Abstract
To improve the test-retest reproducibility of coronary plaque 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) uptake measurements. We recruited 20 patients with coronary artery disease who underwent repeated hybrid PET/CT angiography (CTA) imaging within 3weeks. All patients had 30-min PET acquisition and CTA during a single imaging session. Five PET image-sets with progressive motion correction were reconstructed: (i) a static dataset (no-MC), (ii) end-diastolic PET (standard), (iii) cardiac motion corrected (MC), (iv) combined cardiac and gross patient motion corrected (2 × MC) and, (v) cardiorespiratory and gross patient motion corrected (3 × MC). In addition to motion correction, all datasets were corrected for variations in the background activities which are introduced by variations in the injection-to-scan delays (background blood pool clearance correction, BC). Test-retest reproducibility of PET target-to-background ratio (TBR) was assessed by Bland-Altman analysis and coefficient of reproducibility. A total of 47 unique coronary lesions were identified on CTA. Motion correction in combination with BC improved the PET TBR test-retest reproducibility for all lesions (coefficient of reproducibility: standard = 0.437, no-MC = 0.345 (27% improvement), standard+BC = 0.365 (20% improvement), no-MC + BC = 0.341 (27% improvement), MC + BC = 0.288 (52% improvement), 2 × MC + BC = 0.278 (57% improvement) and 3 × C + BC = 0.254 (72% improvement), all p < 0.001). Importantly, in a sub-analysis of 18F-NaF-avid lesions with gross patient motion >10mm following corrections, reproducibility was improved by 133% (coefficient of reproducibility: standard = 0.745, 3 × MC = 0.320). Joint corrections for cardiac, respiratory, and gross patient motion in combination with background blood pool corrections markedly improve test-retest reproducibility of coronary 18F-NaF PET.
Highlights
Positron Emission Tomography (PET) in combination with Computed Tomography (CT) angiography (CTA) holds promise as a non-invasive technology for identification of high-risk plaques in patients with coronary artery disease [1,2,3,4].Clinical implementation of coronary PET imaging is, challenging, as coronary lesions are small and continuously move during the acquisition
We demonstrate that a novel technique for coronary PET processing which combines triple motion correction (3xMC) with adjustments for injection-to-scan delays significantly improves the scan-rescan reproducibility
The patients underwent repeated 18F-NaF PET / CT angiography (CTA) hybrid imaging studies within a maximum of 21 days. 47 unique lesions were identified on the CTAimages with 15 18F-NaF-avid, 30 18F-NaF-negative and 2 lesions with discordant evaluations (TBR>1.25 in one scan, while to background ratio (TBR)
Summary
Positron Emission Tomography (PET) in combination with Computed Tomography (CT) angiography (CTA) holds promise as a non-invasive technology for identification of high-risk plaques in patients with coronary artery disease [1,2,3,4].Clinical implementation of coronary PET imaging is, challenging, as coronary lesions are small and continuously move during the acquisition. The TBR measurements are significantly degraded by cardiorespiratory and patient motion during the 30-min scans. Typical gross patient motion (other than cardiorespiratory motion) results in repositioning of the heart, typically by 5-15mm, during a 30-min scan [7]. These observations are of key significance for coronary lesions with dimensions measured in single millimeters. In the sub-analysis of 18F-NaFavid lesions, 3xMC +BC correction improved the reproducibility by 78% (Table 4, Figure S1). In a subset of lesions with larger patient motion during one of the scans (>10 mm), 3xMC+BC correction lead to a 133% improvement in reproducibility (Table 5, Figure 4)
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