energy of the scattered photon through Compton kinematics, and this identifies a set of possible scattering trajectories, or 'broken' line of response (LOR). The TOF information localizes the position of the source along the set of broken LOR. The advantages of this proposed method are twofold: including the spatial information about the origin of the scattered pairs could improve the image quality particularly in low count datasets; and the threshold of the energy window can be lowered to include more scatter, thus increasing sensitivity. In this work, this novel approach to scatter in PET is introduced, different implementations are discussed, and the performance of a preliminary version of the 'scatter back projector' is presented.

Coexistence of ergodicity and nonergodicity in LaFeO3-modified Bi(1/2)(Na(0.78)K(0.22))(1/2)TiO3 relaxors.

The effect of LaFeO(3) addition to Bi(1/2)(Na(0.78)K(0.22))(1/2)TiO(3) ceramics on the phase stability and macroscopic functional properties was investigated. Similarly to other chemical modifiers known in the literature, LaFeO(3) addition suppresses an electric-field-induced long-range ferroelectric order, giving rise to a giant unipolar strain of ~0.3% at 2 mol% LaFeO(3) addition. Time-dependent changes in polarization and strain hysteresis loops both during successive electrical cycling and after removal of the electric field suggest that a specimen with 2 mol% LaFeO(3) consists of both ergodic and nonergodic phases, which is unique among the known relaxor materials.