Measured Attenuation Correction Research Articles

Robust-Deep: A Method for Increasing Brain Imaging Datasets to Improve Deep Learning Models' Performance and Robustness.

A small dataset commonly affects generalization, robustness, and overall performance of deep neural networks (DNNs) in medical imaging research. Since gathering large clinical databases is always difficult, we proposed an analytical method for producing a large realistic/diverse dataset. Clinical brain PET/CT/MR images including full-dose (FD), low-dose (LD) corresponding to only 5 % of events acquired in the FD scan, non-attenuated correction (NAC) and CT-based measured attenuation correction (MAC) PET images, CT images and T1 and T2 MR sequences of 35 patients were included. All images were registered to the Montreal Neurological Institute (MNI) template. Laplacian blending was used to make a natural presentation using information in the frequency domain of images from two separate patients, as well as the blending mask. This classical technique from the computer vision and image processing communities is still widely used and unlike modern DNNs, does not require the availability of training data. A modified ResNet DNN was implemented to evaluate four image-to-image translation tasks, including LD to FD, LD+MR to FD, NAC to MAC, and MRI to CT, with and without using the synthesized images. Quantitative analysis using established metrics, including the peak signal-to-noise ratio (PSNR), structural similarity index metric (SSIM), and joint histogram analysis was performed for quantitative evaluation. The quantitative comparison between the registered small dataset containing 35 patients and the large dataset containing 350 synthesized plus 35 real dataset demonstrated improvement of the RMSE and SSIM by 29% and 8% for LD to FD, 40% and 7% for LD+MRI to FD, 16% and 8% for NAC to MAC, and 24% and 11% for MRI to CT mapping task, respectively. The qualitative/quantitative analysis demonstrated that the proposed model improved the performance of all four DNN models through producing images of higher quality and lower quantitative bias and variance compared to reference images.

MR∕PET quantification tools: registration, segmentation, classification, and MR-based attenuation correction.

Combined MR∕PET is a relatively new, hybrid imaging modality. A human MR∕PET prototype system consisting of a Siemens 3T Trio MR and brain PET insert was installed and tested at our institution. Its present design does not offer measured attenuation correction (AC) using traditional transmission imaging. This study is the development of quantification tools including MR-based AC for quantification in combined MR∕PET for brain imaging. The developed quantification tools include image registration, segmentation, classification, and MR-based AC. These components were integrated into a single scheme for processing MR∕PET data. The segmentation method is multiscale and based on the Radon transform of brain MR images. It was developed to segment the skull on T1-weighted MR images. A modified fuzzy C-means classification scheme was developed to classify brain tissue into gray matter, white matter, and cerebrospinal fluid. Classified tissue is assigned an attenuation coefficient so that AC factors can be generated. PET emission data are then reconstructed using a three-dimensional ordered sets expectation maximization method with the MR-based AC map. Ten subjects had separate MR and PET scans. The PET with [(11)C]PIB was acquired using a high-resolution research tomography (HRRT) PET. MR-based AC was compared with transmission (TX)-based AC on the HRRT. Seventeen volumes of interest were drawn manually on each subject image to compare the PET activities between the MR-based and TX-based AC methods. For skull segmentation, the overlap ratio between our segmented results and the ground truth is 85.2 ± 2.6%. Attenuation correction results from the ten subjects show that the difference between the MR and TX-based methods was <6.5%. MR-based AC compared favorably with conventional transmission-based AC. Quantitative tools including registration, segmentation, classification, and MR-based AC have been developed for use in combined MR∕PET.

Attenuation correction for the large non-human primate brain imaging using microPET

Assessment of the biodistribution and pharmacokinetics of radiopharmaceuticals in vivo is often performed on animal models of human disease prior to their use in humans. The baboon brain is physiologically and neuro-anatomically similar to the human brain and is therefore a suitable model for evaluating novel CNS radioligands. We previously demonstrated the feasibility of performing baboon brain imaging on a dedicated small animal PET scanner provided that the data are accurately corrected for degrading physical effects such as photon attenuation in the body. In this study, we investigated factors affecting the accuracy and reliability of alternative attenuation correction strategies when imaging the brain of a large non-human primate (papio hamadryas) using the microPET Focus 220 animal scanner. For measured attenuation correction, the best bias versus noise performance was achieved using a 57Co transmission point source with a 4% energy window. The optimal energy window for a 68Ge transmission source operating in singles acquisition mode was 20%, independent of the source strength, providing bias-noise performance almost as good as for 57Co. For both transmission sources, doubling the acquisition time had minimal impact on the bias-noise trade-off for corrected emission images, despite observable improvements in reconstructed attenuation values. In a [18F]FDG brain scan of a female baboon, both measured attenuation correction strategies achieved good results and similar SNR, while segmented attenuation correction (based on uncorrected emission images) resulted in appreciable regional bias in deep grey matter structures and the skull. We conclude that measured attenuation correction using a single pass 57Co (4% energy window) or 68Ge (20% window) transmission scan achieves an excellent trade-off between bias and propagation of noise when imaging the large non-human primate brain with a microPET scanner.

｀１８´Ｆ−ＦＤＧを用いた脳ＰＥＴ検査の健常者データベースにおける透過撮像および減弱補正法の影響

Although post-injection transmission scan (POST-TS) after 2-[(18)F]fluoro-2-deoxy- D-glucose ((18)F-FDG) injection[A1] is useful for short examination times, the emission count of (18)F-FDG[A2] in the regional brain area was not completely subtracted with use of the POST-TS method. The purpose of this study was to investigate the effect of POST-TS and attenuation correction (AC) methods on the normal database (NDB). A 10 min pre-injection transmission scan (PRE-TS) was performed before (18)F-FDG[A3] was injected in eighteen normal volunteers. A 10 min POST-TS was then conducted beginning 40 min after (18)F-FDG[A4] injection, followed by a 10 min 2-dimentional emission scanning. To reconstruct each image of normal volunteers, the reconstruction was performed using the filtered back-projection (FBP) method and the ordered subsets expectation maximization (OSEM) method, with transmission-based measured attenuation correction (MAC) and the segmented attenuation correction (SAC) technique. Subtraction images of NDB with PRE-TS or POST-TS were evaluated using 3D-SSP. A phantom study was also performed in addition to a human study, and assessment was by region of interests and profile curves. NDB images with POST-TS were significantly lower in the bilateral frontal lobes and higher in the parietal lobes and occipital lobes, including the precuneus, than those with PRE-TS, regardless of the different AC and reconstruction algorithms. Therefore, we have to be careful to confirm not only emission scan methods and reconstruction algorithms, but also TS methods and AC methods in the NDB. It will be best to perform PET examinations using the same TS methods and AC methods between NDB and patients.

Feasibility of Template-Guided Attenuation Correction in Cat Brain PET Imaging

Attenuation correction (AC) is important in quantitative positron emission tomography (PET) imaging of medium-sized animals such as the cat. However, additional time for transmission (TX) scanning and tracer uptake is required in PET studies with animal-dedicated PET scanners because post-injection TX scanning is not available in these systems. The aim of this study was to validate a template-guided AC (TGAC) method that does not require TX PET data for AC in cat 2-deoxy-2-[F-(18)fluoro-D-glucose (FDG) brain PET imaging. PET scans were acquired using a microPET Focus 120 scanner. TX data were obtained using a (68)Ge point source before the injection of FDG. To generate the attention map (mu-map) template for the TGAC, a target image of emission (EM) PET was selected, and spatial normalization parameters of individual EM data onto the target were reapplied to the corresponding mu-maps. The inverse transformations of the mu-map template into the individual spaces were performed, and the transformed template was forward projected to generate the AC factor. The TGAC method was compared with measured AC (MAC) and calculated AC (CAC) methods using region of interest (ROI) and SPM analyses. The ROI analysis showed that the activity of the TGAC EM PET images strongly correlated with those of the MAC data (y = 0.98x + 0.01, R(2) = 0.96). In addition, no significant difference was observed in the SPM analysis. By contrast, the CAC showed a significantly higher uptake in the deep gray regions compared to the MAC (corrected P < 0.05). The ROI correlation with MAC was worse than with the TGAC (R(2) = 0.84). In SPM analysis for the voxel-wise group comparisons between before and after the induction of deafness, only the TGAC showed equivalent results with the MAC. The TGAC was reliable in cat FDG brain PET studies in terms of compatibility with the MAC method. The TGAC might be a useful option for increasing study throughput and decreasing the probability of subject movement. In addition, it might reduce the possible biological effects of long-term anesthesia on the cat brain in investigations using animal-dedicated PET scanners.

Accelerated microPET Transmission Imaging

The Siemens microPET family of scanners provides for acquiring a measured attenuation correction using a 57Co point transmission source that spirals around the field of view (FOV). The standard transmission source mechanism advances the source 0.5 mm for every spiral about the FOV. The transmission scan measurement requires approximately 10 minutes, so that often in the interest of time it is not done. The aim of this work was to reduce the transmission scan time on the microPET without compromising the accuracy of the measured attenuation map. The transmission source mechanisms of a microPET R4 and Focus 120 were modified by replacing the 0.5 mm pitch source driving rod with rods of pitches 1.0 mm and 1.5875 mm, thus reducing the transmission scanning times by 50% and 68% respectively. The reductions in transmission imaging acquisition times drop to 40% and 56% for the two rods when the time required to configure the system to low energy singles mode is considered. Transmission data were acquired of uniform cylinders and of a euthanized rat. The reconstructed attenuation maps showed no apparent artefacts introduced by the increase in source pitch. Image noise increased according to that expected from Poisson statistics. The effects of increased image noise had little effect on the attenuation map when segmentation methods were used. We conclude that accurate measured attenuation maps can be produced in as little as 1/3 of the normal transmission scan time by modifying the transmission source mechanism to have a more aggressive source pitch.

Evaluation of transmission methodology and attenuation correction for the microPET Focus 220 animal scanner

An accurate, low noise estimate of photon attenuation in the subject is required for quantitative microPET studies of molecular tracer distributions in vivo. In this work, several transmission-based measurement techniques were compared, including coincidence mode with and without rod windowing, singles mode with two different energy sources (68Ge and 57Co), and postinjection transmission scanning. In addition, the effectiveness of transmission segmentation and the propagation of transmission bias and noise into the emission images were examined. The 57Co singles measurements provided the most accurate attenuation coefficients and superior signal-to-noise ratio, while 68Ge singles measurements were degraded due to scattering from the object. Scatter correction of 68Ge transmission data improved the accuracy for a 10 cm phantom but over-corrected for a mouse phantom. 57Co scanning also resulted in low bias and noise in postinjection transmission scans for emission activities up to 20 MBq. Segmentation worked most reliably for transmission data acquired with 57Co but the minor improvement in accuracy of attenuation coefficients and signal-to-noise may not justify its use, particularly for small subjects. We conclude that 57Co singles transmission scanning is the most suitable method for measured attenuation correction on the microPET Focus 220 animal scanner.

Motion correction eliminates discontinuities in parametric PET images of neuroreceptor binding

Head movements during PET studies of cerebral neuroreceptors with positron emission tomography (PET), which are often recorded as dynamic studies over periods ranging from one to two hours, do not only lead to blurred images, but, by distorting pixel time-activity curves, may also seriously disturb the kinetic analysis. Here we report on the effect of head motion on parametric images of the distribution volume ratio (DVR) as well as on the elimination of artefacts, if the dynamic PET data are corrected for head movements. For this purpose we utilized six PET studies done with the 5HT2A-receptor ligand [18F]-altanserin. Prior to the tracer injection a transmission scan of 10 min was recorded for measured attenuation correction. During the PET scan, which was acquired in listmode for 1 h, the position of the head was monitored by a Polaris infrared motion tracking system. The listmode data were sorted into 42 time frames between 10 s and 2 min in duration. A time frame consists of 63 images of 128 128 voxels with a voxel size of 2 mm 2 mm 2.43 mm. The motion correction used the multiple acquisition frame (MAF) approach, which calculates individual attenuation files for each emission frame and its corresponding head position to avoid a misalignment between transmission and emission data. After reconstruction of attenuation corrected emission frames each image frame was realigned to match the head position of the first emission frame. Both the motion corrected and not corrected dynamic images were evaluated by the non-invasive Logan plot method to obtain parametric images of DVR. In addition, a dynamic [18F]-altanserin PET scan was simulated and affected by similar movements as seen in the human studies. In this way data without statistical noise could be analysed. DVR images of motion-affected [18F]-altanserin scans showed artefacts whose extent was dependent on the amount of movement. The artefacts were mainly located at the border of the cortical tissue, especially at the interior edge towards white matter. The artefacts exhibited as discontinuities and small spots, whose values exceeded the expected DVR values or were even negative. The discontinuities were found with movements of 4 mm and greater. Isolated spots were present even with movements of only 2 mm. The artefacts disappeared when the MAF based motion correction was applied. The observations obtained in human data could be confirmed in the simulated noise free [18F]-altanserin images confirming that the artefacts are due to motion and not to statistical noise. Whereas the native PET images look just blurred, if the patient has moved during the PET scan, parametric images of the Logan DVR, which are calculated by pixel-wise linear regression, contain severe discontinuities primarily at the cortical edge. At this location, the data used in the DVR calculation change between grey and white matter data because of the head motion. The MAF based head motion correction is able to avoid the described errors.

The influence of measurement uncertainties on the evaluation of the distribution volume ratio and binding potential in rat studies on a microPET® R4: a phantom study

In small animal positron emission tomography (PET) imaging, the injectable radiotracer dose is often limited by the tracer mass which, together with the tracer kinetics and scanner sensitivity, dictates the statistical quality of the time activity curves (TACs) used to extract biological parameters. We investigated the effect of measurement uncertainty on the determination of the distribution volume ratio (DVR) and binding potential (BP) as estimated using the tissue input Logan (DVRL, BPL) and the ratio (DVRr, BPr) methods for two tracers, with the Concorde microPET® R4 camera. Parameters' coefficients of variation (COV) were estimated from a combination of rat and phantom data. For 11C-dihydrotetrabenazine, the COV was 11% for the BPL and 13.4% for the BPr when using TACs obtained from individual regions of interest (ROIs) and segmented attenuation correction. The COVs were reduced to 7.5% (BPL) and 8.6% (BPr) when the striatal and cerebellar TACs were estimated as averages of 3 and 2 ROIs respectively. Results obtained for 11C-methylphenidate (MP) yielded approximately 30% higher COVs. With measured attenuation correction, the COVs were on average 100% higher. The presented method can be used to examine the contribution of a variety of imaging conditions to the uncertainty of biologically meaningful parameters.

PET/CT and PET using [18F]-FDG in a Patient with Soft Tissue Sarcoma

Fluorine-18 Fluordeoxyglucose Positron Emission Tomography (FDG-PET) is a useful tool in monitoring of sarcoma treatment. Recent data demonstrated an increase of tumour uptake with time compared to a decline in inflammatory lesions in dual time PET scanning. We demonstrate a patient with pulmonary masses 6 months after surgical removement of a mediastinal soft tissue sarcoma. Using PET scans 1h and 3h p.i 320 MBq FDG (,i.e. a combined PET/CT using CT-based attenuation correction and a conventional PET with measured attenuation correction), an increased tracer-uptake was observed in a single pulmonary mass, thus leading to the diagnosis of malignancy. Subsequent CT guided biopsy and further clinical follow-up, however, demonstrated the absence of malignancy and showed inflammatory disease instead.

Validation of quantitative accuracy of the post-injection transmission-based and transmissionless attenuation correction techniques in neurological FDG-PET

We evaluated the quantitative accuracy of the post-injection transmission-based segmented attenuation correction (SAC) technique and transmissionless calculated attenuation correction (CAC) technique in both 2D and 3D scanning for the brain, and compared the results with those obtained using the pre-injection transmission-based measured attenuation correction (MAC) technique, which is generally accepted as the 'gold standard'. We examined [18F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) on both a cylindrical phantom and in 10 patients with epilepsy. The statistical analyses were performed using both the region of interest (ROI) method and statistical parametric mapping (SPM). In the ROI analysis, [18F] activity concentration values obtained by the SAC technique were well correlated with those obtained by the MAC technique (2D, R2=0.94; 3D, R2=0.98; P<0.001), although these values were underestimated over the entire brain. The CAC technique was also found to have significant correlation with the MAC technique (2D, R2=0.84; 3D, R2=0.86; P<0.001), but this technique showed apparent overestimation or underestimation in several parts of the brain. In the SPM analysis, there were no significant differences between the SAC and MAC technique, while those values obtained by the CAC technique were significantly lower in the parieto-occipital region and higher in the lower frontal region (P<0.001, uncorrected). The SAC technique was superior to the CAC technique in both 2D and 3D scanning, although we found that both the SAC and CAC techniques had some problems in quantitative evaluation. We considered that the SAC technique may yield adequate qualitative measurements of the [18F] activity concentration value after global normalization.

Interscan Displacement-Induced Variance in PET Activation Data Is Excluded by a Scan-Specific Attenuation Correction

In PET activation studies, linear changes in regional cerebral blood flow may be caused by subject interscan displacements rather than by changes in cognitive state. The aim of this study was to investigate the impact of these artifacts and to assess whether they can be removed by applying a scan-specific calculated attenuation correction (CAC) instead of the default measured attenuation correction (MAC). Two independent data sets were analyzed, one with large (data I) and one with small (data II) interscan displacements. After attenuation correction (CAC or MAC), data were analyzed using SPM99. Interscan displacement parameters (IDP), obtained during scan realignment, were included as additional regressors in the General Linear Model and their impact was assessed by variance statistics revealing the affected brain volume. For data I, this volume reduced dramatically from 579 to 12 cm 3 (approximately 50-fold) at P uncorr ≤ 0.001 and from 100 to 0 cm 3 at P corr ≤ 0.05 when CAC was applied instead of MAC. Surprisingly, for data II, applying CAC instead of MAC still resulted in a substantial (approximately 10-fold) reduction of the affected volume from 23 to 2 cm 3 at P uncorr ≤ 0.001. We conclude that interscan displacement-induced variance can be prevented by applying a (realigned attenuation correction scan (e.g., CAC). With MAC data, introducing IDP covariates is not an alternative since they model only this variance. Even in data with minor interscan displacements, applying a (realigned attenuation correction method (e.g., CAC) is superior to a nonaligned MAC with IDP covariates.

Quantitative Evaluation of 2-Deoxy-2-[ 18F] Fluoro-D-Glucose Uptake in Hepatic Metastases with Combined PET-CT : Iterative Reconstruction with CT Attenuation Correction Versus Filtered Back Projection with 68Germanium Attenuation Correction

Purpose: Iterative reconstruction (IR) is a statistical reconstruction method that may be influenced by high background activity such as in the liver. Recently developed combined positron emission tomography (PET) and computerized tomography (CT) instrumentation utilizes CT attenuation correction that may also differ compared to 68Germanium ( 68Ge) segmented attenuation correction (IR SAC). Quantitative differences could affect the clinical interpretation of metastatic foci and subsequent response to therapy. The purpose of this study is to characterize potential quantitative differences specifically in hepatic metastases. Procedures: Thirty-three metastatic liver lesions in 23 patients were evaluated. Whole-body 2-deoxy-2[ 18F]fluoro-D-glucose(FDG) PET images were obtained on a dedicated PET-CT device and reconstructed with IR and CT measured attenuation correction (IR CT MAC), IR and 68Ge segmented attenuation correction, and also with filtered back-projection and segmented attenuation correction (FBP SAC). Regions of interest over the liver lesions (L) and liver background (B) were drawn on FBP SAC images and superimposed on the co-registered IR CT MAC and IR SAC images for comparison. To identify the individual effects of IR and CT attenuation correction, IR SAC was first compared to FBP SAC, followed by a comparison of IR CT MAC and IR SAC. Differences were expressed as bias (%) and compared to FBP SAC. Results: Compared to FBP SAC, IR SAC showed significantly lower liver lesion (mean bias −7.1%; P < 0.00001), significantly higher liver background (mean bias −3.5%; P = 0.005), and significantly lower L/B ratio (mean bias −10.1%; P < 0.00001). Compared to IR SAC, the IR CT MAC showed small but not statistically significant increases in liver lesion (mean bias 3.0%; P = 0.1) and liver background (mean bias 4.3%; P = 0.09), and no significant difference in L/B ratio (mean bias −1.3%; P = 0.5). The overall effect of IR CT MAC compared to FBP SAC was a significant decrease in liver lesion (mean bias −4.2%; P = 0.002), significant increase in liver background (mean bias 8.7%; P = 0.002), and significantly lower L/B (mean bias −11.1%; P < 0.00001) compared to FBP SAC. Conclusion: Compared to FBP, IR resulted in significantly lower mean hepatic tumor activity, higher mean liver background activity, and lower L/B activity, but these differences were modest. These differences were similarly seen in the CT corrected IR CT MAC when compared to FBP SAC. CT attenuation correction did not result in significant differences when compared to 68Ge correction. Although the differences in IR CT MAC were modest, consistent reconstruction methods are important to decrease the measurement variability and improve reproducibility.

Standardized Uptake Values in 2-Deoxy-2-[ 18F]Fluoro-D-Glucose with Positron Emission Tomography : Clinical Significance of Iterative Reconstruction and Segmented Attenuation Compared with Conventional Filtered Back Projection and Measured Attenuation Correction

Purpose: To evaluate the clinical significance of differences in 2-deoxy-2-[ 18F]fluoro-D-glucose positron emission tomography (FDG-PET) lymph node standardized uptake values (SUV) in human immunodeficiency virus (HIV) infection using iterative reconstruction with segmented attenuation correction (IR SAC) compared to filtered back-projection with measured attenuation correction (FBP MAC). Procedures: Seven patients with HIV infection and multiple focal lymph node abnormalities were investigated with whole-body FDG-PET. Mean and maximum SUVs from lymph node regions of interest (n = 961) were compared for quantitative differences between reconstruction techniques. Results: IR MAC resulted in significantly lower mean SUV [0.06; 95% (confidence interval (CI)) = 0.04–0.07] and maximum SUV (0.82; 95% CI = 0.77–0.88) values compared to FBP MAC. With IR, segmentation of attenuation correction (AC) resulted in significantly higher mean SUV (0.12; 95% CI = 0.11–0.13) and maximum SUV (0.21; 95% CI = 0.18–0.23) values compared to IR MAC. The overall effect of both IR and SAC was a slight but significant increase in mean SUV (0.06; 95% CI = 0.06–0.08; bias = 2.1%) and a significant decrease in maximum SUV (0.62; 95% CI = 0.56–0.67) compared to FBP MAC. Conclusions: With our reconstruction parameters, significant differences in mean and maximum SUV values were observed. The magnitude of the mean SUV difference, however, was small. IR SAC is a promising method to accurately quantify standardized uptake values for clinical use.

Detection of lung cancer with positron coincidence gamma camera using fluorodeoxyglucose in comparison with dedicated PET

Objective: Dual-head gamma cameras with sodium iodide (NaI) detectors operated in coincidence mode provide a new approach for imaging with positron-labeled tracers. The purpose of this study was to evaluate the feasibility of FDG imaging with positron coincidence detection gamma camera (PCD) in detecting lung tumor in comparison with FDG imaging with the dedicated positron emission tomography (PET). Methods and material: Twenty-six lesions of 13 patients with suspected lung cancer were studied with both FDG PET and FDG PCD on the same day. Pulmonary lesions were analyzed visually and semi-quantitatively using the ratio of target-to-background counts (T/B ratio). Results and conclusions: FDG PCD and FDG PET could detect visually 21 lesions (80.8%) and 23 lesions (88.0%), respectively. The mean T/B ratio and standard deviation (S.D.) of FDG PCD was 4.6±3.9, significantly lower than that of FDG PET (11.4±6.6, P<0.001). When pulmonary lesions were no more than 2.0 cm in diameter, the sensitivity of FDG PCD was 37.5%, significantly inferior to that of FDG PET (62.5%, P<0.001). There was no statistically significant difference of the sensitivity between the FDG PCD and FDG PET in lesions of more than 2.0 cm in diameter. FDG PCD with uniform attenuation correction was clinically available in detecting lung cancer. However, the sensitivity for small lesions less than 2.0 cm was limited. The application of measured attenuation correction and scatter correction may to be needed to improve the detectability of FDG PCD, especially for detecting small lung cancer.

Fundamental evaluation of segmented attenuation correction method for clinical FDG-PET studies: simulation of pulmonary mass lesions in phantom studies

Both the segmented attenuation correction (SAC) method and post-injection transmission scanning are useful and widespread in clinical whole-body FDG-PET studies. The SAC method usually accomplishes smoothing of the transmission data. This calculation segments a micro -map into three degrees (lung, soft tissue, and bone) of attenuation coefficient. This method is used to reduce transmission scan time without deteriorating the quality of PET images. However, the SAC method has a tendency to underestimate the attenuation coefficient, resulting lower detectability for lung field mass lesions. We therefore evaluated the quantitative accuracy of the SAC method using transmission scanning and emission scanning data in a phantom study. A dedicated 3D PET scanner, the Siemens ECAT EXACT HR+, was used to scan images of two types of phantoms, a spherical phantom (Japan Radioisotope Association phantom) and a cylindrical phantom (20 cm in diameter). We evaluated differences between transmission images ( micro -map) of the SAC method and measured attenuation correction (MAC) method, these two kinds of attenuation-corrected emission data (emission + SAC method, emission + MAC method), and emission data only (without attenuation correction). In the micro -map, recovery coefficient (RC) values at 10 mm in diameter were 0.27 and 0.00 in the MAC and SAC methods, respectively, in the spherical hot area. For the emission data, the emission + SAC method and emission + MAC method showed almost the same RC values for all sizes of hot area diameter. The SAC method, however, resulted in 20% underestimation for all sizes of hot area diameter as compared with the MAC method. In pulmonary mass lesions, it is necessary to correct for the partial volume effect in quantitative PET measurement. However, from our data, the SAC method is not appropriate for partial volume effect correction.

Influence of OSEM and segmented attenuation correction in the calculation of standardised uptake values for [18F]FDG PET

Standardised Uptake Values (SUVs) are widely used in positron emission tomography (PET) as a semi-quantitative index of fluorine-18 labelled fluorodeoxyglucose uptake. The objective of this study was to investigate any bias introduced in the calculation of SUVs as a result of employing ordered subsets-expectation maximisation (OSEM) image reconstruction and segmented attenuation correction (SAC). Variable emission and transmission time durations were investigated. Both a phantom and a clinical evaluation of the bias were carried out. The software implemented in the GE Advance PET scanner was used. Phantom studies simulating tumour imaging conditions were performed. Since a variable count rate may influence the results obtained using OSEM, similar acquisitions were performed at total count rates of 34kcps and 12kcps. Clinical data consisted of 100 patient studies. Emission datasets of 5 and 15min duration were combined with 15-, 3-, 2- and 1-min transmission datasets for the reconstruction of both phantom and patient studies. Two SUVs were estimated using the average (SUVavg) and the maximum (SUVmax) count density from regions of interest placed well inside structures of interest. The percentage bias of these SUVs compared with the values obtained using a reference image was calculated. The reference image was considered to be the one produced by filtered backprojection (FBP) image reconstruction with measured attenuation correction using the 15-min emission and transmission datasets for each phantom and patient study. A bias of 5%-20% was found for the SUVavg and SUVmax in the case of FBP with SAC using variable transmission times. In the case of OSEM with SAC, the bias increased to 10%-30%. An overall increase of 5%-10% was observed with the use of SUVmax. The 5-min emission dataset led to an increase in the bias of 25%-100%, with the larger increase recorded for the SUVmax. The results suggest that OSEM and SAC with 3 and 2min transmission may be reliably used to reduce the overall data acquisition time without compromising the accuracy of SUVs.

5. Utility of F-18 FDG Imaging for Diagnosing the Infected Joint Replacement

Purpose: F-18 FDG (FDG) is reportedly useful for detecting infection. Because the procedure is simple, with results being readily available, this prospective study was undertaken to evaluate the utility of FDG imaging for diagnosing infected joint replacements.Methods: 26 pts, 18 females and 4 males between 37 and 87 years old, with 31 joint replacements were studied. 21 pts had single joint replacement (10 hip, 11 knee); 5 pts had bilateral replacements (1 hip, 4 knee). Imaging was performed on a Hybrid PET system, with measured attenuation correction, one hour after administration of 150 MBq FDG. Increased peri-prosthetic uptake compared to adjacent, presumably normal, activity was interpreted as positive for infection.Results: 11 of 31 prostheses were infected. Sensitivity, specificity, and accuracy of FDG were 100%, 55%, and 71% respectively. The PPV was 55% and the NPV was 100%. Excluding the 5 asymptomatic prostheses in pts with bilateral joint replacements, the sensitivity, specificity, and accuracy were 100%, 47%, and 69% respectively. The PPV was 58% and the NPV was 100%. 4 pts with infected prostheses underwent a total of 6 follow-up studies after treatment. In 1 pt with persistent infection, all 3 follow-up studies were true positive. In the other 3 pts in whom infection had been eradicated, follow-up FDG studies were false positive.Conclusion: FDG imaging is sensitive but not specific; consequently, its role in pts with suspected prosthetic infection is limited to that of a screening test. These data also suggest that this technique is not useful for monitoring response to treatment.

9:15—9:30: A Clinical Evaluation of Segmented Attenuation Correction

Segmented attenuation correction (SAC) has been introduced as a method of reducing transmission scan times without degrading the quality of PET images. Presented are the results of a clinical evaluation of a SAC algorithm implemented on the GE Advance PET system. FDG whole body patient emission scans of eight minute duration were acquired. Dynamic transmission (Tx) scans of 5 frames and 6 minute total duration were acquired and rebinned into Tx scans of 2, 3, 4, 5 and 6 minute duration. Images (I) were generated using iterative reconstruction with measured attenuation correction (MAC) or SAC for all Tx scans—denoted as I(Tx6MAC), I(Tx6SAC), etc. Anthropomorphic phantom data was also acquired and reconstructed using the same methodology. Images were evaluated quantitatively using the normalized mean square error (NMSE) of different regions and the variance and bias of liver activity. I(Tx6MAC) served as the reference. A blinded observer ranked image quality. The NMSE increased as the Tx duration decreased; for patient images the NMSE was typically 20% and 40% greater for I(Tx3SAC) and I(Tx2SAC) than I(Tx6SAC) respectively. The NMSE of the MAC images increased much more rapidly as the Tx duration decreased. Similar trends were found for the variance in the liver. Bias in liver activity of the SAC images was approximately −8% for large patients. The observer consistently preferred SAC images over MAC images. SAC images demonstrated improved boundary delineation and reduced noise in areas of homogeneous high activity background. Areas of discordance were projected into areas of large difference between Tx and segmented Tx sinograms. This study has validated the use of SAC with short Tx scans. Images reconstructed with Tx scans of 3 minutes were not compromised with noise or severe artifacts.

Dual-head gamma camera 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography in oncological patients: effects of non-uniform attenuation correction on lesion detection.

The purpose of this study was to evaluate a dual head coincidence gamma camera (DH-PET) equipped with single-photon transmission for 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) imaging in oncological patients. Forty-five patients with known or suspected malignancies, scheduled for a positron emission tomography (PET) scan, were first studied with a dedicated ring PET and subsequently with DH-PET. All patients underwent measured attenuation correction using germanium-68 rod sources for ring PET and caesium-137 sources for DH-PET. Ring PET emission scan was started 64+/-17 min after intravenous administration of 235+/-42 MBq FDG. DH-PET emission followed 160+/-32 min after i.v. FDG. Attenuation-corrected and non-attenuation-corrected images were reconstructed for ring PET and DH-PET. The image sets were evaluated independently by three observers blinded to clinical data and to results of conventional imaging. Attenuation-corrected ring PET as the standard of reference depicted 118 lesions, non-attenuation-corrected ring PET 113 (96%) lesions, and attenuation-corrected DH-PET and non-attenuation-corrected DH-PET, 101 (86%) and 84 (71%) lesions, respectively (P<0.05). The lesion detection rate of attenuation-corrected and non-attenuation-corrected DH-PET was almost similar for lesions >20 mm, whereas attenuation correction increased the detection rate from 60% to 80% for lesions </=20 mm (P<0.01). A patient-based analysis revealed concordant results relative to attenuation-corrected ring PET for non-attenuation-corrected ring PET, attenuation-corrected DH-PET and non-attenuation-corrected DH-PET in 42 (93%), 36 (80%) and 31 (69%) patients, respectively. Differences might have influenced patient management in two (4%), six (13%) and ten (22%) patients, respectively. In conclusion, measured attenuation correction markedly improves the lesion detection capability of DH-PET. With measured attenuation correction the diagnostic performance of DH-PET is closer to that of dedicated ring PET.