Modeling magnetization transfer effects of Q2TIPS bolus saturation in multi-TI pulsed arterial spin labeling.

PURPOSE: To estimate the relaxation time changes during Q2TIPS bolus saturation caused by magnetization transfer effects and to propose and evaluate an extended model for perfusion quantification which takes this into account. METHOD: Three multi inversion-time pulsed arterial spin labeling sequences with different bolus saturation duration were acquired for five healthy volunteers. Magnetization transfer exchange rates in tissue and blood were obtained from control image saturation recovery. Cerebral blood flow (CBF) obtained using the extended model and the standard model was compared. RESULTS: A decrease of obtained CBF of 6% (10%) was observed in grey matter when the duration of bolus saturation increased from 600 to 900 ms (1200 ms). This decrease was reduced to 1.6% (2.8%) when the extended quantification model was used. Compared with the extended model, the standard model underestimated CBF in grey matter by 9.7, 15.0, and 18.7% for saturation durations 600, 900, and 1200 ms, respectively. Results for simulated single inversion-time data showed 5-16% CBF underestimation depending on blood arrival time and bolus saturation duration. CONCLUSION: Magnetization transfer effects caused by bolus saturation pulses should not be ignored when performing quantification as they can cause appreciable underestimation of the CBF.

Partial volume correction in arterial spin labeling using a Look-Locker sequence.

PURPOSE: Partial volume (PV) effects are caused by limited spatial resolution and significantly affect cerebral blood flow investigations with arterial spin labeling. Therefore, accurate PV correction (PVC) procedures are required. PVC is commonly based on PV maps obtained from segmented high-resolution T1 -weighted images. Segmentation of these images is error-prone, and it can be difficult to coregister these images accurately with the single-shot ASL images such as those created by echo-planar imaging (EPI). In this paper, an alternative method for PV map generation is proposed. METHODS: The Look-Locker EPI (LL-EPI) acquisition is used for analyzing the T1 -recovery curve and for subsequent PV map generation. The new method was evaluated in five healthy volunteers (mean age 30 ± 3.7 years). RESULTS: By applying a linear regression method for PVC, a 12% decrease in regression error was reached with the new method. CONCLUSION: PV maps extraction from LL-EPI is a viable, possibly superior alternative to the standard approach based on segmentation of high-resolution T1 -weighted images.

PET/MRI in head and neck cancer: initial experience.

PURPOSE: To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG ((18)F-fluorodeoxyglucose) for initial staging of head and neck cancer. METHODS: The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267-395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUV(max)) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets. RESULTS: No MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUV(max) than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001). CONCLUSION: The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality.

PET/MR for therapy response evaluation in malignant lymphoma: initial experience.

OBJECT: To evaluate the feasibility of positron emission tomography/magnetic resonance imaging (PET/MR) with (18)fluoro-2-deoxyglucose (FDG) for therapy response evaluation of malignant lymphoma. MATERIALS AND METHODS: Nine patients with malignant lymphoma who underwent FDG-PET/MR before and after chemotherapy were included in this retrospective study. Average time between the two scans was 70 days. The scans were evaluated independently by two nuclear medicine physicians. The Ann Arbor classification was used to describe lymphoma stage. Furthermore, the readers also rated PET image quality using a five point scale. Weighted kappa (κ) was used to calculate interrater agreement. RESULTS: The initial scan showed foci of increased FDG uptake in all patients, with Ann Arbor stage varying between I and IV. In the follow-up examination, all but one patient showed complete response to chemotherapy. PET image quality was rated as very good or excellent for all scans. Interrater agreement was excellent regarding Ann Arbor stage (κ = 0.97) and good regarding image quality (κ = 0.41). CONCLUSION: PET/MR shows promising initial results for therapy response evaluation in lymphoma patients.

Quantitative accuracy of attenuation correction in the Philips Ingenuity TF whole-body PET/MR system: a direct comparison with transmission-based attenuation correction.

OBJECTIVE: Evaluation of the quantitative accuracy of MR-based attenuation correction (MRAC) in the Philips Ingenuity TF whole-body PET/MR. MATERIALS AND METHODS: In 13 patients, PET emission data from the PET/MR were reconstructed using two different methods for attenuation correction. In the first reconstruction, the vendor-provided standard MRAC was used. In the second reconstruction, a coregistered transmission-based attenuation map from a second immediately preceding investigation with a stand-alone Siemens ECAT EXACT HR(+) PET scanner was used (TRAC). The two attenuation maps were compared regarding occurrence of segmentation artifacts in the MRAC procedure. Standard uptake values (SUVs) of multiple VOIs (liver, cerebellum, hot focal structures at various locations in the trunk) were compared between both reconstructed data sets. Furthermore, a voxel-wise intensity correlation analysis of both data sets in the lung and trunk was performed. RESULTS: VOI averaged SUV differences between MRAC and TRAC were as follows (relative differences, mean ± standard deviation): (+12 ± 6) % cerebellum, (-4 ± 9) % liver, (-2 ± 11) % hot focal structures. The fitted slopes of the voxel-wise correlations in the lung and trunk were 0.87 ± 0.17 and 0.95 ± 0.10 with averaged adjusted R (2) values of 0.96 and 0.98, respectively. These figures include two instances with partially erroneous lung segmentation due to artifacts in the underlying MR images. CONCLUSION: The MR-based attenuation correction implemented on the Philips Ingenuity PET/MR provides reasonable quantitative accuracy. On average, deviations from TRAC-based results are small (on the order of 10% or below) across the trunk, but due to interindividual variability of the segmentation quality, deviations of more than 20% can occur. Future improvement of the segmentation quality would help to increase the quantitation accuracy further and to reduce the inter-subject variability.

Comparison of dopamine turnover, dopamine influx constant and activity ratio of striatum and occipital brain with ¹8F-dopa brain PET in normal controls and patients with Parkinson's disease.

PURPOSE: The aim of the study was to estimate normal ranges and test-retest measures for various parameters characterising dopamine metabolism from a prolonged (18)F-dopa positron emission tomography (PET) measurement using a reference tissue model and compare their value for the detection of early Parkinson's disease (PD). METHODS: Healthy volunteers (n = 9) and patients (n = 36) in an early stage of PD underwent an (18)F-dopa PET measurement lasting 4 h. The influx rate constant k(occ) and the effective distribution volume ratio (EDVR, its inverse is an indicator for dopamine turnover) were estimated by a graphical approach using dynamic data in the striatum and, as a reference region, the occipital cortex. Furthermore, ratios of activity concentrations between striatum and occipital brain taken for three time intervals completed the data analysis. All parameters were determined both in eight small volumes of interest placed in the striatum as well as averaged for caudate nucleus and putamen. For the control group, reproducibility was checked in a second study 3 months later and ranges for normal values were derived from mean ± 2 standard deviations. Receiver-operating characteristic (ROC) analyses were performed to assess the value of the parameters for diagnostic purposes. RESULTS: Patients with early-stage PD and healthy volunteers could be separated by the values of the putamen, not the caudate nucleus. The normal ranges of the putamen were 0.0151-0.0216/min for the influx rate constant k(occ) and 2.02-3.00 for EDVR. For the various time intervals used the striato-occipital ratios yielded 2.24-3.06, 2.43-3.42 and 2.35-3.21, respectively. Patients were characterised by significantly lower values (p < 0.001) and significant differences between ipsi- and contralateral sides (p < 0.001) with regard to their clinical symptoms and a rostrocaudal gradient. EDVR as well as k(occ) for the putamen were able to effectively differentiate between groups (sensitivity >97%, specificity 100%). In contrast, striato-occipital ratios showed a sensitivity of about only 85%. CONCLUSION: For clinical applications, our data do not demonstrate any superiority of the EDVR determination compared to influx rate constant, while requiring long and tedious acquisition protocols. The normal range estimates do not represent absolute quantitative measures for dopamine metabolism but are specific for the chosen acquisition and processing procedures.

Optimized list-mode acquisition and data processing procedures for ACS2 based PET systems.

PET systems using the acquisition control system version 2 (ACS2), e.g. the ECAT Exact HR PET scanner series, offer a rather restricted list-mode functionality. For instance, typical transfers of acquisition data consume a considerable amount of time. This represents a severe obstacle to the utilization of potential advantages of list-mode acquisition. In our study, we have developed hardware and software solutions which do not only allow for the integration of list-mode into routine procedures, but also improve the overall runtime stability of the system. We show that our methods are able to speed up the transfer of the acquired data to the image reconstruction and processing workstations by a factor of up to 140. We discuss how this improvement allows for the integration of list-mode-based post-processing methods such as an event-driven movement correction into the data processing environment, and how list-mode is able to improve the overall flexibility of PET investigations in general. Furthermore, we show that our methods are also attractive for conventional histogram-mode acquisition, due to the improved stability of the ACS2 system.

Dual time point based quantification of metabolic uptake rates in 18F-FDG PET.

BACKGROUND: Assessment of dual time point (DTP) positron emission tomography was carried out with the aim of a quantitative determination of Km, the metabolic uptake rate of [18F]fluorodeoxyglucose as a measure of glucose consumption. METHODS: Starting from the Patlak equation, it is shown that Km≈mt/ca0+V̄r/τa, where mt is the secant slope of the tissue response function between the dual time point measurements centered at t = t0. ca0=ca(t0) denotes arterial tracer concentration, V̄r is an estimate of the Patlak intercept, and τa is the time constant of the ca(t) decrease. We compared the theoretical predictions with the observed relation between Ks=mt/ca0 and Km in a group of nine patients with liver metastases of colorectal cancer for which dynamic scans were available, and Km was derived from conventional Patlak analysis. Twenty-two lesion regions of interest (ROIs) were evaluated. ca(t) was determined from a three-dimensional ROI in the aorta. Furthermore, the correlation between Km and late standard uptake value (SUV) as well as retention index was investigated. Additionally, feasibility of the approach was demonstrated in a whole-body investigation. RESULTS: Patlak analysis yielded a mean Vr of V̄r=0.53±0.08 ml/ml. The patient averaged τa was 99 ± 23 min. Linear regression between Patlak-derived Km and DTP-derived Ks according to Ks = b · Km + a yielded b = 0.98 ± 0.05 and a = -0.0054 ± 0.0013 ml/min/ml (r = 0.98) in full accordance with the theoretical predictions b = 1 and a≈-V̄r/τa. Ks exhibits better correlation with Km than late SUV and retention index, respectively. Ks(c)=Ks+V̄r/τa is proposed as a quantitative estimator of Km which is independent of patient weight, scan time, and scanner calibration. CONCLUSION: Quantification of Km from dual time point measurements compatible with clinical routine is feasible. The proposed approach eliminates the issues of static SUV and conventional DTP imaging regarding influence of chosen scanning times and inter-study variability of the input function. Ks and Ks(c) exhibit improved stability and better correlation with the true Km. These properties might prove especially relevant in the context of radiation treatment planning and therapy response control.

A method for model-free partial volume correction in oncological PET.

BACKGROUND: As is well known, limited spatial resolution leads to partial volume effects (PVE) and consequently to limited signal recovery. Determination of the mean activity concentration of a target structure is thus compromised even at target sizes much larger than the reconstructed spatial resolution. This leads to serious size-dependent underestimates of true signal intensity in hot spot imaging. For quantitative PET in general and in the context of therapy assessment in particular it is, therefore, mandatory to perform an adequate partial volume correction (PVC). The goal of our work was to develop and to validate a model-free PVC algorithm for hot spot imaging. METHODS: The algorithm proceeds in two automated steps. Step 1: estimation of the actual object boundary with a threshold based method and determination of the total activity A measured within the enclosed volume V. Step 2: determination of the activity fraction B, which is measured outside the object due to the partial volume effect (spill-out). The PVE corrected mean value is then given by Cmean = (A+B)/V. For validation simulated tumours were used which were derived from real patient data (liver metastases of a colorectal carcinoma and head and neck cancer, respectively). The simulated tumours have characteristics (regarding tumour shape, contrast, noise, etc.) which are very similar to those of the underlying patient data, but the boundaries and tracer accumulation are exactly known. The PVE corrected mean values of 37 simulated tumours were determined and compared with the true mean values. RESULTS: For the investigated simulated data the proposed approach yields PVE corrected mean values which agree very well with the true values (mean deviation (± s.d.): (-0.8±2.5)%). CONCLUSIONS: The described method enables accurate quantitative partial volume correction in oncological hot spot imaging.

Suitability of bilateral filtering for edge-preserving noise reduction in PET.

BACKGROUND: To achieve an acceptable signal-to-noise ratio (SNR) in PET images, smoothing filters (SF) are usually employed during or after image reconstruction preventing utilisation of the full intrinsic resolution of the respective scanner. Quite generally Gaussian-shaped moving average filters (MAF) are used for this purpose. A potential alternative to MAF is the group of so-called bilateral filters (BF) which provide a combination of noise reduction and edge preservation thus minimising resolution deterioration of the images. We have investigated the performance of this filter type with respect to improvement of SNR, influence on spatial resolution and for derivation of SUVmax values in target structures of varying size. METHODS: Data of ten patients with head and neck cancer were evaluated. The patients had been investigated by routine whole body scans (ECAT EXACT HR+, Siemens, Erlangen). Tomographic images were reconstructed (OSEM 6i/16s) using a Gaussian filter (full width half maximum (FWHM): Γ0 = 4 mm). Image data were then post-processed with a Gaussian MAF (FWHM: ΓM = 7 mm) and a Gaussian BF (spatial domain: ΓS = 9 mm, intensity domain: ΓI = 2.5 SUV), respectively. Images were assessed regarding SNR as well as spatial resolution. Thirty-four lesions (volumes of about 1-100 mL) were analysed with respect to their SUVmax values in the original as well as in the MAF and BF filtered images. RESULTS: With the chosen filter parameters both filters improved SNR approximately by a factor of two in comparison to the original data. Spatial resolution was significantly better in the BF-filtered images in comparison to MAF (MAF: 9.5 mm, BF: 6.8 mm). In MAF-filtered data, the SUVmax was lower by 24.1 ± 9.9% compared to the original data and showed a strong size dependency. In the BF-filtered data, the SUVmax was lower by 4.6 ± 3.7% and no size effects were observed. CONCLUSION: Bilateral filtering allows to increase the SNR of PET image data while preserving spatial resolution and preventing smoothing-induced underestimation of SUVmax values in small lesions. Bilateral filtering seems a promising and superior alternative to standard smoothing filters.