Search

Background Dual-gating reduces respiratory and cardiac motion effects but increases noise. With motion correction, motion is minimized and image quality preserved. We applied motion correction to create end-diastolic respiratory motion corrected images from dual-gated images. Methods [18F]-fluorodeoxyglucose ([18F]-FDG) PET images of 13 subjects were reconstructed with 4 methods: non-gated, dual-gated, motion corrected, and motion corrected with 4D-CT (MoCo-4D). Image quality was evaluated using standardized uptake values, contrast ratio, signal-to-noise ratio, coefficient of variation, and contrast-to-noise ratio. Motion minimization was evaluated using myocardial wall thickness. Results MoCo-4D showed improvement for contrast ratio (2.83 vs 2.76), signal-to-noise ratio (27.5 vs 20.3) and contrast-to-noise ratio (14.5 vs 11.1) compared to dual-gating. The uptake difference between MoCo-4D and non-gated images was non-significant (P > .05) for the myocardium (2.06 vs 2.15 g/mL), but significant (P < .05) for the blood pool (.80 vs .86 g/mL). Non-gated images had the lowest coefficient of variation (27.3%), with significant increase for all other methods (31.6-32.5%). MoCo-4D showed smallest myocardial wall thickness (16.6 mm) with significant decrease compared to non-gated images (20.9 mm). Conclusions End-diastolic respiratory motion correction and 4D-CT resulted in improved motion minimization and image quality over standard dual-gating.

Abstract In Myocardial Perfusion Imaging (MPI) with Positron Emission Tomography/Computed Tomography (PET/CT) systems, accurate quantification is essential. We assessed flow quantification accuracy over various injected activities using a flow phantom. Methods The study was performed on the digital 4-ring Discovery MI (DMI-20) and analog Discovery 690 (D690) PET/CT systems, using 325-1257 MBq of [15O]H2O. PET performance and flow quantification accuracy were assessed in terms of count-rates, dead-time factors (DTF), scatter fractions (SF), time-activity curves (TACs), areas-under-the-curves (AUCs) and flow values. Results On DMI-20, prompts of 12.8 Mcps, DTF of 2.06 and SF of 46.1% were measured with 1257 MBq of activity. On the D690, prompts of 6.85 Mcps, DTF of 1.57 and SF of 32.5% were measured with 1230 MBq of activity. AUC values were linear over all activities. Mean wash-in flow error was − 9% for both systems whereas wash-out flow error was − 5% and − 6% for DMI-20 and D690. With the highest activity, wash-out flow error was − 12% and − 7% for the DMI-20 and D690. Conclusion DMI-20 and D690 preserved accurate flow quantification over all injected activities, with maximum error of − 12%. In the future, flow quantification accuracy over the activities and count-rates evaluated in this study should be assessed.

Noise and motion artifacts in Positron emission tomography (PET) scans can interfere in diagnosis and result in inaccurate interpretations. PET gating techniques effectively reduce motion blurring, but at the cost of increasing noise, as only a subset of the data is used to reconstruct the image. Deep convolutional neural networks (DCNNs) could complement gating techniques by correcting such noise. However, there is little research on the specific application of DCNNs to gated datasets, which present additional challenges that are not considered in these studies yet, such as the varying level of noise depending on the gate, and performance pitfalls due to changes in the noise properties between non-gated and gated scans. To extend the current status of artificial intelligence (AI) in gated-PET imaging, we present a post-reconstruction denoising approach based on U-Net architectures on cardiac dual-gated PET images obtained from 40 patients. To this end, we first evaluate the denoising performance of four different variants of the U-Net architecture (2D, semi-3D, 3D, Hybrid) on non-gated data to better understand the advantages of each type of model, and to shed more light on the factors to take in consideration when selecting a denoising architecture. Then, we tackle the denoising of gated-PET reconstructions, revising challenges and limitations, and propose two training approaches, which overcome the need for gated targets. Quantification results show that the proposed deep learning (DL) frameworks can successfully reduce noise levels while correctly preserving the original motionless resolution of the gates.

Contrast-enhanced magnetic resonance imaging (MRI) is a promising method for estimating myocardial blood flow (MBF). However, it is often affected by noise from imaging artefacts, such as dark rim artefact obscuring relevant features. Machine learning enables extracting important features from such noisy data and is increasingly applied in areas where traditional approaches are limited. In this study, we investigate the capacity of machine learning, particularly support vector machines (SVM) and random forests (RF), for estimating MBF from tissue impulse response signal in an animal model. Domestic pigs (n = 5) were subjected to contrast enhanced first pass MRI (MRI-FP) and the impulse response at different regions of the myocardium (n = 24/pig) were evaluated at rest (n = 120) and stress (n = 96). Reference MBF was then measured using positron emission tomography (PET). Since the impulse response may include artefacts, classification models based on SVM and RF were developed to discriminate noisy signal. In addition, regression models based on SVM, RF and linear regression (for comparison) were developed for estimating MBF from the impulse response at rest and stress. The classification and regression models were trained on data from 4 pigs (n = 168) and tested on 1 pig (n = 48). Models based on SVM and RF outperformed linear regression, with higher correlation (R SVM 2 = 0.81, R RF 2 = 0.74, R linear_regression 2 = 0.60; ρSVM = 0.76, ρRF = 0.76, ρlinear_regression = 0.71) and lower error (RMSESVM = 0.67 mL/g/min, RMSERF = 0.77 mL/g/min, RMSElinear_regression = 0.96 mL/g/min) for predicting MBF from MRI impulse response signal. Classifier based on SVM was optimal for detecting impulse response signals with artefacts (accuracy = 92%). Modified dual bolus MRI signal, combined with machine learning, has potential for accurately estimating MBF at rest and stress states, even from signals with dark rim artefacts. This could provide a protocol for reliable and easy estimation of MBF, although further research is needed to clinically validate the approach.

The aim of this prospective single-institution clinical trial (NCT02002455) was to evaluate the potential of advanced post-processing methods for 18F-Fluciclovine PET and multisequence multiparametric MRI in the prediction of prostate cancer (PCa) aggressiveness, defined by Gleason Grade Group (GGG). 21 patients with PCa underwent PET/CT, PET/MRI and MRI before prostatectomy. DWI was post-processed using kurtosis (ADCk, K), mono- (ADCm), and biexponential functions (f, Dp, Df) while Logan plots were used to calculate volume of distribution (VT). In total, 16 unique PET (VT, SUV) and MRI derived quantitative parameters were evaluated. Univariate and multivariate analysis were carried out to estimate the potential of the quantitative parameters and their combinations to predict GGG 1 vs >1, using logistic regression with a nested leave-pair out cross validation (LPOCV) scheme and recursive feature elimination technique applied for feature selection. The second order rotating frame imaging (RAFF), monoexponential and kurtosis derived parameters had LPOCV AUC in the range of 0.72 to 0.92 while the corresponding value for VT was 0.85. The best performance for GGG prediction was achieved by K parameter of kurtosis function followed by quantitative parameters based on DWI, RAFF and 18F-FACBC PET. No major improvement was achieved using parameter combinations with or without feature selection. Addition of 18F-FACBC PET derived parameters (VT, SUV) to DWI and RAFF derived parameters did not improve LPOCV AUC.

Background Assessment of myocardial viability is often needed in patients with chest pain and reduced ejection fraction. We evaluated the performance of reduced resting MBF, perfusable tissue fraction (PTF), and perfusable tissue index (PTI) in the assessment of myocardial viability in a pig model of myocardial infarction (MI). Methods and results Pigs underwent resting [15O]water PET perfusion study 12 weeks after surgical (n = 16) or 2 weeks after catheter-based (n = 4) occlusion of the proximal left anterior descending coronary artery. MBF, PTF, and PTI were compared with volume fraction of MI in matched segments as assessed by triphenyl tetrazolium chloride staining of LV slices. MBF and PTF were lower in infarcted than non-infarcted segments. Segmental analysis of MBF showed similar area under the curve (AUC) of 0.85, 0.86, and 0.90 with relative MBF, PTF, and PTI for the detection of viable myocardium defined as infarct volume fraction of < 75%. Cut-off values of relative MBF of ≥ 67% and PTF of ≥ 66% resulted in accuracies of 90% and 81%, respectively. Conclusions Our results indicate that resting MBF, PTF, and PTI based on [15O]water PET perfusion imaging are useful for the assessment of myocardial viability.

Funding Acknowledgements Type of funding sources: None. Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can detect arterial inflammation in individuals with atherosclerosis, but the associations among different vascular territories for 18F-FDG uptake are not known. Purpose We explored any possible correlation between arterial inflammation quantified by 18F-FDG PET in the aorta, carotid arteries, and coronary arteries in patients presenting with acute coronary syndrome (ACS), or chronic coronary artery disease (CAD). Methods Prospectively, we performed hybrid computed tomography angiography and 18F-FDG PET in 43 patients (26 ACS and 17 chronic CAD) at 6.6 ± 5.7 days following invasive coronary angiography. 18F-FDG PET was performed 90 minutes after injection of 302.2 ± 28.4 MBq 18F-FDG. Arterial 18F-FDG uptake was measured in the thoracic aorta, carotid arteries, and coronary arteries, and expressed as the target-to-background ratio (TBR; the ratio between arterial maximal standardized uptake value normalized to blood pool mean standardized uptake value) in the whole artery, and in the most diseased segment (MDS). Results Mean age was 64.9 ± 9.1 years, 90.7% males. The whole artery 18F-FDG uptake was higher in the aorta than in the carotid arteries (median TBR 2.23, interquartile range [0.36] vs. 1.88 [0.42], p Conclusions In patients with ACS or chronic CAD, large arteries had higher 18F-FDG uptake than the coronary arteries. The intensity of 18F-FDG uptake in the coronary arteries did not correlate with that in the carotid arteries or the aorta, indicating that disease activity differs between large arteries and coronary arteries.

Publisher Copyright: © 2021 The Authors We studied the association between episodic memory and cortical fibrillar β-amyloid pathology within twin pairs. Using telephone-administered cognitive screening of 1415 twin pairs in a population-based older Finnish Twin Cohort study, we identified 45 (mean [SD] age 72.9 [4.0] years, 40% women) cognitively discordant same-sex twin pairs (24 dizygotic and 21 monozygotic) without neurological or psychiatric disorders other than AD or mild cognitive impairment. In-person neuropsychological testing was conducted. Cortical amyloid was measured with carbon 11-labelled Pittsburgh compound B ([11C]PiB) positron emission tomography imaging and quantified as the average standardized uptake value ratio in cortical regions affected in AD. Larger within-twin pair differences in verbal immediate (r = -0.42) and delayed free recall (r = -0.41), and visual delayed free recall (r = -0.46) were associated with larger within-twin pair differences in [11C]PiB uptake (p's < 0.01). Correlations were not significantly different in dizygotic and monozygotic pairs suggesting that the episodic memory-cortical amyloid relationship is not confounded by genetic effects. However, larger samples are needed to draw more definitive conclusions.

Background We investigated the image quality of 11C, 68Ga, 18F and 89Zr, which have different positron fractions, physical half-lifes and positron ranges. Three small animal positron emission tomography/computed tomography (PET/CT) systems were used in the evaluation, including the Siemens Inveon, RAYCAN X5 and Molecubes β-cube. The evaluation was performed on a single scanner level using the national electrical manufacturers association (NEMA) image quality phantom and analysis protocol. Acquisitions were performed with the standard NEMA protocol for 18F and using a radionuclide-specific acquisition time for 11C, 68Ga and 89Zr. Images were assessed using percent recovery coefficient (%RC), percentage standard deviation (%STD), image uniformity (%SD), spill-over ratio (SOR) and evaluation of image quantification. Results 68Ga had the lowest %RC (18F had the highest maximum %RC (> 85%) and lowest %STD for the 5 mm rod across all systems. For 11C and 89Zr, the maximum %RC was close (> 76%) to the %RC with 18F. A larger SOR were measured in water with 11C and 68Ga compared to 18F on all systems. SOR in air reflected image reconstruction and data correction performance. Large variation in image quantification was observed, with maximal errors of 22.73% (89Zr, Inveon), 17.54% (89Zr, RAYCAN) and − 14.87% (68Ga, Molecubes). Conclusions The systems performed most optimal in terms of NEMA image quality parameters when using 18F, where 11C and 89Zr performed slightly worse than 18F. The performance was least optimal when using 68Ga, due to large positron range. The large quantification differences prompt optimization not only by terms of image quality but also quantification. Further investigation should be performed to find an appropriate calibration and harmonization protocol and the evaluation should be conducted on a multi-scanner and multi-center level.

Automated segmentation of myocardium is essential as it allows reproducible and fast image analysis. In this study, three methods for automated myocardial segmentation were validated. The methods were based on the connected components (CC) derived from Positron Emission Tomography (PET) images. PET images were acquired on 22 patients with [18F]- Fluorodeoxyglucose ([18F]-FDG). The methods were compared against manual segmentation in terms of Dice indices as well as volume and center-of-mass (COM) differences. The developed methods are called the largest of CCs (LCC), number of CCs (NCC) and supervised CCs (SCC). LCC method is based on deriving the largest CCs, NCC deriving the number of CCs and SCC considers CCs that contain a voxel that locates in the myocardium. Dice indices for these methods (mean ± SD) were 0.70 ± 0.35, 0.54 ± 0.45 and 0.84 ± 0.17 for LCC, NCC and SCC, respectively. Volume differences were (mean ± SD) 0.73 dL ± 0.65 dL, 4.78 dL ± 5.77 dL and 0.58 dL ± 0.63 dL and COM differences were (mean ± SD) 16.9 mm ± 36.7 mm, 46.3 mm ± 58.1 mm and 2.47 mm ± 2.54 mm for LCC, NCC and SCC, respectively. The SCC method had the highest Dice indices with lower volume and COM differences compared to NCC and LCC.

Magnetic resonance imaging-only radiotherapy treatment planning (MRI-only RTP) and positron emission tomography (PET)-MRI imaging require generation of synthetic computed tomography (sCT) images from MRI images. In this study, initial dosimetric evaluation was performed for a previously developed MRI-based attenuation correction (MRAC) method for use in MRI-only RTP of the brain. MRAC-based sCT images were retrospectively generated from Dixon MR images of 20 patients who had previously received external beam radiation therapy (EBRT). Bone segmentation performance and Dice similarity coefficient of the sCT conversion method were evaluated for bone volumes on CT images. Dose calculation accuracy was assessed by recalculating the CT-based EBRT plans using the sCT images as the base attenuation data. Dose comparison was done for the sCT- and CT-based EBRT plans in planning target volume (PTV) and organs at risk (OAR). Parametric dose comparison showed mean relative differences of

BACKGROUND AND PURPOSE: The relationship between brain β-amyloid and regional atrophy is still incompletely understood in elderly individuals at risk of dementia. Here, we studied the associations between brain β-amyloid load and regional GM and WM volumes in older adults who were clinically evaluated as being at increased risk of cognitive decline based on cardiovascular risk factors. MATERIALS AND METHODS: Forty subjects (63–81 years of age) were recruited as part of a larger study, the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. Neuroimaging consisted of PET using (11)C Pittsburgh compound-B and T1-weighted 3D MR imaging for the measurement of brain β-amyloid and GM and WM volumes, respectively. All subjects underwent clinical, genetic, and neuropsychological evaluations for the assessment of cognitive function and the identification of cardiovascular risk factors. RESULTS: Sixteen subjects were visually evaluated as showing cortical β-amyloid (positive for β-amyloid). In the voxel-by-voxel analyses, no significant differences were found in GM and WM volumes between the samples positive and negative for β-amyloid. However, in the sample positive for β-amyloid, increases in (11)C Pittsburgh compound-B uptake were associated with reductions in GM volume in the left prefrontal (P = .02) and right temporal lobes (P = .04). CONCLUSIONS: Our results show a significant association between increases in brain β-amyloid and reductions in regional GM volume in individuals at increased risk of cognitive decline. This evidence is consistent with a model in which increases in β-amyloid incite neurodegeneration in memory systems before cognitive impairment manifests.

ObjectiveTo investigate brain amyloid pathology in a dementia-risk population defined as cardiovascular risk factors, aging, and dementia risk (CAIDE) score of at least 6 but with normal cognition and to examine associations between brain amyloid load and cognitive performance and vascular risk factors.MethodsA subgroup of 48 individuals from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) main study participated in brain 11C-Pittsburgh compound B (PiB)-PET imaging, brain MRI, and neuropsychological assessment at the beginning of the study. Lifestyle/vascular risk factors were determined as body mass index, blood pressure, total and low-density lipoprotein cholesterol, and glucose homeostasis model assessment. White matter lesions were visually rated from MRIs by a semiquantitative Fazekas score.ResultsTwenty participants (42%) had a positive PiB-PET on visual analysis. The PiB-positive group performed worse in executive functioning tests, included more participants with APOE ε4 allele (50%), and showed slightly better glucose homeostasis compared to PiB-negative participants. PiB-positive and -negative participants did not differ significantly in other cognitive domain scores or other vascular risk factors. There was no significant difference in Fazekas score between the PiB groups.ConclusionsThe high percentage of PiB-positive participants provides evidence of a successful recruitment process of the at-risk population in the main FINGER intervention trial. The results suggest a possible association between early brain amyloid accumulation and decline in executive functions. APOE ε4 was clearly associated with amyloid positivity, but no other risk factor was found to be associated with positive PiB-PET.

The purpose of this study was to evaluate 18F-FACBC PET/CT, PET/MRI, and multiparametric MRI (mpMRI) in detection of primary prostate cancer (PCa). Twenty-six men with histologically confirmed PCa underwent PET/CT immediately after injection of 369 ± 10 MBq 18F-FACBC (fluciclovine) followed by PET/MRI started 55 ± 7 min from injection. Maximum standardized uptake values (SUVmax) were measured for both hybrid PET acquisitions. A separate mpMRI was acquired within a week of the PET scans. Logan plots were used to calculate volume of distribution (VT). The presence of PCa was estimated in 12 regions with radical prostatectomy findings as ground truth. For each imaging modality, area under the curve (AUC) for detection of PCa was determined to predict diagnostic performance. The clinical trial registration number is NCT02002455. In the visual analysis, 164/312 (53%) regions contained PCa, and 41 tumor foci were identified. PET/CT demonstrated the highest sensitivity at 87% while its specificity was low at 56%. The AUC of both PET/MRI and mpMRI significantly (p 3 + 4 tumors were significantly (p

Background Radiolabeled RGD peptides detect αvβ3 integrin expression associated with angiogenesis and extracellular matrix remodeling after myocardial infarction. We studied whether cardiac positron emission tomography (PET) with [68Ga]NODAGA-RGD detects increased αvβ3 integrin expression after induction of flow-limiting coronary stenosis in pigs, and whether αvβ3 integrin is expressed in viable ischemic or injured myocardium. Methods We studied 8 Finnish landrace pigs 13 ± 4 days after percutaneous implantation of a bottleneck stent in the proximal left anterior descending coronary artery. Antithrombotic therapy was used to prevent stent occlusion. Myocardial uptake of [68Ga]NODAGA-RGD (290 ± 31 MBq) was evaluated by a 62 min dynamic PET scan. The ischemic area was defined as the regional perfusion abnormality during adenosine-induced stress by [15O]water PET. Guided by triphenyltetrazolium chloride staining, tissue samples from viable and injured myocardial areas were obtained for autoradiography and histology. Results Stent implantation resulted in a partly reversible myocardial perfusion abnormality. Compared with remote myocardium, [68Ga]NODAGA-RGD PET showed increased tracer uptake in the ischemic area (ischemic-to-remote ratio 1.3 ± 0.20, p = 0.0034). Tissue samples from the injured areas, but not from the viable ischemic areas, showed higher [68Ga]NODAGA-RGD uptake than the remote non-ischemic myocardium. Uptake of [68Ga]NODAGA-RGD correlated with immunohistochemical detection of αvβ3 integrin that was expressed in the injured myocardial areas. Conclusions Cardiac [68Ga]NODAGA-RGD PET demonstrates increased myocardial αvβ3 integrin expression after induction of flow-limiting coronary stenosis in pigs. Localization of [68Ga]NODAGA-RGD uptake indicates that it reflects αvβ3 integrin expression associated with repair of recent myocardial injury., published version, peerReviewed

For quantitative and visually consistent brain imaging on positron emission tomography magnetic resonance imaging systems, a minimum of three tissue classes are needed for MR-based attenuation correction (MRAC): soft tissue, air, and bone. However, gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) have a higher attenuation value than soft tissue. In addition, a continuous $\mu $ -value for bone is desired as bone density varies across the skull. In this paper, we evaluated the effect of brain tissue and implemented a continuous template-based skull for MRAC, using a previously introduced tissue-probability-based attenuation correction (TPB-AC) method. The method allows deriving an MR-based attenuation map ( $\mu $ -map) from T1-weighted MR images. The procedures to implement GM, WM, CSF, and continuous skull to TPB-AC method are described. MR-based $\mu $ -maps with 3, 4, and 6 tissue classes using discrete segmentation-based and continuous template-based skull were created. The 3-class $\mu $ -map included air, soft tissue, and bone. The 4-class $\mu $ -map included an additional brain tissue class defined as the mean value of GM, WM, and CSF. The 6-class $\mu $ -map included all individual tissue classes. A visual and quantitative comparison of PET images reconstructed with six different MR-based $\mu $ -maps was performed by using computed tomography (CT)-based attenuation correction (CTAC) as reference. The MR-based $\mu $ -maps were evaluated against CTAC for similarity in structures containing bone, brain, soft tissue, and air. The quantitative accuracy of MRAC-reconstructed PET was evaluated by comparison of ratio images, linear regression plots and regional volume of interest (VOI) analysis against CTAC reconstructed PET data. Results show that accounting the higher attenuation in the brain tissue reduces the underestimation seen in PET images reconstructed with 3-class MRAC. No major difference existed between 4-class and 6-class MRAC to account for higher attenuation of the brain. The quantitative bias in PET between a discrete segmentation-based skull and continuous template-based skull was similar. Segmentation-based skull resulted in better delineation of individual anatomy. The whole-brain error across all VOI was: −3.77% (±1.95%) and −4.14% (±2.07%) with 3-class MRAC with discrete and continuous skull, −0.74% (±1.87%) and −1.70% (±1.96%) with 4-class MRAC, −0.69% (±2.07%) and −1.65% (±1.96%) with 6-class MRAC. Therefore, a 4-class $\mu $ -map accounting for soft tissue, air, bone, and brain at minimum with either discrete segmentation-based or continuous template-based skull is applicable for improving the quantitative accuracy of MRAC. Further development is needed to accurately define optimal attenuation coefficients for brain tissues and to improve the registration and delineation of the CT template-based skull.

In PET, corrections for photon scatter and attenuation are essential for visual and quantitative consistency. MR attenuation correction (MRAC) is generally conducted by image segmentation and assignment of discrete attenuation coefficients, which offer limited accuracy compared with CT attenuation correction. Potential inaccuracies in MRAC may affect scatter correction, because the attenuation image (μ-map) is used in single scatter simulation (SSS) to calculate the scatter estimate. We assessed the impact of MRAC to scatter correction using 2 scatter-correction techniques and 3 μ-maps for MRAC. Methods: The tail-fitted SSS (TF-SSS) and a Monte Carlo-based single scatter simulation (MC-SSS) algorithm implementations on the Philips Ingenuity TF PET/MR were used with 1 CT-based and 2 MR-based μ-maps. Data from 7 subjects were used in the clinical evaluation, and a phantom study using an anatomic brain phantom was conducted. Scatter-correction sinograms were evaluated for each scatter correction method and μ-map. Absolute image quantification was investigated with the phantom data. Quantitative assessment of PET images was performed by volume-of-interest and ratio image analysis. Results: MRAC did not result in large differences in scatter algorithm performance, especially with TF-SSS. Scatter sinograms and scatter fractions did not reveal large differences regardless of the μ-map used. TF-SSS showed slightly higher absolute quantification. The differences in volume-of-interest analysis between TF-SSS and MC-SSS were 3% at maximum in the phantom and 4% in the patient study. Both algorithms showed excellent correlation with each other with no visual differences between PET images. MC-SSS showed a slight dependency on the μ-map used, with a difference of 2% on average and 4% at maximum when a μ-map without bone was used. Conclusion: The effect of different MR-based μ-maps on the performance of scatter correction was minimal in non-time-of-flight 18F-FDG PET/MR brain imaging. The SSS algorithm was not affected significantly by MRAC. The performance of the MC-SSS algorithm is comparable but not superior to TF-SSS, warranting further investigations of algorithm optimization and performance with different radiotracers and time-of-flight imaging.

Background Chronic kidney disease (CKD) is associated with endothelial dysfunction and increased cardiovascular mortality. Endothelial dysfunction can be studied measuring myocardial perfusion reserve (MPR). MPR is the ratio of stress and rest myocardial perfusion (MP) and reflects the capacity of vascular bed to increase perfusion and microvascular responsiveness. In this pilot study, our aim was to assess MPR of 19 patients with kidney transplant (CKD stages 2–3) and of ten healthy controls with quantitative [15O]H2O positron emission tomography (PET) method. Results Basal MP was statistically significantly higher at rest in the kidney transplant patients than in the healthy controls [1.3 (0.4) ml/min/g and 1.0 (0.2) ml/min/g, respectively, p = 0.0015]. After correction of basal MP by cardiac workload [MPcorr = basal MP/individual rate pressure product (RPP) × average RPP of the healthy controls], the difference between the groups disappeared [0.9 (0.2) ml/min/g and 1.0 (0.3) ml/min/g, respectively, p = 0.55)]. There was no difference in stress MP between the kidney transplant patients and the healthy subjects [3.8 (1.0) ml/min/g and 4.0 (0.9) ml/min/g, respectively, p = 0.53]. Although MPR was reduced, MPRcorr (stress MP/basal MPcorr) did not differ between the kidney transplant patients and the healthy controls [4.1 (1.1) and 4.3 (1.6), respectively, p = 0.8]. Conclusions MP during stress is preserved in kidney transplant patients with CKD stage 2–3. The reduced MPR appears to be explained by increased resting MP. This is likely linked with increased cardiac workload due to sympathetic overactivation in kidney transplant patients.

Background The reliable quantification of myocardial blood flow (MBF) with MRI, necessitates the correction of errors in arterial input function (AIF) caused by the T1 saturation effect. The aim of this study was to compare MBF determined by a traditional dual bolus method against a modified dual bolus approach and to evaluate both methods against PET in a porcine model of myocardial ischemia. Methods Local myocardial ischemia was induced in five pigs, which were subsequently examined with contrast enhanced MRI (gadoteric acid) and PET (O-15 water). In the determination of MBF, the initial high concentration AIF was corrected using the ratio of low and high contrast AIF areas, normalized according to the corresponding heart rates. MBF was determined from the MRI, during stress and at rest, using the dual bolus and the modified dual bolus methods in 24 segments of the myocardium (total of 240 segments, five pigs in stress and rest). Due to image artifacts and technical problems 53% of the segments had to be rejected from further analyses. These two estimates were later compared against respective rest and stress PET-based MBF measurements. Results Values of MBF were determined for 112/240 regions. Correlations for MBF between the modified dual bolus method and PET was rs = 0.84, and between the traditional dual bolus method and PET rs = 0.79. The intraclass correlation was very good (ICC = 0.85) between the modified dual bolus method and PET, but poor between the traditional dual bolus method and PET (ICC = 0.07). Conclusions The modified dual bolus method showed a better agreement with PET than the traditional dual bolus method. The modified dual bolus method was found to be more reliable than the traditional dual bolus method, especially when there was variation in the heart rate. However, the difference between the MBF values estimated with either of the two MRI-based dual-bolus methods and those estimated with the gold-standard PET method were statistically significant. Electronic supplementary material The online version of this article (10.1186/s12880-019-0359-8) contains supplementary material, which is available to authorized users.

Bariatric surgery results in notable weight loss and alleviates hyperglycemia in patients with type 2 diabetes (T2D). We aimed to characterize the vascular effects of a mixed meal and infusion of exogenous glucose-dependent insulinotropic polypeptide (GIP) in the splanchnic region in 10 obese patients with T2D before and after bariatric surgery and in 10 lean control subjects. The experiments were carried out on two separate days. Pancreatic and intestinal blood flow (BF) were measured at baseline, 20 min, and 50 min with 15O-water by using positron emission tomography and MRI. Before surgery, pancreatic and intestinal BF responses to a mixed meal did not differ between obese and lean control subjects. Compared with presurgery, the mixed meal induced a greater increase in plasma glucose, insulin, and GIP concentrations after surgery, which was accompanied by a marked augmentation of pancreatic and intestinal BF responses. GIP infusion decreased pancreatic but increased small intestinal BF similarly in all groups both before and after surgery. Taken together, these results demonstrate that bariatric surgery leads to enhanced splanchnic vascular responses as a likely consequence of rapid glucose appearance and GIP hypersecretion.

Positron emission tomography (PET) is a non-invasive imaging technique which may be considered as the state of art for the examination of cardiac inflammation due to atherosclerosis. A fundamental limitation of PET is that cardiac and respiratory motions reduce the quality of the achieved images. Current approaches for motion compensation involve gating the PET data based on the timing of quiescent periods of cardiac and respiratory cycles. In this study, we present a novel gating method called microelectromechanical (MEMS) dual gating which relies on joint non-electrical sensors, i.e. tri-axial accelerometer and gyroscope. This approach can be used for optimized selection of quiescent phases of cardiac and respiratory cycles. Cardiomechanical activity according to echocardiography observations was investigated to confirm whether this dual sensor solution can provide accurate trigger timings for cardiac gating. Additionally, longitudinal chest motions originating from breathing were measured by accelerometric- and gyroscopic-derived respiratory (ADR and GDR) tracking. The ADR and GDR signals were evaluated against Varian real-time position management (RPM) signals in terms of amplitude and phase. Accordingly, high linear correlation and agreement were achieved between the reference electrocardiography, RPM, and measured MEMS signals. We also performed a Ge-68 phantom study to evaluate possible metal artifacts caused by the integrated read-out electronics including mechanical sensors and semiconductors. The reconstructed phantom images did not reveal any image artifacts. Thus, it was concluded that MEMS-driven dual gating can be used in PET studies without an effect on the quantitative or visual accuracy of the PET images. Finally, the applicability of MEMS dual gating for cardiac PET imaging was investigated with two atherosclerosis patients. Dual gated PET images were successfully reconstructed using only MEMS signals and both qualitative and quantitative assessments revealed encouraging results that warrant further investigation of this method.

Attenuation correction is essential for image quantification in PET. At minimum, bone, soft tissue and air need to be included in MR-based attenuation correction (MRAC) of the head. Additional tissue classes might be beneficial to improve the accuracy of MRAC further. We studied the attenuation effect of nasal sinuses in MRAC by four attenuation maps and by assessment of regional PET quantification.

Background. Respiratory motion in positron emission tomography/computed tomography (PET/CT) causes underestimation of standardized uptake value (SUV) and variation of lesion volume, while PET and CT attenuation correction (CTAC) mismatch may introduce artefacts. The aim was to compare end-expiratory gating methods of PET and CTAC.Material and methods. Three methods named the minimum-constant, slope-based and amplitude-median were developed and evaluated on gating efficiency. Method evaluation and optimization was performed on 23 simulated and 23 recorded signals from a mixed patient group. The optimized methods were applied in PET/CT imaging of seven patients, consisting of non-gated CTAC, whole-body PET and four-dimensional (4D) PET/CT. Gating efficiency was evaluated by preservation of the respiratory signal, PET-CTAC alignment, image noise and measurement of lesion SUV maximum (SUVmax), SUV mean (SUVmean) and volume. The methods were evaluated with non-gated PET and end-expiratory phase of five-bin phase-gated PET. End-expiratory gated 4D-CTAC and averaged CTAC were compared for attenuation correction of end-expiratory gated PET.Results. Mean fraction of data preserved was larger (23–34%) with end-expiratory gating compared to phase-gated PET. End-expiratory gating showed increased SUVmax (8.2–8.4 g/ml), SUVmean (5.7–5.8 g/ml) and decreased lesion volume (-11.3–16.8%) compared to non-gated PET (SUVmax 6.2 g/ml, SUVmean 4.7 g/ml) and phase-gated PET (SUVmax 8.0 g/ml, SUVmean 5.6 g/ml). Using averaged CTAC and end-expiratory 4D-CTAC produced similar results concerning SUVmax, with less than 5% difference. Additionally, CTAC-PET-mismatch was minimal when end-expiratory 4D-CTAC was used.Conclusion. End-expiratory gating in PET/CT results in SUVmax and SUVmean increase and reduced lesion volume compared to non-gated PET and phase-gated PET. End-expiratory 4D-CTAC or averaged CTAC will offer similar accuracy for attenuation correction of end-expiratory gated PET.

The quantitative accuracy of brain PET/MR has been reported to be reduced compared to PET/CT due to difficulties related to bone in MR-based attenuation correction (MRAC), especially in regions near the skull. To reduce these effects, we designed an offline, tissue probability-based (TPB-AC) using SPM8, which includes soft tissue, air and bone. Thus, both the increased attenuation due to skull and the reduced attenuation due to sinuses are taken into account. The method was developed to use the data collected with the standard anatomical MRAC consisting of 3D T1 FFE, with isotropic voxel size of 2 mm. Thus, collection of additional sequences or modifications to the standard attenuation correction sequence are not required. Data from F18-FDG brain studies performed both with PET/CT and PET/MR was used in AC validation. Seven patients were reconstructed with the standard attenuation map, TPB-AC and CTAC in PET/MR. Regional analysis between attenuation corrected PET images was conducted using CTAC as reference. Using TPB-AC, the relative difference in seven subjects when compared to CTAC in all regions was -3 %, -2 %, -5 %, 4 %, -3 %, 1 %, 0 %. In clinical AC the difference was -9 %, -8 %, -9 %, -3 %, -10 %, -5 %, -6 %. Region-wise, the benefit from TPB-AC was most pronounced in precentral, superior frontal and middle frontal gyrus where underestimation from clinical AC of: -11 %, -12 % and -12 % was reduced to: -1%, -2 % and -1 % when using TPB-AC. Tissue probability-based AC was deemed a promising interim method for PET/MR AC until standardized, commercialized solutions become widely available. To test the robustness of the method, patients with dental implants or deformed anatomy would have to be included in the study group.

Purpose For monitoring the performance of Magnetic Resonance Imaging (MRI) systems, it is essential to implement regular quality control (QC) protocols. We evaluated the MRI system performance of the Philips Ingenuity TF PET/MR, using the American college of radiology (ACR) QC protocol [1] and automated QC software. Methods A total of 80 QC scans were performed during years 2013 to 2018 using the ACR QC protocol. In the initial analysis, 21 scans were analyzed by a human observer and automatic software implemented in MATLAB2015b [2] , which performs the analysis according to ACR guidelines [1] . Five quantitative tests were included: geometric accuracy (148 ± 2 and 190 ± 2 mm), slice thickness accuracy (5.0 ± 0.7 mm), slice position accuracy ( 82 %) and percent signal ghosting ( Results For geometric accuracy, (M = 147 ± 1), (A = 148 ± 1) and (M = 190 ± 0.5), (A = 191 ± 0.2) were measured for the localizer and T1 series. For slice thickness accuracy, (M = 5.5 ± 0.5), (A = 4.7 ± 0.8) and (M = 5.9 ± 0.5), (A = 4.5 ± 1.4) were measured for the T1 and T2 series. For slice position accuracy, (M = 5.6 ± 3.3), (A = 4.2 ± 2.7) and (M = 5.3 ± 2.8), (A = 4.0 ± 2.5) were measured for the T1 and T2 series. For image intensity uniformity, (M = 85 ± 1), (A = 96 ± 1) and (M = 89 ± 2), (A = 97 ± 2) were measured for the T1 and T2 series. For percent signal ghosting, (M = 0.0010 ± 0.0009) and (M = 0.0015 ± 0.0007) were measured. The time to analyze and report was two minutes with the automatic software. Conclusions Majority of the tests reached the acceptance criteria in the initial analysis. Slice thickness and slice position accuracy were the most common tests to fail. Automated software was beneficial for easing the analysis workflow. The QC software with a test dataset will be provided during the conference.

Objective Inflammation is an important contributor to atherosclerosis progression. A glucose analogue 18F-fluorodeoxyglucose ([18F]FDG) has been used to detect atherosclerotic inflammation. However, it is not known to what extent [18F]FDG is taken up in different stages of atherosclerosis. We aimed to study the uptake of [18F]FDG to various stages of coronary plaques in a pig model. Methods First, diabetes was caused by streptozotocin injections (50 mg/kg for 3 days) in farm pigs (n = 10). After 6 months on high-fat diet, pigs underwent dual-gated cardiac PET/CT to measure [18F]FDG uptake in coronary arteries. Coronary segments (n = 33) were harvested for ex vivo measurement of radioactivity and autoradiography (ARG). Results Intimal thickening was observed in 16 segments and atheroma type plaques in 10 segments. Compared with the normal vessel wall, ARG showed 1.7±0.7 times higher [18F]FDG accumulation in the intimal thickening and 4.1±2.3 times higher in the atheromas (P = 0.004 and P = 0.003, respectively). Ex vivo mean vessel-to-blood ratio was higher in segments with atheroma than those without atherosclerosis (2.6±1.2 vs. 1.3±0.7, P = 0.04). In vivo PET imaging showed the highest target-to-background ratio (TBR) of 2.7. However, maximum TBR was not significantly different in segments without atherosclerosis (1.1±0.5) and either intimal thickening (1.2±0.4, P = 1.0) or atheroma (1.6±0.6, P = 0.4). Conclusions We found increased uptake of [18F]FDG in coronary atherosclerotic lesions in a pig model. However, uptake in these early stage lesions was not detectable with in vivo PET imaging. Further studies are needed to clarify whether visible [18F]FDG uptake in coronary arteries represents more advanced, highly inflamed plaques.

Image quality in cardiac PET is impaired by both respiratory and cardiac motion. Dual-gating has been proposed as a means to obtain sinograms in various motion states. This data can then be used to produce dual-gated images or as a first step in processing that corrects for one or both types of motion. The gating is normally performed based on external signals such as an ECG signal and a camera or belt for monitoring respiration. However, it could be advantageous if the gating could be performed without ancillary equipment. It has been shown by various authors that it is possible to extract a respiratory signal out of the PET data itself, usually based on low spatial resolution but high time resolution sinograms. Here, we propose an extension to extract the cardiac beating signal as well. We illustrate this using a recently proposed technique that uses PCA to extract multiple signals from the data and show that the cardiac signal can be obtained in a two stage process. The method does not need any image reconstruction and is therefore very fast. We show results on PET patient data using various tracers. We compare the signals extracted using the data-driven method with those obtained with external monitors (including ECG). Our results indicate that in many clinical situations, the data-driven method can achieve equivalent dual-gated images compared to methods that use ancillary equipment.

This study was performed to evaluate the feasibility of preclinical imaging in a clinical PET/MR system. Preliminary sequences were evaluated for establishing preclinical protocols for rat brain and rabbit knee. Rats were placed in a stereotactic holder, allowing a 30 minute scan time before re-administration of anesthesia. In-house developed warm-water heating system was used to maintain the body temperature at 37.5°C, monitored using an MR-compatible rectal probe. Brain imaging was performed with a dedicated 4 channel phased array receive coil (RAPID Biomedical GmbH, Germany). High resolution coronal images were acquired using conventional T1-SE (0.30x0.30x1.2mm) and T2-TSE (0.23x0.23x0.7mm) with a total scan time of 30 min. PET/MR imaging was performed on two white rabbits. The rabbits were imaged in a custom wooden holder. PET/MR protocol had a total duration of 45 minutes. No external heating was used. MR protocol consisted of anatomical T1, T2 and PDW of the knees, using a SENSE Flex-S coil. MR attenuation correction (MRAC) was acquired with 3D T1-FFE using three-class segmentation. A dynamic 30 minute PET acquisition was started on injection of 33.8MBq of Ga-68. Animal coils enabled high resolution images to be acquired in reasonable acquisition time with regards to animal handling and anesthesia. T1 and T2 images provided good differentiation of anatomy in the rat brain with high contrast. T1, T2 and PDW images of the rabbit knee had high resolution and differentiation of anatomical structures. MRAC was able to distinguish the knees and the body contour. Image fusion of PET and MR was able to localize the infection, which was confirmed by a physician. Pre-clinical imaging with the Ingenuity TF was deemed feasible, although PET imaging is limited by the resolution of the scanner. The preliminary sequences were successfully implemented for future studies on the Ingenuity TF.

Respiratory motion may cause significant image artefacts in positron emission tomography/computed tomography (PET/CT) imaging. This study introduces a new bioimpedance-based gating method for minimizing respiratory artefacts. The method was studied in 12 oncologic patients by evaluating the following three parameters: maximum metabolic activity of radiopharmaceutical accumulations, the size of these targets as well as their target-to-background ratio. The bioimpedance-gated images were compared with non-gated images and images that were gated with a reference method, chest wall motion monitoring by infrared camera. The bioimpedance method showed clear improvement as increased metabolic activity and decreased target volume compared to non-gated images and produced consistent results with the reference method. Thus, the method may have great potential in the future of respiratory gating in nuclear medicine imaging.

The Philips Ingenuity TF is a sequential PET/MR with an Achieva 3T X-series MR and Gemini TF PET system connected with a rotating table. Both the PET and MR systems are designed to minimize mutual system interference. However, a longitudinal study concerning the stability of the MR system has not been conducted before. The stability of the MR system affects diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and functional MRI (fMRI), especially in longterm and multi-center studies. In addition, the variation of geometric distortions and consistency of MR image quality is important for clinical studies and radiotherapy planning. The long-term stability of the MR system was monitored by weekly quality control (QC) scans during one year. For measuring DWI, DTI and fMRI stability, protocols from fBIRN and vendor QA were implemented by using a spherical agar phantom and a liquid sphere phantom. For measuring the variations of image quality, ACR phantom measurements were performed. For the fBIRN and vendor QA protocols, automatic QC programs provided by the consortium and manufacturer were used. For the ACR phantom, an automatic quality control measurement was developed in MATLAB 2011b. Analysis of the QC scans did not show any significant variations with the fBIRN, vendor QA or ACR protocols. Thus, the MR system of the Ingenuity TF was deemed to be stable in the longitudinal study. Automated analysis of QC measurements was deemed necessary for implementing multiple, weekly measurements for PET/MR.

The aim of the study was to evaluate the effect of misalignment and head motion on image quantification in PET/MR with a novel brain phantom and a healthy control group. The phantom was imaged at two time points in PET/MR, concurrently with PET and PET/CT. Phantom images were evaluated visually and the relative difference in hemispheric accumulation was calculated. Difference in cortical accumulation in a healthy control group was evaluated from non-attenuation corrected (NAC) and MR attenuation corrected (MRAC) images. Regional ROI mean values from F18-FDG ratio images and regional hemispheric asymmetries were calculated. Controls were divided to high and low asymmetry groups. A student’s t-test (p