Computed Tomography Coregistration Research Articles

Intraprocedural assessment of ablation margins using computed tomography co-registration in hepatocellular carcinoma treatment with percutaneous ablation: IAMCOMPLETE study

PurposeThe primary objective of this study was to determine the feasibility of ablation margin quantification using a standardized scanning protocol during thermal ablation (TA) of hepatocellular carcinoma (HCC), and a rigid registration algorithm. Secondary objectives were to determine the inter- and intra-observer variability of tumor segmentation and quantification of the minimal ablation margin (MAM). Materials and methodsTwenty patients who underwent thermal ablation for HCC were included. There were thirteen men and seven women with a mean age of 67.1 ± 10.8 (standard deviation [SD]) years (age range: 49.1–81.1 years). All patients underwent contrast-enhanced computed tomography examination under general anesthesia directly before and after TA, with preoxygenated breath hold. Contrast-enhanced computed tomography examinations were analyzed by radiologists using rigid registration software. Registration was deemed feasible when accurate rigid co-registration could be obtained. Inter- and intra-observer rates of tumor segmentation and MAM quantification were calculated. MAM values were correlated with local tumor progression (LTP) after one year of follow-up. ResultsCo-registration of pre- and post-ablation images was feasible in 16 out of 20 patients (80%) and 26 out of 31 tumors (84%). Mean Dice similarity coefficient for inter- and intra-observer variability of tumor segmentation were 0.815 and 0.830, respectively. Mean MAM was 0.63 ± 3.589 (SD) mm (range: -6.26–6.65 mm). LTP occurred in four out of 20 patients (20%). The mean MAM value for patients who developed LTP was -4.00 mm, as compared to 0.727 mm for patients who did not develop LTP. ConclusionAblation margin quantification is feasible using a standardized contrast-enhanced computed tomography protocol. Interpretation of MAM was hampered by the occurrence of tissue shrinkage during TA. Further validation in a larger cohort should lead to meaningful cut-off values for technical success of TA.

Efficient volume-based localization and automatic labeling of intracranial depth electrodes.

The accurate localization and anatomical labeling of intracranial depth electrodes are crucial for stereoelectroencephalography (SEEG) recordings and the interpretation of results in patients with epilepsy. The laborious electrode localization procedure requires an efficient and easy-to-use pipeline. Thus, we developed a useful tool, which we called the depth electrode localizer (DELLO), to automatically identify and label depth electrode contacts with ease. The DELLO is an open-source package developed in MATLAB (MathWorks). It was specifically fine-tuned to expedite the localization of depth electrodes. The basic procedures include preoperative magnetic resonance imaging (MRI) and postoperative computed tomography coregistration, intensity threshold electrode spatial sampling, the hierarchical clustering of electrode samples, and gray-matter and automatic anatomical labeling (AAL). The DELLO also has a graphical user interface (GUI) that can be used to review the results. The only manual intervention procedures are the identification of the target (tip) and entry point of each electrode and the naming of the clustered electrode contact groups, which generally take ~5 min per case. The coordinates of each contact were recorded in individual spaces and were also transformed in standard space by applying a volume-based deformation field. To validate the performance of the current method, 7 patients with epilepsy were retrospectively included in the analysis. A total of 80 depth electrodes, including 1,030 contacts from the 7 patients with epilepsy, were localized. All the procedures functioned well, and the entire process was robust and intuitive. Among the 1,030 contacts, 746 (72.43%) were labeled as inside the gray matter. The gray-matter and AAL accuracy rates were 95.83% and 90.78%, respectively, over all contacts. The DELLO is an integrated tool that was designed to semi-automatically localize and label intracranial depth electrodes. It is open source and freely available. Given its high accuracy and efficiency, the DELLO could facilitate SEEG interpretation and be used in SEEG-based cognitive neuroscience studies.

Delayed PET imaging using image synthesis network and nonrigid registration without additional CT scan.

Attenuation correction is critical for positron emission tomography (PET) image reconstruction. The standard protocol for obtaining attenuation information in a clinical PET scanner is via coregistered computed tomography (CT) images. Therefore, for delayed PET imaging, the CT scan is repeated twice, which increases the radiation dose for the patient. In this paper, we propose a zero-extradose delayed PET imaging method that requires no additional CT scans. A deep learning-based synthesis network is designed to convert PET data into pseudo-CT images for delayed scans. Then, nonrigid registration is performed between this pseudo CT image and the CT image of the first scan, warping the CT image of the first scan to an estimated CT image for the delayed scan. Finally, the PET image attenuation correction in the delayed scan is obtained from this estimated CT image. Experiments with clinical datasets are implemented to assess the effectiveness of the proposed method with the well-recognized Generative Adversarial Networks (GAN) method. The average peak signal-to-noise ratio (PSNR) and the mean absolute percent error (MAPE) are used for comparison. We also use scoring from three experienced radiologists as subjective measurement means based on the diagnostic consistency of the PET images reconstructed from GAN and the proposed method with respect to the ground truth images. The experiments show that the average PSNR is 47.04dB (the proposed method) vs. 44.41dB (the traditional GAN method) for the reconstructed delayed PET images in our evaluation dataset. The average MAPEs are 1.59% for the proposed method and 3.32% for the traditional GAN method across five organ regions of interest (ROIs). The scores for the GAN and the proposed method rated by three experienced radiologists are 8.08±0.60 and 9.02±0.52, indicating that the proposed method yields more consistent PET images with the ground truth. This work proposes a novel method for CT-less delayed PET imaging based on image synthesis network and nonrigid image registration. The PET image reconstructed using the proposed method yields delayed PET images with high image quality without artifacts and is quantitatively more accurate than the traditional GAN method.

CT and MRI Image Fusion Error: An Analysis of Co-Registration Error Using Commercially Available Deep Brain Stimulation Surgical Planning Software

Introduction: During deep brain stimulation (DBS) surgery, computed tomography (CT) and magnetic resonance imaging (MRI) scans need to be co-registered or fused. Image fusion is associated with the error that can distort the location of anatomical structures. Co-registration in DBS surgery is usually performed automatically by proprietary software; the amount of error during this process is not well understood. Here, our goal is to quantify the error during automated image co-registration with FrameLink™, a commonly used software for DBS planning and clinical research. Methods: This is a single-center retrospective study at a quaternary care referral center, comparing CT and MR imaging co-registration for a consecutive series of patients over a 12-month period. We collected CT images and MRI scans for 22 patients with Parkinson’s disease requiring placement of DBS. Anatomical landmarks were located on CT images and MRI scans using a novel image analysis algorithm that included a method for capturing the potential error inherent in the image standardization step of the analysis. The distance between the anatomical landmarks was measured, and the error was found by averaging the distances across all patients. Results: The average error during co-registration was 1.25 mm. This error was significantly larger than the error resulting from image standardization (0.19 mm) and was worse in the anterior-posterior direction. Conclusions: The image fusion errors found in this analysis were nontrivial. Although the estimated error may be inflated, it is sig­nificant enough that users must be aware of this potential inaccuracy, and developers of proprietary software should provide details about the magnitude and direction of co-registration errors.

Intraprocedural Assessment of Ablation Margins Using Computed Tomography Co-registration in Primary Liver Tumor Treatment With Percutaneous Ablation

Intraprocedural Assessment of Ablation Margins Using Computed Tomography Co-registration in Primary Liver Tumor Treatment With Percutaneous Ablation

Spirometric assessment of emphysema presence and severity as measured by quantitative CT and CT-based radiomics in COPD

BackgroundThe mechanisms underlying airflow obstruction in COPD cannot be distinguished by standard spirometry. We ascertain whether mathematical modeling of airway biomechanical properties, as assessed from spirometry, could provide estimates of emphysema presence and severity, as quantified by computed tomography (CT) metrics and CT-based radiomics.MethodsWe quantified presence and severity of emphysema by standard CT metrics (VIDA) and co-registration analysis (ImbioLDA) of inspiratory-expiratory CT in 194 COPD patients who underwent pulmonary function testing. According to percentages of low attenuation area below − 950 Hounsfield Units (%LAA-950insp) patients were classified as having no emphysema (NE) with %LAA-950insp < 6, moderate emphysema (ME) with %LAA-950insp ≥ 6 and < 14, and severe emphysema (SE) with %LAA-950insp ≥ 14. We also obtained stratified clusters of emphysema CT features by an automated unsupervised radiomics approach (CALIPER). An emphysema severity index (ESI), derived from mathematical modeling of the maximum expiratory flow-volume curve descending limb, was compared with pulmonary function data and the three CT classifications of emphysema presence and severity as derived from CT metrics and radiomics.ResultsESI mean values and pulmonary function data differed significantly in the subgroups with different emphysema degree classified by VIDA, ImbioLDA and CALIPER (p < 0.001 by ANOVA). ESI differentiated NE from ME/SE CT-classified patients (sensitivity 0.80, specificity 0.85, AUC 0.86) and SE from ME CT-classified patients (sensitivity 0.82, specificity 0.87, AUC 0.88).ConclusionsPresence and severity of emphysema in patients with COPD, as quantified by CT metrics and radiomics can be estimated by mathematical modeling of airway function as derived from standard spirometry.

Ex-vivo study in nephroureterectomy specimens defining the role of 3-D upper urinary tract visualization using optical coherence tomography and endoluminal ultrasound.

Minimal invasive endoscopic treatment for upper urinary tract urothelial carcinoma (UUT-UC) is advocated in patients with low-risk disease and limited tumor volume. Diagnostic ureterorenoscopy combined with biopsy is the diagnostic standard. This study aims to evaluate two alternative diagnostic techniques for UUT-UC: optical coherence tomography (OCT) and endoluminal ultrasound (ELUS). Following nephroureterectomy, OCT, ELUS, and computed tomography (CT) were performed of the complete nephroureterectomy specimen. Visualization software (AMIRA®) was used for reconstruction and coregistration of CT, OCT, and ELUS. Finally, CT was used to obtain exact probe localization. Coregistered OCT and ELUS datasets were compared with histology. Coregistration with three-dimensional CT makes exact data matching possible in this ex-vivo setting to compare histology with OCT and ELUS. In OCT images of normal-appearing renal pelvis and ureter, urothelium, lamina propria, and muscularis were visible. With ELUS, all anatomical layers of the ureter could be distinguished, besides the urothelial layer. ELUS identified suspect lesions, although exact staging and differentiation between noninvasive and invasive lesions were not possible. OCT provides high-resolution imaging of normal ureter and ureter lesions. ELUS, however, is of limited value as it cannot differentiate between noninvasive and invasive tumors.

Diagnostic Computed Tomography Coregistration With In-111-DTPA-Octreotide Single Photon Emission Tomography/Low-Dose Computed Tomography.

In-111-DTPA-octreotide (OctreoScan) is still pivotal for neuroendocrine tumor imaging, despite the introduction of Ga-68-octreotide tracers. Low-dose computed tomography (LDCT) assists in the localization of SPECT findings but often results in uncertain interpretation. This retrospective study evaluates the impact of coregistration of In-111-DTPA-octreotide SPECT/LDCT with diagnostic CT on interpretation. Thirty-five consecutive studies, in which coregistration was performed because of uncertain interpretation, were evaluated. Presence of somatostatin receptors was categorized retrospectively as definitely positive, probably positive, probably negative, or definitely negative with and without rigid registration with diagnostic CT, and possible added value of coregistration was evaluated. Coregistration was performed in 35 studies. However, on subsequent reading, 4 SPECT/CTs yielded definite results and were omitted. Coregistration was helpful in 30 of the remaining 31 cases, changing reading to definitely positive (7) or to definitely negative (23). In 13 of the 23 cases, diagnosis changed from probably positive to definitely negative. Coregistration contributed in 42 of 48 sites, with greatest benefit in the liver (13/14), pancreas (10/10), and lymph nodes (6/6). Coregistration is becoming increasingly easier and may be utilized when SPECT/LDCT is inconclusive.

Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations

PurposeBone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans—as validated in previous studies—as a reference standard. Materials and methodsMen with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤−2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. ResultsAll measurements from PET/CT versus MDCT were strongly correlated (R2=0.93–0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm2, 1.1%), femoral strength (−60N, 1.3%), vertebral trabecular BMD (2mg/cm3, 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (−0.018g/cm2; −2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). ConclusionAncillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.

Three-dimensional localization of cortical electrodes in deep brain stimulation surgery from intraoperative fluoroscopy

Electrophysiological recordings from subdural electrocorticography (ECoG) electrodes implanted temporarily during deep brain stimulation (DBS) surgeries offer a unique opportunity to record cortical activity for research purposes. The optimal utilization of this important research method relies on accurate and robust localization of ECoG electrodes, and intraoperative fluoroscopy is often the only imaging modality available to visualize electrode locations. However, the localization of a three-dimensional electrode position using a two-dimensional fluoroscopic image is problematic due to the lost dimension orthogonal to the fluoroscopic image, a parallax distortion implicit to fluoroscopy, and variability of visible skull contour among fluoroscopic images. Here, we present a method to project electrodes visible on the fluoroscopic image onto a reconstructed cortical surface by leveraging numerous common landmarks to translate, rotate, and scale coregistered computed tomography (CT) and magnetic resonance imaging (MRI) reconstructed surfaces in order to recreate the coordinate framework in which the fluoroscopic image was acquired, while accounting for parallax distortion. Validation of this approach demonstrated high precision with an average total Euclidian distance between three independent reviewers of 1.65±0.68mm across 8 patients and 82 electrodes. Spatial accuracy was confirmed by correspondence between recorded neural activity over sensorimotor cortex during hand movement. This semi-automated interface reliably estimates the location of temporarily implanted subdural ECoG electrodes visible on intraoperative fluoroscopy to a cortical surface.

Automated Computed Tomography–Ultrasound Cross-Modality 3-D Contouring Algorithm for Prostate

A novel fully automated algorithm is introduced for 3-D cross-modality image segmentation of the prostate, based on the simultaneous use of co-registered computed tomography (CT) and 3-D ultrasound (US) images. By use of a Gabor feature detector, the algorithm can outline in three dimensions and in cross-modality the prostate, and it can be trained and optimized on specific patient populations. We applied it to 16 prostate cancer patients and evaluated the conformity between the automatically segmented prostate contours and the contours manually outlined by an experienced physician, on the CT–US fusion, using the mean distance to conformity (MDC) index. When only the CT scans were used, the average MDC value was 4.5 ± 1.7 mm (maximum value = 9.0 mm). When the US scans also were considered, the mean ± standard deviation was reduced to 3.9 ± 0.7 mm (maximum value = 5.5 mm). The cross-modality approach acted on all the largest distance values, reducing them to acceptable discrepancies.

A Prospective Study of 18FDG-PET With CT Coregistration for Radiation Treatment Planning of Lymphomas and Other Hematologic Malignancies

This prospective single-institution study examined the impact of positron emission tomography (PET) with the use of 2-[(18)F] fluoro-2-deoxyglucose and computed tomography (CT) scan radiation treatment planning (TP) on target volume definition in lymphoma. 118 patients underwent PET/CT TP during June 2007 to May 2009. Gross tumor volume (GTV) was contoured on CT-only and PET/CT studies by radiation oncologists (ROs) and nuclear medicine physicians (NMPs) for 95 patients with positive PET scans. Treatment plans and dose-volume histograms were generated for CT-only and PET/CT for 95 evaluable sites. Paired t test statistics and Pearson correlation coefficients were used for analysis. 70 (74%) patients had non-Hodgkin lymphoma, 10 (11%) had Hodgkin lymphoma, 12 (10%) had plasma-cell neoplasm, and 3 (3%) had other hematologic malignancies. Forty-three (45%) presented with relapsed/refractory disease. Forty-five (47%) received no prior chemotherapy. The addition of PET increased GTV as defined by ROs in 38 patients (median, 27%; range, 5%-70%) and decreased GTV in 41 (median, 39.5%; range, 5%-80%). The addition of PET increased GTV as defined by NMPs in 27 patients (median, 26.5%; range, 5%-95%) and decreased GTV in 52 (median, 70%; range, 5%-99%). The intraobserver correlation between CT-GTV and PET-GTV was higher for ROs than for NMPs (0.94, P<.01 vs 0.89, P<.01). On the basis of Bland-Altman plots, the PET-GTVs defined by ROs were larger than those defined by NMPs. On evaluation of clinical TPs, only 4 (4%) patients had inadequate target coverage (D95 <95%) of the PET-GTV defined byNMPs. Significant differences between the RO and NMP volumes were identified when PET was coregistered to CT for radiation planning. Despite this, the PET-GTV defined by ROs and NMPs received acceptable prescription dose in nearly all patients. However, given the potential for a marginal miss, consultation with an experienced PET reader is highly encouraged when PET/CT volumes are delineated, particularly for questionable lesions and to assure complete and accurate target volume coverage.

Target volume delineation in breast conserving radiotherapy: are co-registered CT and MR images of added value?

IntroductionIn breast conserving radiotherapy differences of target volume delineations between observers do occur. We evaluated whether delineations based on co-registered computed tomography (CT) and magnetic resonance (MR) imaging may result in an improved consistency between observers. We used the delineation conformity index (CI) to compare clinical target volumes of glandular breast tissue (CTV breast) and lumpectomy cavity (LC) on both imaging modalities.Methods and materialsFour observers delineated CTV breast and LC on co-registered CTMR images in ten breast cancer patients. CIs were determined for CT and CTMR. Furthermore, the Cavity Visualization Score (CVS) of LC was taken into account.ResultsThe mean CI for CTV breast (CICT;CTV: 0.82 and CICT-CTMR;CTV: 0.80) and LC (CICT;LC: 0.52 and CICT-CTMR;LC: 0.48) did not differ significantly (p = 0.07 and p = 0.33, respectively). Taking CVS into account for the LC, with a CVS ≥ 4 the mean CI was 0.62 for both CICT;LC and CICT-CTMR;LC.ConclusionThe mean volume of the delineated glandular breast tissue based on CT was significantly larger compared to the volume based on CTMR. For patients with a CVS ≥ 4, the mean CIs of the LC were higher compared to CVS < 4 for volumes delineated on both CT as well as CTMR images. In our study cohort no significant differences between the CIs of the CTV breast and the LC delineated on CTMR co-registered images were found compared to the CIs on CT images only. Adding MR images does not seem to improve consistency of the delineation of the CTV breast and the LC, even though the volumes were copied from CT images. Since we included only ten patients, caution should be taken with regard to the results of our study.

Three-Dimensional Accuracy of ECOG Strip Electrode Localization Using Coregistration of Preoperative MRI and Intraoperative Fluoroscopy

Background/Aims: Algorithms that estimate implanted cortical strip electrode coordinates using postoperative skull X-ray coregistration with preoperative magnetic resonance imaging (MRI) have been proposed. However, when cortical strip electrodes are inserted for temporary use and removed prior to closure, intraoperative imaging - either fluoroscopy or computed tomography (CT) - must be substituted. Objectives: To measure the accuracy of temporarily inserted subdural strip electrode coordinates using intraoperative fluoroscopic coregistration with preoperative MRI compared to intraoperative CT coregistration with preoperative MRI. Methods: In 5 patients undergoing movement disorder surgery, preoperative MRI was used to generate a three-dimensional cortical surface manually scaled to fit an intraoperative skull fluorogram with an in situ six-contact subdural electrode strip. Individual contact coordinates were estimated using subjacent gyral and sulcal patterns. Estimated coordinates were compared to reference coordinates obtained by preoperative MRI coregistration with intraoperative CT in the same patients. Results: Mean electrode coordinate distances between estimated and reference locations were 6.0 ± 0.8 (x-axis, mediolateral), 3.3 ± 0.5 (y-axis, anterior-posterior) and 4.0 ± 0.5 mm (z-axis, superior-inferior; n = 30). Conclusions: Localization of temporarily inserted subdural electrodes can be accomplished using preoperative MRI and intraoperative fluoroscopy. The accuracy of this approach is verified by preoperative MRI and intraoperative CT coregistration in the same patients.

5-HT1A-receptor agonist modified amygdala activity and amygdala-associated social behavior in a valproate-induced rat autism model

Accumulating evidence suggests that dysfunction of the amygdala is related to abnormal fear processing, anxiety, and social behaviors noted in autistic spectrum disorders (ASDs). In addition, studies have shown that disrupted brain serotonin homeostasis is linked to ASD. With a valproate (VPA)-induced rat ASD model, we investigated the possible role of amygdala serotonin homeostasis in autistic phenotypes and further explored the underlying mechanism. We first discovered that the distribution of tryptophan hydroxylase immunoreactivity in the caudal raphe system was modulated on postnatal day (PD) 28 of the VPA-exposed offspring. Then, we found a significantly higher serotonin transporter availability in the amygdala of the VPA-exposed offspring on PD 56 by using single photon emission computed tomography and computed tomography co-registration following injection of (123)I-labeled 2-((2-(dimethylamino)methyl)phenyl)thio)-5-iodophenylamine((123)I[ADAM]). Furthermore, treatment with 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a 5-HT1A receptor agonist, increased social interaction and improved fear memory extinction in the VPA-exposed offspring. 8-OH-DPAT treatment also reversed the characteristics of miniature excitatory post-synaptic currents as well as paired pulse facilitation observed in lateral amygdala slices. These results provided further evidence to support the role of the amygdala in characteristic behavioral changes in the rat ASD model. The serotonergic projections that modulate the amygdala function might play a certain role in the development and treatment of behavioral symptoms exhibited in individuals with ASD.

Estimation of input functions from dynamic [18F]FLT PET studies of the head and neck with correction for partial volume effects

BackgroundWe present a method for extracting arterial input functions from dynamic [18F]FLT PET images of the head and neck, directly accounting for the partial volume effect. The method uses two blood samples, for which the optimum collection times are assessed.MethodsSix datasets comprising dynamic PET images, co-registered computed tomography (CT) scans and blood-sampled input functions were collected from four patients with head and neck tumours. In each PET image set, a region was identified that comprised the carotid artery (outlined on CT images) and surrounding tissue within the voxels containing the artery. The time course of activity in the region was modelled as the sum of the blood-sampled input function and a compartmental model of tracer uptake in the surrounding tissue.The time course of arterial activity was described by a mathematical function with seven parameters. The parameters of the function and the compartmental model were simultaneously estimated, aiming to achieve the best match between the modelled and imaged time course of regional activity and the best match of the estimated blood activity to between 0 and 3 samples. The normalised root-mean-square (RMSnorm) differences and errors in areas under the curves (AUCs) between the measured and estimated input functions were assessed.ResultsA one-compartment model of tracer movement to and from the artery best described uptake in the tissue surrounding the artery, so the final model of the input function and tissue kinetics has nine parameters to be estimated. The estimated and blood-sampled input functions agreed well when two blood samples, obtained at times between 2 and 8 min and between 8 and 60 min, were used in the estimation process (RMSnorm values of 1.1 ± 0.5 and AUC errors for the peak and tail region of the curves of 15% ± 9% and 10% ± 8%, respectively). A third blood sample did not significantly improve the accuracy of the estimated input functions.ConclusionsInput functions for FLT-PET studies of the head and neck can be estimated well using a one-compartment model of tracer movement and TWO blood samples obtained after the peak in arterial activity.

Anti-Tumor Necrosis Factor-α Therapy Reduces Aortic Inflammation and Stiffness in Patients With Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory condition associated with increased cardiovascular risk. This is not fully explained by traditional risk factors, but direct vascular inflammation and aortic stiffening may play a role. We hypothesized that patients with RA exhibit aortic inflammation, which can be reversed with anti-tumor necrosis factor-α therapy and correlates with aortic stiffness reduction. Aortic inflammation was quantified in 17 patients with RA, before and after 8 weeks of anti-tumor necrosis factor-α therapy by using (18)F-fluorodeoxyglucose positron emission tomography with computed tomography coregistration. Concomitantly, 34 patients with stable cardiovascular disease were imaged as positive controls at baseline. Aortic fluorodeoxyglucose target-to-background ratios (TBRs) and aortic pulse wave velocity were assessed. RA patients had higher baseline aortic TBRs in comparison with patients who have cardiovascular disease (2.02±0.22 versus 1.74±0.22, P=0.0001). Following therapy, aortic TBR fell to 1.90±0.29, P=0.03, and the proportion of inflamed aortic slices (defined as TBR >2.0) decreased from 50±33% to 33±27%, P=0.03. Also, TBR in the most diseased segment of the aorta fell from 2.51±0.33 to 2.05±0.29, P<0.0001. Treatment also reduced aortic pulse wave velocity significantly (from 9.09±1.77 to 8.63±1.42 m/s, P=0.04), which correlated with the reduction of aortic TBR (R=0.60, P=0.01). This study demonstrates that RA patients have increased aortic (18)F-fluorodeoxyglucose uptake in comparison with patients who have stable cardiovascular disease. Anti-tumor necrosis factor-α therapy reduces aortic inflammation in patients with RA, and this effect correlates with the decrease in aortic stiffness. These results suggest that RA patients exhibit a subclinical vasculitis, which provides a mechanism for the increased cardiovascular disease risk seen in RA.

Sci-Fri AM: Imaging - 07: Symmetric geometric transfer matrix partial volume correction technique for emission tomography: Principle, validation, and robustness.

Partial volume correction (PVC) is often needed to correct for limited spatial resolution in quantitative Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) studies. In conventional region-based PVC methods, spill over between regions segmented from coregistered computed tomography (CT) or magnetic resonance (MR) images is accounted for by calculating regional spread functions (RSFs) in a geometric transfer matrix (GTM) framework. This paper describes a new analytically derived symmetric GTM (sGTM) method that considers spill over between RSFs rather than between regions. The sGTM is mathematically equivalent to Labbe's method, however it is region-based rather than voxel-based and it avoids handling large matrices. The sGTM method was validated using an MR-based 3D digital brain phantom and a physical phantom containing spheres 5 mm to 30 mm in diameter. The sGTM method was compared to the GTM method in terms of accuracy, precision, noise propagation, and robustness, i.e. effects of mis-registration or point spread function (PSF) estimation errors. The results showed that the sGTM method has accuracy similar to that of the GTM method, and within 5% of the true value. However, the sGTM method showed better precision and noise propagation than the GTM method, especially for spheres smaller than 13 mm. Moreover, the sGTM method was more robust than the GTM method when misregistration or errors in estimates of PSF occurred. In conclusion, the sGTM method was analytically derived and validated and shown to exhibit better noise characteristics and robustness compared to the GTM method.

An Atlas-Based Electron Density Mapping Method for Magnetic Resonance Imaging (MRI)-Alone Treatment Planning and Adaptive MRI-Based Prostate Radiation Therapy

Prostate radiation therapy dose planning directly on magnetic resonance imaging (MRI) scans would reduce costs and uncertainties due to multimodality image registration. Adaptive planning using a combined MRI-linear accelerator approach will also require dose calculations to be performed using MRI data. The aim of this work was to develop an atlas-based method to map realistic electron densities to MRI scans for dose calculations and digitally reconstructed radiograph (DRR) generation. Whole-pelvis MRI and CT scan data were collected from 39 prostate patients. Scans from 2 patients showed significantly different anatomy from that of the remaining patient population, and these patients were excluded. A whole-pelvis MRI atlas was generated based on the manually delineated MRI scans. In addition, a conjugate electron-density atlas was generated from the coregistered computed tomography (CT)-MRI scans. Pseudo-CT scans for each patient were automatically generated by global and nonrigid registration of the MRI atlas to the patient MRI scan, followed by application of the same transformations to the electron-density atlas. Comparisons were made between organ segmentations by using the Dice similarity coefficient (DSC) and point dose calculations for 26 patients on planning CT and pseudo-CT scans. The agreement between pseudo-CT and planning CT was quantified by differences in the point dose at isocenter and distance to agreement in corresponding voxels. Dose differences were found to be less than 2%. Chi-squared values indicated that the planning CT and pseudo-CT dose distributions were equivalent. No significant differences (p > 0.9) were found between CT and pseudo-CT Hounsfield units for organs of interest. Mean ± standard deviation DSC scores for the atlas-based segmentation of the pelvic bones were 0.79 ± 0.12, 0.70 ± 0.14 for the prostate, 0.64 ± 0.16 for the bladder, and 0.63 ± 0.16 for the rectum. The electron-density atlas method provides the ability to automatically define organs and map realistic electron densities to MRI scans for radiotherapy dose planning and DRR generation. This method provides the necessary tools for MRI-alone treatment planning and adaptive MRI-based prostate radiation therapy.

Accuracy of Postoperative Computed Tomography and Magnetic Resonance Image Fusion for Assessing Deep Brain Stimulation Electrodes

Knowledge of the anatomic location of the deep brain stimulation (DBS) electrode in the brain is essential in quality control and judicious selection of stimulation parameters. Postoperative computed tomography (CT) imaging coregistered with preoperative magnetic resonance imaging (MRI) is commonly used to document the electrode location safely. The accuracy of this method, however, depends on many factors, including the quality of the source images, the area of signal artifact created by the DBS lead, and the fusion algorithm. To calculate the accuracy of determining the location of active contacts of the DBS electrode by coregistering postoperative CT image to intraoperative MRI. Intraoperative MRI with a surrogate marker (carbothane stylette) was digitally coregistered with postoperative CT with DBS electrodes in 8 consecutive patients. The location of the active contact of the DBS electrode was calculated in the stereotactic frame space, and the discrepancy between the 2 images was assessed. The carbothane stylette significantly reduces the signal void on the MRI to a mean diameter of 1.4 ± 0.1 mm. The discrepancy between the CT and MRI coregistration in assessing the active contact location of the DBS lead is 1.6 ± 0.2 mm, P < .001 with iPlan (BrainLab AG, Erlangen, Germany) and 1.5 ± 0.2 mm, P < .001 with Framelink (Medtronic, Minneapolis, Minnesota) software. CT/MRI coregistration is an acceptable method of identifying the anatomic location of DBS electrode and active contacts.