Design Features and Mutual Compatibility Studies of the Time-of-Flight PET Capable GE SIGNA PET/MR System

Advanced clinical imaging for the evaluation of stem cell based therapies

Introduction: As stem cell treatments reach closer to the clinic, the need for appropriate noninvasive imaging for accurate disease diagnosis, treatment planning, follow-up, and early detection of complications, is constantly rising. Clinical radiology affords an extensive arsenal of advanced imaging techniques, to provide anatomical and functional information on the whole spectrum of stem cell treatments from diagnosis to follow-up.Areas covered: This manuscript aims at providing a critical review of major published studies on the utilization of advanced imaging for stem cell treatments. Uses of magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, and positron emission tomography (PET) are reviewed and interrogated for their applicability to stem cell imaging.Expert opinion: A wide spectrum of imaging methods have been utilized for the evaluation of stem cell therapies. The majority of published techniques are not clinically applicable, using methods exclusively applicable to animals or technology irrelevant to current clinical practice. Harmonization of preclinical methods with clinical reality is necessary for the timely translation of stem cell therapies to the clinic. Methods such as diffusion weighted MRI, hybrid imaging, and contrast-enhanced ultrasound hold great promise and should be routinely incorporated in the evaluation of patients receiving stem cell treatments.

Performance Evaluation and Compatibility Studies of a Compact Preclinical Scanner for Simultaneous PET/MR Imaging at 7 Tesla

We present the design and performance of a new compact preclinical system combining positron emission tomography (PET) and magnetic resonance imaging (MRI) for simultaneous scans. The PET contains sixteen SiPM-based detector heads arranged in two octagons and covers an axial field of view (FOV) of 102.5 mm. Depth of interaction effects and detector's temperature variations are compensated by the system. The PET is integrated in a dry magnet operating at 7 T. PET and MRI characteristics were assessed complying with international standards and interferences between both subsystems during simultaneous scans were addressed. For the rat size phantom, the peak noise equivalent count rates (NECR) were 96.4 kcps at 30.2 MBq and 132.3 kcps at 28.4 MBq respectively with and without RF coil. For mouse, the peak NECR was 300.0 kcps at 34.5 MBq and 426.9 kcps at 34.3 MBq respectively with and without coil. At the axial centre of the FOV, spatial resolutions expressed as full width at half maximum / full width at tenth maximum (FWHM/FWTM) ranged from 1.69/3.19 mm to 2.39/4.87 mm. The peak absolute sensitivity obtained with a 250-750 keV energy window was 7.5% with coil and 7.9% without coil. Spill over ratios of the NEMA NU4-2008 image quality (NEMA-IQ) phantom ranged from 0.25 to 0.96 and the percentage of non-uniformity was 5.7%. The image count versus activity was linear up to 40 MBq. The principal magnetic field variation was 0.03 ppm/mm over 40 mm. The qualitative and quantitative aspects of data were preserved during simultaneous scans.

Real-Time Gain Control of PET Detectors and Evaluation With Challenging Radionuclides

Accurate gain control of PET detectors is a prerequisite for quantitative accuracy. A shift in the 511 keV peak position can lead to errors in scatter correction, degrading quantitation. The PET detectors in a PET/MR scanner are subject to thermal transients due to eddy currents induced during gradient-intensive MRI sequences. Since the gain of silicon photomultiplier-based detectors changes with temperature, good gain control is particularly challenging. In this paper we describe a method that utilizes information from the entire singles spectrum to create a real-time gain control method that maintains gain of PET detectors stable within approximately ±0.5% (±2.5 keV) with varying levels of scatter and in the presence of significant thermal transients. We describe the methods used to combine information about multiple peaks and how this algorithm is implemented in a way that permits real-time processing on a field-programmable gate array. Simulations demonstrate rapid response time and stability. A method ("virtual scatter filter") is also described that extracts unscattered photopeak events from phantom data and demonstrates the accuracy of the photopeak for various radionuclides that emit energies in addition to the pure 511 keV annihilation peak. Radionuclides ⁵² Mn, ⁵⁵ Co, ⁶⁴ Cu, ⁸⁹ Zr, ⁹⁰ Y, and ¹²⁴ I are included in the study for their various forms of spectral contamination.

Evaluation of the radiofrequency performance of a wide-bore 1.5 T positron emission tomography/magnetic resonance imaging body coil for radiotherapy planning

Background and purpose

The restricted bore diameter of current simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) systems can be an impediment to achieving similar patient positioning during PET/MRI planning and radiotherapy. Our goal was to evaluate the B₁ transmit (B₁⁺) uniformity, B₁⁺ efficiency, and specific absorption rate (SAR) of a novel radiofrequency (RF) body coil design, in which RF shielded PET detectors were integrated with the specific aim of enabling a wide-bore PET/MRI system.

Materials and methods

We designed and constructed a wide-bore PET/MRI RF body coil to be integrated with a clinical MRI system. To increase its inner bore diameter, the PET detectors were positioned between the conductors and the RF shield of the RF body coil. Simulations and experiments with phantoms and human volunteers were performed to compare the B₁⁺ uniformity, B₁⁺ efficiency, and SAR between our design and the clinical body coil.

Results

In the simulations, our design achieved nearly the same B₁⁺ field uniformity as the clinical body coil and an almost identical SAR distribution. The uniformity findings were confirmed by the physical experiments. The B₁⁺ efficiency was 38% lower compared to the clinical body coil.

Conclusions

To achieve wide-bore PET/MRI, it is possible to integrate shielding for PET detectors between the body coil conductors and the RF shield without compromising MRI performance. Reduced B₁⁺ efficiency may be compensated by adding a second RF amplifier. This finding may facilitate the application of simultaneous whole-body PET/MRI in radiotherapy planning.

Update on latest advances in time-of-flight PET

This paper provides an update on time-of-flight (TOF) PET with a focus on latest hardware developments leading to current commercial PET/CT instruments. We describe advances in scintillator development, new photosensors and associated electronics readout, and detector designs for utilization in complete systems. Next, we introduce the latest commercial PET/CT scanners based on the aforementioned technologies, and discuss the detector design choices made that are relevant to differences in the system performance. Finally, we end with a discussion of the latest performance benchmarks for improved timing in PET detectors, challenges in scaling this performance to a complete system, and the outlook towards achieving a sub-50 ps coincidence timing resolution (CTR) in a PET detector.

Musculoskeletal trauma imaging in the era of novel molecular methods and artificial intelligence

Over the past decade rapid advancements in molecular imaging (MI) and artificial intelligence (AI) have revolutionized traditional musculoskeletal radiology. Molecular imaging refers to the ability of various methods to in vivo characterize and quantify biological processes, at a molecular level. The extracted information provides the tools to understand the pathophysiology of diseases and thus to early detect, to accurately evaluate the extend and to apply and evaluate targeted treatments. At present, molecular imaging mainly involves CT, MRI, radionuclide, US, and optical imaging and has been reported in many clinical and preclinical studies. Although originally MI techniques targeted at central nervous system disorders, later on their value on musculoskeletal disorders was also studied in depth. Meaningful exploitation of the large volume of imaging data generated by molecular and conventional imaging techniques, requires state-of-the-art computational methods that enable rapid handling of large volumes of information. AI allows end-to-end training of computer algorithms to perform tasks encountered in everyday clinical practice including diagnosis, disease severity classification and image optimization. Notably, the development of deep learning algorithms has offered novel methods that enable intelligent processing of large imaging datasets in an attempt to automate decision-making in a wide variety of settings related to musculoskeletal trauma. Current applications of AI include the diagnosis of bone and soft tissue injuries, monitoring of the healing process and prediction of injuries in the professional sports setting. This review presents the current applications of novel MI techniques and methods and the emerging role of AI regarding the diagnosis and evaluation of musculoskeletal trauma.

Noninvasive Measurement of [11C]PiB Distribution Volume Using Integrated PET/MRI

A noninvasive image-derived input function (IDIF) method using PET/MRI was applied to quantitative measurements of [¹¹C] Pittsburgh compound-B (PiB) distribution volume (DV) and compared with other metrics. Fifty-three patients suspected of early dementia (71 ± 11 y) underwent 70 min [¹¹C]PiB PET/MRI. Nineteen of them (68 ± 11 y) without head motion during the scan were enrolled in this study and compared with 16 age-matched healthy controls (CTL: 68 ± 11 y). The dynamic frames reconstructed from listmode PET data were used for DV calculation. IDIF with metabolite correction was applied to the Logan plot method, and DV was normalized into DV ratio (DVR) images using the cerebellar reference (DVR_L). DVR and standardized uptake value ratio (SUVR) images were also calculated using the reference tissue graphical method (DVR_r) and the 50–70 min static data with cerebellar reference, respectively. Cortical values were compared using the 3D-T1WI MRI segmentation. All patients were assigned to the early Alzheimer’s disease (eAD) group because of positive [¹¹C]PiB accumulation. The correlations of regional values were better for DVR_L vs. DVR_r (r² = 0.97) than for SUVR vs. DVR_r (r² = 0.88). However, all metrics clearly differentiated eAD from CTL with appropriate thresholds. Noninvasive quantitative [¹¹C]PiB PET/MRI measurement provided equivalent DVRs with the two methods. SUVR images showed acceptable results despite inferior variability and image quality to DVR images.

Direct comparison of brain [18F]FDG images acquired by SiPM-based and PMT-based PET/CT: phantom and clinical studies

Background

Silicon photomultiplier-positron emission tomography (SiPM-PET) has better sensitivity, spatial resolution, and timing resolution than photomultiplier tube (PMT)-PET. The present study aimed to clarify the advantages of SiPM-PET in ¹⁸F-fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) brain imaging in a head-to-head comparison with PMT-PET in phantom and clinical studies.

Methods

Contrast was calculated from images acquired from a Hoffman 3D brain phantom, and image noise and uniformity were calculated from images acquired from a pool phantom using SiPM- and PMT-PET. Sequential PMT-PET and SiPM-PET [¹⁸F]FDG images were acquired over a period of 10 min from 22 controls and 10 patients. All images were separately normalized to a standard [¹⁸F]FDG PET template, then the mean standardized uptake values (SUV_mean) and Z-score were calculated using MIMneuro and CortexID Suite, respectively.

Results

Image contrast, image noise, and uniformity in SiPM-PET changed 19.2, 3.5, and − 40.0% from PMT-PET, respectively. These physical indices of both PET scanners satisfied the criteria for acceptable image quality published by the Japanese Society of Nuclear Medicine of contrast > 55%, CV ≤ 15%, and SD ≤ 0.0249, respectively. Contrast was 70.0% for SiPM-PET without TOF and 59.5% for PMT-PET without TOF. The TOF improved contrast by 3.5% in SiPM-PET. The SUV_mean using SiPM-PET was significantly higher than PMT-PET and did not correlate with a time delay. Z-scores were also significantly higher in images acquired from SiPM-PET (except for the bilateral posterior cingulate) than PMT-PET because the peak signal that was extracted by the calculation of Z-score in CortexID Suite was increased. The hypometabolic area in statistical maps was reduced and localized using SiPM-PET. The trend was independent of whether the images were derived from controls or patients.

Conclusions

The improved spatial resolution and sensitivity of SiPM-PET contributed to better image contrast and uniformity in brain [¹⁸F]FDG images. The SiPM-PET offers better quality and more accurate quantitation of brain PET images. The SUV_mean and Z-scores were higher in SiPM-PET than PMT-PET due to improved PVE. [¹⁸F]FDG images acquired using SiPM-PET will help to improve diagnostic outcomes based on statistical image analysis because SiPM-PET would localize the distribution of glucose metabolism on Z-score maps.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40658-020-00337-4.

Roadmap toward the 10 ps time-of-flight PET challenge

Since the seventies, positron emission tomography (PET) has become an invaluable medical molecular imaging modality with an unprecedented sensitivity at the picomolar level, especially for cancer diagnosis and the monitoring of its response to therapy. More recently, its combination with x-ray computed tomography (CT) or magnetic resonance (MR) has added high precision anatomic information in fused PET/CT and PET/MR images, thus compensating for the modest intrinsic spatial resolution of PET. Nevertheless, a number of medical challenges call for further improvements in PET sensitivity. These concern in particular new treatment opportunities in the context personalized (also called precision) medicine, such as the need to dynamically track a small number of cells in cancer immunotherapy or stem cells for tissue repair procedures. A better signal-to-noise ratio (SNR) in the image would allow detecting smaller size tumours together with a better staging of the patients, thus increasing the chances of putting cancer in complete remission. Moreover, there is an increasing demand for reducing the radioactive doses injected to the patients without impairing image quality. There are three ways to improve PET scanner sensitivity: improving detector efficiency, increasing geometrical acceptance of the imaging device and pushing the timing performance of the detectors. Currently, some pre-localization of the electron-positron annihilation along a line-of-response (LOR) given by the detection of a pair of annihilation photons is provided by the detection of the time difference between the two photons, also known as the time-of-flight (TOF) difference of the photons, whose accuracy is given by the coincidence time resolution (CTR). A CTR of about 10 picoseconds FWHM will ultimately allow to obtain a direct 3D volume representation of the activity distribution of a positron emitting radiopharmaceutical, at the millimetre level, thus introducing a quantum leap in PET imaging and quantification and fostering more frequent use of 11C radiopharmaceuticals. The present roadmap article toward the advent of 10 ps TOF-PET addresses the status and current/future challenges along the development of TOF-PET with the objective to reach this mythic 10 ps frontier that will open the door to real-time volume imaging virtually without tomographic inversion. The medical impact and prospects to achieve this technological revolution from the detection and image reconstruction point-of-views, together with a few perspectives beyond the TOF-PET application are discussed.

Monte Carlo Simulations of the GE Signa PET/MR for Different Radioisotopes

NEMA characterization of PET systems is generally based on ¹⁸F because it is the most relevant radioisotope for the clinical use of PET. ¹⁸F has a half-life of 109.7 min and decays into stable ¹⁸O via β+ emission with a probability of over 96% and a maximum positron energy of 0.633 MeV. Other commercially available PET radioisotopes, such as ⁸²Rb and ⁶⁸Ga have more complex decay schemes with a variety of prompt gammas, which can directly fall into the energy window and induce false coincidence detections by the PET scanner.

From a PMT-based to a SiPM-based PET system: a study to define matched acquisition/reconstruction parameters and NEMA performance of the Biograph Vision 450

Background

The purpose of this work was to propose an approach based on noise measurement to adapt present clinical acquisition and reconstruction parameters adapted to a PMT-based system (Biograph mCT) to a SiPM-based system (Biograph Vision 450) sharing identical geometrical properties. The NEMA performance (NEMA) of the recently released Biograph Vision 450 PET/CT (Vision) was also derived.

Methods

All measurements were conducted on Vision and Biograph mCT with TrueV (mCT). A full NEMA-based performance was derived for Vision only. The adaptation of acquisition and reconstruction parameters from mCT to Vision was done using the NEMA image quality phantom. The noise level reached using mCT was set as the reference value for six different numbers of net true coincidences. The noise level computed using Vision was matched to the reference noise level (within 0.01%) using a different reconstruction set-up to determine the potential reduction of count numbers for the same noise level.

Results

Vision sensitivity was 9.1 kcps/MBq for a timing resolution of 213 ps at 5.3 kBq/mL. The NEMA-based CR for the 10-mm sphere was better than 75% regardless the reconstruction set-up studied. The mCT reference noise properties could be achieved using Vision with a scan time reduction (STR) of 1.34 with four iterations and a 440 × 440 matrix size (or STR = 1.89 with a 220 × 220 matrix size) together with a 3D CR improvement of 53% for the 10-mm sphere (24% using 220 × 220).

Conclusion

The Vision exhibited improved NEMA performances compared to mCT. Using the proposed approach, the time acquisition could be divided by almost two, while keeping the same noise properties as that of mCT with a marked improvement of contrast recovery.

Ultra-Fast List-Mode Reconstruction of Short PET Frames and Example Applications

Standard clinical reconstructions usually require several minutes to complete, and this time is mostly independent of the duration of the data being reconstructed. Applications such as data-driven motion estimation, which require many short frames over the duration of the scan, become unfeasible with such long reconstruction times. In this work, we present an infrastructure whereby ultra-fast list-mode reconstructions of very short frames (≤1 s) are performed. With this infrastructure, it is possible to have a dynamic series of frames that can be used for various applications, such as data-driven motion estimation, whole-body surveys, quick reconstructions of gated data to select the optimal gate for a given attenuation map, and, if the infrastructure runs simultaneously with the scan, real-time display of the reconstructed data during the scan and automated alerts for patient motion. Methods: A fast ray-tracing time-of-flight projector was implemented and parallelized. The reconstruction parameters were optimized to allow for fast performance: only a few iterations are performed, without point-spread-function modeling, and scatter correction is not used. The resulting reconstructions are thus not quantitative but are acceptable for motion estimation and visualization purposes. Data-driven motion can be estimated using image registration, with the resultant motion data being used in a fully motion-corrected list-mode reconstruction. Results: The infrastructure provided images that can be used for visualization and gating purposes and for motion estimation using image registration. Several case studies are presented, including data-driven motion estimation and correction for brain studies, abdominal studies in which respiratory and cardiac motion is visible, and a whole-body survey. Conclusion: The presented infrastructure provides the capability to quickly create a series of very short frames for PET data that can be used in a variety of applications.

What scans we will read: imaging instrumentation trends in clinical oncology

Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non-invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/CT), advanced MRI, optical or ultrasound imaging.This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and, then point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now.Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by advances in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as "data", and - through the wider adoption of advanced analysis, including machine learning approaches and a "big data" concept - move to the next stage of non-invasive tumour phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi-dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging.

Estimation of Crystal Timing Properties and Efficiencies for the Improvement of (Joint) Maximum-Likelihood Reconstructions in TOF-PET

With increasing improvements in the time of flight (TOF) resolution of positron emission tomography (PET) scanners, an accurate model of the TOF measurements is becoming increasingly important. This work considers two parameters of the TOF kernel; the relative positioning of the timing data-bins and the timing resolution along each line of response (LOR). Similar to an existing data-driven method, we assume that any shifts of data-bins along lines of response can be modelled as differences between crystal timing offsets. Inspired by this, timing resolutions of all LORs are modelled as the hypotenuse of timing resolutions of the crystal-pairs in coincidence. Furthermore, in order to mitigate the influence of potential inaccuracies of detector-pair sensitivities on crystal timing resolutions, relative LOR sensitivities are modelled as the product of efficiency factors for the two crystals in coincidence. We validate estimating maps of crystal timing offsets, timing resolutions and efficiencies from the emission data using noisy simulations of a brain phantom. Results are shown for phantom and patient data scanned on clinically available TOF-PET scanners. We find that the estimation of crystal timing resolutions is more sensitive to the data statistics than the estimation of crystal timing offsets. As a result, estimation of crystal timing properties could either be limited to high count emission data, or be obtained utilizing additional regularizations on the estimates. Using a more accurate model of the TOF acquisition, improvements are observed in standard activity reconstructions as well as joint reconstructions of activity and attenuation.

Multimodal analysis using [11C]PiB-PET/MRI for functional evaluation of patients with Alzheimer's disease

BACKGROUND

Multimodal PET/MRI image data simultaneously obtained from patients with early-stage of Alzheimer's disease (eAD) were assessed in order to observe pathophysiologic and functional changes, as well as alterations of morphology and connectivity in the brain. Fifty-eight patients with mild cognitive impairment and early dementia (29 males, 69 ± 12 years) underwent [¹¹C]Pittsburgh compound-B (PiB) PET/MRI with 70-min PET and MRI scans. Sixteen age-matched healthy controls (CTL) (9 males, 68 ± 11 years) were also studied with the same scanning protocol. Cerebral blood flow (CBF) was calculated from the early phase PET images using the image-derived input function method. A standardized uptake value ratio (SUVr) was calculated from 50 to 70 min PET data with a reference region of the cerebellar cortex. MR images such as 3D-T1WI, resting-state functional MRI (RS-fMRI), diffusion tensor image (DTI), and perfusion MRI acquired during the dynamic PET scan were also analyzed to evaluate various brain functions on MRI.

RESULTS

Twenty-seven of the 58 patients were determined as eAD based on the results of PiB-PET and clinical findings, and a total of 43 subjects' data including CTL were analyzed in this study. PiB SUVr values in all cortical regions of eAD were significantly greater than those of CTL. The PiB accumulation intensity was negatively correlated with cognitive scores. The regional PET-CBF values of eAD were significantly lower in the bilateral parietal lobes and right temporal lobe compared with CTL, but not in MRI perfusion; however, SPM showed regional differences on both PET- and MRI-CBF. SPM analysis of RS-fMRI delineated regional differences between the groups in the anterior cingulate cortex and the left precuneus. VBM analysis showed atrophic changes in the AD group in a part of the bilateral hippocampus; however, analysis of fractional anisotropy calculated from DTI data did not show differences between the two groups.

CONCLUSION

Multimodal analysis conducted with various image data from PiB-PET/MRI scans showed differences in regional CBF, cortical volume, and neuronal networks in different regions, indicating that pathophysiologic and functional changes in the AD brain can be observed from various aspects of neurophysiologic parameters. Application of multimodal brain images using PET/MRI would be ideal for investigating pathophysiologic changes in patients with dementia and other neurodegenerative diseases.

PET/CT and PET/MRI in ophthalmic oncology (Review)

Orbital and ocular anatomy is quite complex, consisting of several tissues, which can give rise to both benign and malignant tumors, while several primary neoplasms can metastasize to the orbital and ocular space. Early detection, accurate staging and re-staging, efficient monitoring of treatment response, non-invasive differentiation between benign and malignant lesions, and accurate planning of external radiation treatment, are of utmost importance for the optimal and individualized management of ophthalmic oncology patients. Addressing these challenges requires the employment of several diagnostic imaging techniques, such as high-definition digital fundus photography, ultrasound imaging, optical coherence tomography, optical coherence tomography (OCT)-angiography, computed tomography (CT) and magnetic resonance imaging (MRI). In recent years, technological advances have enabled the development of hybrid positron emission tomography (PET)/CT and PET/MRI systems, setting new standards in cancer diagnosis and treatment. The capability of simultaneously targeting several cancer-related biochemical procedures using positron emitting-radiopharmaceuticals, while morphologically characterizing lesions by CT or MRI, together with the intrinsic quantitative capabilities of PET-imaging, provide incremental diagnostic information, enabling accurate, highly efficient and personalized treatment strategies. Aim of the current review is to discuss the current applications of hybrid PET/CT and PET/MRI imaging in the management of patients presenting with the most commonly encountered orbital and ocular tumors.

Validation of MR-Based Attenuation Correction of a Newly Released Whole-Body Simultaneous PET/MR System

The aim of this study was to validate quantitative performance of a newly released simultaneous positron emission tomography (PET)/magnetic resonance imaging (MRI) scanner, by using MR-based attenuation correction (MRAC), both in phantom study and in patient study. PET/MRI image uniformities of a phantom under different hardware configurations were tested and compared. Thirty patients were examined with 2-deoxy-2-[¹⁸F]fluoro-D-glucose (¹⁸F-FDG) PET/computed tomography (CT) and subsequent PET/MRI. PET images from PET/MRI were corrected with MRAC (PET_MR), CT-based attenuation maps (μ-maps, PET_CT), and segmented CT μ-maps (PET_CTSeg) derived from PET/CT. Standardized uptake values (SUVs) were compared among the 3 sets of PET in main organs (bone, liver and lung) and in 52 FDG-avid lesions, including soft-tissue lesions and bone lesions. The result showed that PET imaging uniformities of PET/MRI under different configurations were good (<8.8%). The SUV differences among the 3 sets of PET varied with organs and lesion types. In detail, the mean relative differences of SUV between PET_MR and PET_CT were as follows: -18.8%, bone (SUV_mean); -8.0%, liver (SUV_mean); -12.2%, lung (SUV_mean); -18.1%, bone lesions (SUV_mean); -13.3%, bone lesions (SUV_max); -8.2%, soft-tissue lesions (SUV_mean); and -7.3%, soft-tissue lesions (SUV_max). The mean relative differences between PET_MR and PET_CTSeg were as follows: -19.0%, bone (SUV_mean); -3.5%, liver (SUV_mean); -3.3%, lung (SUV_mean); -19.3%, bone lesions (SUV_mean); -17.5%, bone lesions (SUV_max); -5.5%, soft-tissue lesions (SUV_mean); and -4.4%, soft-tissue lesions (SUV_max). The differences of SUV between PET_MR and PET_CT were larger than those between PET_MR and PET_CTSeg, in both soft tissue and soft-tissue lesions (P < 0.001), but not in bone or bone lesions. In conclusion, MRAC in the newly released PET/MR system is accurate in most tissues, with SUV deviations being generally less than 10%, compared to PET/CT. In bone, however, underestimations can be substantial, which may be partially attributed to segmentation of the MR-based μ-maps.

Time-of-flight (TOF) implementation for PET reconstruction in practice

The time-of-flight (TOF) feature of PET scanners has been used for a long time in PET reconstruction, but many implementational aspects are still incomplete or ambiguous in the literature. Here we formalize and present theoretical and practical implementation details for the reconstruction of clinical TOF histogram and list-mode data using ML-EM. Relevant aspects include the computation of the TOF component of the system matrix, the processing of TOF bins, the use of estimations of random and scattered coincidences, and differences between histogram and list-mode ML-EM TOF reconstruction. Several approaches and approximations have been implemented in the CASToR platform and compared for OSEM reconstructions of patient data from the GE Signa PET/MR scanner. Differences between implementations are not larger than the typical bias in clinical data reconstruction. The largest difference and contrast loss occur when the processing of histogram TOF bins is simplified, and list-mode reconstruction is most sensitive to the truncation of the Gaussian TOF probability distribution.

Initial experience with a PET/computed tomography system using silicon photomultiplier detectors

PURPOSE

A PET/computed tomography (CT) that uses silicon photomultiplier (SiPM) technology was installed at our institution. Here, we report the initial use of the new scanner and evaluate the image quality in comparison to standard PET/CT scanners.

PROCEDURES

Seventy-two patients were scanned first using standard PET/CT followed immediately by the new PET/CT system. Images from the new PET/CT system were reconstructed using a conventional [non time-of-flight (TOF)] algorithm, TOF alone and TOF in combination with BSREM. Images from standard PET/CT were reconstructed using clinical standard-of-care settings. Three blinded readers randomly reviewed four datasets (standard, non-TOF, TOF alone, TOF+BSREM) per patient for image quality using a five-point Likert scale. SUV measurements for the single most avid lesion on each dataset were also recorded.

RESULTS

Datasets from the new scanner had higher image quality (P < 0.001) and SUV measurements (P < 0.001) compared with the standard scanners, and scores further improved when TOF and BSREM algorithms were added (mean scores for standard, non-TOF, TOF alone and TOF+BSREM were 3.1, 3.9, 4.3 and 5.0, respectively; mean SUVmax for hottest lesion were 8.8, 10.3, 10.7 and 13.3, respectively).

CONCLUSION

The SiPM-based PET/CT system outperforms two standard Bismuth germanium oxide- and Lutetium-yttrium oxyorthosilicate-based scanners in terms of image quality, with further benefits added using TOF and BSREM. This may be beneficial for detecting small lesions and more accurate disease staging.

Summary of the First ISMRM-SNMMI Workshop on PET/MRI: Applications and Limitations

Since the introduction of simultaneous PET/MRI in 2011, there have been significant advancements. In this review, we highlight several technical advancements that have been made primarily in attenuation and motion correction and discuss the status of multiple clinical applications using PET/MRI. This review is based on the experience at the first PET/MRI conference cosponsored by the International Society for Magnetic Resonance in Medicine and the Society of Nuclear Medicine and Molecular Imaging.

Resolution modeling in projection space using a factorized multi-block detector response function for PET image reconstruction

Positron emission tomography (PET) images usually suffer from limited resolution and statistical uncertainties. However, a technique known as resolution modeling (RM) can be used to improve image quality by accurately modeling the system's detection process within the iterative reconstruction. In this study, we present an accurate RM method in projection space based on a simulated multi-block detector response function (DRF) and evaluate it on the Siemens hybrid MR-BrainPET system. The DRF is obtained using GATE simulations that consider nearly all the possible annihilation photons from the field-of-view (FOV). Intrinsically, the multi-block DRF allows the block crosstalk to be modeled. The RM blurring kernel is further generated by factorizing the blurring matrix of one line-of-response (LOR) into two independent detector responses, which can then be addressed with the DRF. Such a kernel is shift-variant in 4D projection space without any distance or angle compression, and is integrated into the image reconstruction for the BrainPET insert with single instruction multiple data (SIMD) and multi-thread support. Evaluation of simulations and measured data demonstrate that the reconstruction with RM yields significantly improved resolutions and reduced mean squared error (MSE) values at different locations of the FOV, compared with reconstruction without RM. Furthermore, the shift-variant RM kernel models the varying blurring intensity for different LORs due to the depth-of-interaction (DOI) dependencies, thus avoiding severe edge artifacts in the images. Additionally, compared to RM in single-block mode, the multi-block mode shows significantly improved resolution and edge recovery at locations beyond 10 cm from the center of BrainPET insert in the transverse plane. However, the differences have been observed to be low for patient data between single-block and multi-block mode RM, due to the brain size and location as well as the geometry of the BrainPET insert. In conclusion, the RM method proposed in this study can yield better reconstructed images in terms of resolution and MSE value, compared to conventional reconstruction without RM.

NEMA NU 2-2007 performance characteristics of GE Signa integrated PET/MR for different PET isotopes

BACKGROUND

Fully integrated PET/MR systems are being used frequently in clinical research and routine. National Electrical Manufacturers Association (NEMA) characterization of these systems is generally done with ¹⁸F which is clinically the most relevant PET isotope. However, other PET isotopes, such as ⁶⁸Ga and ⁹⁰Y, are gaining clinical importance as they are of specific interest for oncological applications and for follow-up of ⁹⁰Y-based radionuclide therapy. These isotopes have a complex decay scheme with a variety of prompt gammas in coincidence. ⁶⁸Ga and ⁹⁰Y have higher positron energy and, because of the larger positron range, there may be interference with the magnetic field of the MR compared to ¹⁸F. Therefore, it is relevant to determine the performance of PET/MR for these clinically relevant and commercially available isotopes.

METHODS

NEMA NU 2-2007 performance measurements were performed for characterizing the spatial resolution, sensitivity, image quality, and the accuracy of attenuation and scatter corrections for ¹⁸F, ⁶⁸Ga, and ⁹⁰Y. Scatter fraction and noise equivalent count rate (NECR) tests were performed using ¹⁸F and ⁶⁸Ga. All phantom data were acquired on the GE Signa integrated PET/MR system, installed in UZ Leuven, Belgium.

RESULTS

¹⁸F, ⁶⁸Ga, and ⁹⁰Y NEMA performance tests resulted in substantially different system characteristics. In comparison with ¹⁸F, the spatial resolution is about 1 mm larger in the axial direction for ⁶⁸Ga and no significative effect was found for ⁹⁰Y. The impact of this lower resolution is also visible in the recovery coefficients of the smallest spheres of ⁶⁸Ga in image quality measurements, where clearly lower values are obtained. For ⁹⁰Y, the low number of counts leads to a large variability in the image quality measurements. The primary factor for the sensitivity change is the scale factor related to the positron emission fraction. There is also an impact on the peak NECR, which is lower for ⁶⁸Ga than for ¹⁸F and appears at higher activities.

CONCLUSIONS

The system performance of GE Signa integrated PET/MR was substantially different, in terms of NEMA spatial resolution, image quality, and NECR for ⁶⁸Ga and ⁹⁰Y compared to ¹⁸F. But these differences are compensated by the PET/MR scanner technologies and reconstructions methods.

Assessing time-of-flight signal-to-noise ratio gains within the myocardium and subsequent reductions in administered activity in cardiac PET studies

BACKGROUND

Time-of-flight (TOF) is known to increase signal-to-noise ratio (SNR) and facilitate reductions in administered activity. Established measures of SNR gain are derived from areas of uniform uptake, which is not applicable to the heterogeneous uptake in cardiac PET images using fluoro-deoxyglucose (FDG). This study aimed to develop a technique to quantify SNR gains within the myocardium due to TOF.

METHODS

Reference TOF SNR gains were measured in 88 FDG oncology patients. Phantom data were used to translate reference SNR gains and validate a method of quantifying SNR gains within the myocardium from parametric images produced from multiple replicate images. This technique was applied to 13 FDG cardiac viability patients.

RESULTS

Reference TOF SNR gains of +23% ± 8.5% were measured in oncology patients. Measurements of SNR gain from the phantom data were in agreement and showed the parametric image technique to be sufficiently robust. SNR gains within the myocardium in the viability patients were +21% ± 2.8%.

CONCLUSION

A method to quantify SNR gains from TOF within the myocardium has been developed and evaluated. SNR gains within the myocardium are comparable to those observed by established methods. This allows guidance for protocol optimization for TOF systems in cardiac PET.

Advances in imaging instrumentation for nuclear cardiology

Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.

No significant difference found in PET/MRI CBF values reconstructed with CT-atlas-based and ZTE MR attenuation correction

Background

Accurate attenuation correction (AC) is one of the most important issues to be addressed in quantitative brain PET/MRI imaging. Atlas-based MRI AC (AB-MRAC), one of the representative MRAC methods, has been used to estimate the skull attenuation in brain scans. The zero echo time (ZTE) pulse sequence is also expected to provide a better MRAC estimation in brain PET scans. The difference in quantitative measurements of cerebral blood flow (CBF) using H₂¹⁵O-PET/MRI was compared between the two MRAC methods, AB and ZTE.

Method

Twelve patients with cerebrovascular disease (4 males, 43.2 ± 11.7 years) underwent H₂¹⁵O-PET/MRI studies with a 3-min PET scan and MRI scans including the ZTE sequence. Eleven of them were also studied under the conditions of baseline and 10 min after acetazolamide administration, and 2 of them were followed up after several months interval. A total of 25 PET images were reconstructed as dynamic data using 2 sets of reconstruction parameters to obtain the image-derived input function (IDIF), the time-activity curves of the major cerebral artery extracted from images, and CBF images. The CBF images from AB- and ZTE-MRAC were then compared for global and regional differences.

Results

The mean differences of IDIF curves at each point obtained from AB- and ZTE-MRAC dynamic data were less than 5%, and the differences in time-activity curves were very small. The means of CBF from AB- and ZTE-MRAC reconstructions calculated using each IDIF showed differences of less than 5% for all cortical regions. CBF images from AB-MRAC tended to show greater values in the parietal region and smaller values in the skull base region.

Conclusion

The CBF images from AB- and ZTE-MRAC reconstruction showed no significant differences in regional values, although the parietal region tended to show greater values in AB-MRAC reconstruction. Quantitative values in the skull base region were very close, and almost the same IDIFs were obtained.

Generation of PET Attenuation Map for Whole-Body Time-of-Flight 18F-FDG PET/MRI Using a Deep Neural Network Trained with Simultaneously Reconstructed Activity and Attenuation Maps

We propose a new deep learning-based approach to provide more accurate whole-body PET/MRI attenuation correction than is possible with the Dixon-based 4-segment method. We use activity and attenuation maps estimated using the maximum-likelihood reconstruction of activity and attenuation (MLAA) algorithm as inputs to a convolutional neural network (CNN) to learn a CT-derived attenuation map. Methods: The whole-body ¹⁸F-FDG PET/CT scan data of 100 cancer patients (38 men and 62 women; age, 57.3 ± 14.1 y) were retrospectively used for training and testing the CNN. A modified U-net was trained to predict a CT-derived μ-map (μ-CT) from the MLAA-generated activity distribution (λ-MLAA) and μ-map (μ-MLAA). We used 1.3 million patches derived from 60 patients' data for training the CNN, data of 20 others were used as a validation set to prevent overfitting, and the data of the other 20 were used as a test set for the CNN performance analysis. The attenuation maps generated using the proposed method (μ-CNN), μ-MLAA, and 4-segment method (μ-segment) were compared with the μ-CT, a ground truth. We also compared the voxelwise correlation between the activity images reconstructed using ordered-subset expectation maximization with the μ-maps, and the SUVs of primary and metastatic bone lesions obtained by drawing regions of interest on the activity images. Results: The CNN generates less noisy attenuation maps and achieves better bone identification than MLAA. The average Dice similarity coefficient for bone regions between μ-CNN and μ-CT was 0.77, which was significantly higher than that between μ-MLAA and μ-CT (0.36). Also, the CNN result showed the best pixel-by-pixel correlation with the CT-based results and remarkably reduced differences in activity maps in comparison to CT-based attenuation correction. Conclusion: The proposed deep neural network produced a more reliable attenuation map for 511-keV photons than the 4-segment method currently used in whole-body PET/MRI studies.

Cardiac PET/MRI-an update

It is now about 8 years since the first whole-body integrated PET/MRI has been installed. First, reports on technical characteristics and system performance were published. Early after, reports on the first use of PET/MRI in oncological patients were released. Interestingly, the first article on the application in cardiology was a review article, which was published before the first original article was put out. Since then, researchers have gained a lot experience with the PET/MRI in various cardiovascular diseases and an increasing number on auspicious indications is appearing. In this review article, we give an overview on technical updates within these last years with potential impact on cardiac imaging and summarize those scenarios where PET/MRI plays a pivotal role in cardiovascular medicine.

Validation of the physiological background correction method for the suppression of the spill-in effect near highly radioactive regions in positron emission tomography

Background

Positron emission tomography (PET) imaging has a wide applicability in oncology, cardiology and neurology. However, a major drawback when imaging very active regions such as the bladder is the spill-in effect, leading to inaccurate quantification and obscured visualisation of nearby lesions. Therefore, this study aims at investigating and correcting for the spill-in effect from high-activity regions to the surroundings as a function of activity in the hot region, lesion size and location, system resolution and application of post-filtering using a recently proposed background correction technique. This study involves analytical simulations for the digital XCAT2 phantom and validation acquiring NEMA phantom and patient data with the GE Signa PET/MR scanner. Reconstructions were done using the ordered subset expectation maximisation (OSEM) algorithm. Dedicated point-spread function (OSEM+PSF) and a recently proposed background correction (OSEM+PSF+BC) were incorporated into the reconstruction for spill-in correction. The standardised uptake values (SUV) were compared for all reconstruction algorithms.

Results

The simulation study revealed that lesions within 15–20 mm from the hot region were predominantly affected by the spill-in effect, leading to an increased bias and impaired lesion visualisation within the region. For OSEM, lesion SUV_max converged to the true value at low bladder activity, but as activity increased, there was an overestimation as much as 19% for proximal lesions (distance around 15–20 mm from the bladder edge) and 2–4% for distant lesions (distance larger than 20 mm from the bladder edge). As bladder SUV increases, the % SUV change for proximal lesions is about 31% and 6% for SUV_max and SUV_mean, respectively, showing that the spill-in effect is more evident for the SUV_max than the SUV_mean. Also, the application of post-filtering resulted in up to 65% increment in the spill-in effect around the bladder edges. For proximal lesions, PSF has no major improvement over OSEM because of the spill-in effect, coupled with the blurring effect by post-filtering. Within two voxels around the bladder, the spill-in effect in OSEM is 42% (32%), while for OSEM+PSF, it is 31% (19%), with (and without) post-filtering, respectively. But with OSEM+PSF+BC, the spill-in contribution from the bladder was relatively low (below 5%, either with or without post-filtering). These results were further validated using the NEMA phantom and patient data for which OSEM+PSF+BC showed about 70–80% spill-in reduction around the bladder edges and increased contrast-to-noise ratio up to 36% compared to OSEM and OSEM+PSF reconstructions without post-filtering.

Conclusion

The spill-in effect is dependent on the activity in the hot region, lesion size and location, as well as post-filtering; and this is more evident in SUV_max than SUV_mean. However, the recently proposed background correction method facilitates stability in quantification and enhances the contrast in lesions with low uptake.

Electronic supplementary material

The online version of this article (10.1186/s40658-018-0233-8) contains supplementary material, which is available to authorized users.

Highly Integrated FPGA-Only Signal Digitization Method Using Single-Ended Memory Interface Input Receivers for Time-of-Flight PET Detectors

We propose a new highly integrated field-programm-able gate array (FPGA) only signal digitization method for individual signal digitization of time-of-flight positron emission tomography (TOF PET). We configured I/O port of the FPGA with a single-ended memory interface (SeMI) input receiver. The SeMI is a single-ended voltage-referenced interface that has a common reference voltage per I/O Bank, such that each SeMI input receiver can serve as a voltage comparator. The FPGA-only digitizer that uses the single-ended input receivers does not require a separate digitizing integrated chip, and can obtain twice as many signals as that using LVDS input receivers. We implemented a highly integrated digitizer consisting of 82 energy and 82 timing channels using a 28-nm FPGA. The energy and arrival time were measured using a 625-ps binary counter, and a 10-ps time-to-digital converter (TDC), respectively. We first measured the intrinsic characteristics of the proposed FPGA-only digitizer. The SeMI input receiver functioned as the voltage comparator without undesirable offset voltage. The standard deviation value of the time difference measured using two SeMI input receivers with respective TDCs was less than 14.6 ps RMS. In addition, we fed signals from the TOF PET detectors to the SeMI input receivers directly and collected data. The TOF PET detector consisted of a 3 × 3 × 20 mm³ LYSO crystal coupled with a silicon photomultiplier. The energy resolutions were 7.7% and 7.1% for two TOF PET detectors. The coincidence resolving time was 204 ps full width at half maximum. The SeMI digitizer with a high-performance signal digitizer, processor, and high-speed transceivers provides a compact all-in-one data acquisition system.

Performance evaluation of RF coils integrated with an RF-penetrable PET insert for simultaneous PET/MRI

PURPOSE

An "RF-penetrable" PET insert that allows the MR body coil to be used for RF transmission was developed to make it easier for an existing MR center to achieve simultaneous PET/MRI. This study focuses on experiments and analyses to study PET/RF coil configurations for simultaneous PET/MR studies.

METHODS

To investigate the appropriate RF coil design, a transmit/receive (TX/RX) birdcage coil and an RX-only phased-array coil (TX from body coil), both fitting inside the PET ring were built and characterized. For MR performance evaluation, B₁ field uniformity and MR image SNR were calculated. PET photon attenuation due to each coil was studied by means of CT-based attenuation maps and reconstructed PET images.

RESULTS

When using the RX-only phased-array coil (TX from body coil), compared with the TX/RX birdcage coil, the B₁ field uniformity and the MR image (gradient echo and fast spin echo) SNR increased by 2.4±4.8%, 386.1±62.3%, and 205.0±56.5%, respectively. Although some components of the coil were distributed within the PET FOV, no significant PET photon attenuation was shown in the CT-based attenuation map and reconstructed PET images.

CONCLUSION

RF coil configurations for an RF-penetrable PET insert for simultaneous PET/MRI were studied. The RX-only phased-array coil (TX from body coil) outperformed the TX/RX birdcage coil with improved MR performance as well as negligible PET photon attenuation.

Impact of a Bayesian penalized likelihood reconstruction algorithm on image quality in novel digital PET/CT: clinical implications for the assessment of lung tumors

Background

The aim of this study was to evaluate and compare PET image reconstruction algorithms on novel digital silicon photomultiplier PET/CT in patients with newly diagnosed and histopathologically confirmed lung cancer. A total of 45 patients undergoing 18F-FDG PET/CT for initial lung cancer staging were included. PET images were reconstructed using ordered subset expectation maximization (OSEM) with time-of-flight and point spread function modelling as well as Bayesian penalized likelihood reconstruction algorithm (BSREM) with different β-values yielding a total of 7 datasets per patient. Subjective and objective image assessment with all image datasets was carried out, including subgroup analyses for patients with high dose (> 2.0 MBq/kg) and low dose (≤ 2.0 MBq/kg) of 18F-FDG injection regimen.

Results

Subjective image quality ratings were significantly different among all different reconstruction algorithms as well as among BSREM using different β-values only (both p < 0.001). BSREM with a β-value of 600 was assigned the highest score for general image quality, image sharpness, and lesion conspicuity. BSREM reconstructions resulted in higher SUV_max of lung tumors compared to OSEM of up to + 28.0% (p < 0.001). BSREM reconstruction resulted in higher signal-/ and contrast-to-background ratios of lung tumor and higher signal-/ and contrast-to-noise ratio compared to OSEM up to a β-value of 800. Lower β-values (BSREM₄₅₀) resulted in the best image quality for high dose 18F-FDG injections, whereas higher β-values (BSREM₆₀₀) lead to the best image quality in low dose 18F-FDG PET/CT (p < 0.05).

Conclusions

BSREM reconstruction algorithm used in digital detector PET leads to significant increases of lung tumor SUV_max, signal-to-background ratio, and signal-to-noise ratio, which translates into a higher image quality, tumor conspicuity, and image sharpness.

MR Performance in the Presence of a Radio Frequency-Penetrable Positron Emission Tomography (PET) Insert for Simultaneous PET/MRI

Despite the great promise of integrated positron emission tomography (PET)/magnetic resonance (MR) imaging to add molecular information to anatomical and functional MR, its potential impact in medicine is diminished by a very high cost, limiting its dissemination. An RF-penetrable PET ring that can be inserted into any existing MR system has been developed to address this issue. Employing optical signal transmission along with battery power enables the PET ring insert to electrically float with respect to the MR system. Then, inter-modular gaps of the PET ring allow the RF transmit field from the standard built-in body coil to penetrate into the PET fields-of-view (FOV) with some attenuation that can be compensated for. MR performance, including RF noise, magnetic susceptibility, RF penetrability through and $B_{1}$ uniformity within the PET insert, and MR image quality, were analyzed with and without the PET ring present. The simulated and experimentally measured RF field attenuation factors with the PET ring present were -2.7 and -3.2 dB, respectively. The magnetic susceptibility effect (0.063 ppm) and noise emitted from the PET ring in the MR receive channel were insignificant. $B_{1}$ homogeneity of a spherical agar phantom within the PET ring FOV dropped by 8.4% and MR image SNR was reduced by 3.5 and 4.3 dB with the PET present for gradient-recalled echo and fast-spin echo, respectively. This paper demonstrates, for the first time, an RF-penetrable PET insert comprising a full ring of operating detectors that achieves simultaneous PET/MR using the standard built-in body coil as the RF transmitter.

Clinical Evaluation of 68Ga-PSMA-II and 68Ga-RM2 PET Images Reconstructed With an Improved Scatter Correction Algorithm

OBJECTIVE

Gallium-68-labeled radiopharmaceuticals pose a challenge for scatter estimation because their targeted nature can produce high contrast in these regions of the kidneys and bladder. Even small errors in the scatter estimate can result in washout artifacts. Administration of diuretics can reduce these artifacts, but they may result in adverse events. Here, we investigated the ability of algorithmic modifications to mitigate washout artifacts and eliminate the need for diuretics or other interventions.

MATERIALS AND METHODS

The model-based scatter algorithm was modified to account for PET/MRI scanner geometry and challenges of non-FDG tracers. Fifty-three clinical 68Ga-RM2 and 68Ga-PSMA-11 whole-body images were reconstructed using the baseline scatter algorithm. For comparison, reconstruction was also processed with modified sampling in the single-scatter estimation and with an offset in the scatter tail-scaling process. None of the patients received furosemide to attempt to decrease the accumulation of radiopharmaceuticals in the bladder. The images were scored independently by three blinded reviewers using the 5-point Likert scale.

RESULTS

The scatter algorithm improvements significantly decreased or completely eliminated the washout artifacts. When comparing the baseline and most improved algorithm, the image quality increased and image artifacts were reduced for both 68Ga-RM2 and for 68Ga-PSMA-11 in the kidneys and bladder regions.

CONCLUSION

Image reconstruction with the improved scatter correction algorithm mitigated washout artifacts and recovered diagnostic image quality in 68Ga PET, indicating that the use of diuretics may be avoided.

Hybrid PET/MRI Methodology

The hybrid PET/MR scanner represents the first implementation of the effective integration of two modalities allowing truly synchronous/simultaneous acquisition of their imaging signals. This integration, resulting from the innovation and development of specific hardware components has paved the way for new approaches in the study of neurodegenerative diseases. This chapter will describe the hardware development that has led to the availability of different clinical solutions for PET/MR imaging as well as the still-open technological challenges and opportunities related to the processing and exploitation of the simultaneous acquisition in neurological studies.

Sub-3 mm, near-200 ps TOF/DOI-PET imaging with monolithic scintillator detectors in a 70 cm diameter tomographic setup

Recently, a monolithic scintillator detector for time-of-flight (TOF)/depth-of-interaction (DOI) positron emission tomography (PET) was developed. It has a detector spatial resolution of ~1.7 mm full-width-at-half-maximum (FWHM), a coincidence resolving time (CRT) of ~215 ps FWHM, and ~4.7 mm FWHM DOI resolution. Here, we demonstrate, for the first time, the imaging performance of this detector in a 70 cm diameter PET geometry. We built a tomographic setup representative of a whole-body clinical scanner, comprising two coaxially rotating arms, each carrying a detector module, and a central, rotating phantom table. The fully automated setup sequentially acquires all possible lines of response (LORs) of a complete detector ring, using a step-and-shoot acquisition approach. The modules contained 2  ×  2 detectors, each detector consisting of a 32 mm  ×  32 mm  ×  22 mm LYSO crystal and a digital silicon photomultiplier (dSiPM) array. The system spatial resolution was assessed using a Na-22 point source at different radial distances in the field-of-view (FOV). Using 2D filtered back projection (2D FBP, non-TOF), tangential and radial spatial resolutions of ~2.9 mm FWHM were obtained at the center of the FOV. The use of DOI information resulted in almost uniform spatial resolution throughout the FOV up to a radial distance of 25 cm, where the radial and tangential resolution are ~3.3 mm FWHM and ~4.7 mm FWHM, respectively, whereas without DOI the resolution deteriorates to ~9 mm FWHM. Additional measurements were performed with a Na-22 filled Derenzo-like phantom at different locations within the FOV. Images reconstructed with a TOF maximum-likelihood expectation-maximization (TOF ML-EM) algorithm show that the system is able to clearly resolve 3 mm diameter hot rods up to 25 cm radial distance. The excellent and uniform spatial resolution, combined with an energy resolution of 10.2% FWHM and a CRT of ~212 ps FWHM, indicates a great potential for monolithic scintillators as practical high-performance detectors in TOF/DOI-PET systems.

Innovations in Instrumentation for Positron Emission Tomography

PET scanners are sophisticated and highly sensitive biomedical imaging devices that can produce highly quantitative images showing the 3-dimensional distribution of radiotracers inside the body. PET scanners are commonly integrated with x-ray CT or MRI scanners in hybrid devices that can provide both molecular imaging (PET) and anatomical imaging (CT or MRI). Despite decades of development, significant opportunities still exist to make major improvements in the performance of PET systems for a variety of clinical and research tasks. These opportunities stem from new ideas and concepts, as well as a range of enabling technologies and methodologies. In this paper, we review current state of the art in PET instrumentation, detectors and systems, describe the major limitations in PET as currently practiced, and offer our own personal insights into some of the recent and emerging technological innovations that we believe will impact the field. Our focus is on the technical aspects of PET imaging, specifically detectors and system design, and the opportunity and necessity to move closer to PET systems for diagnostic patient use and in vivo biomedical research that truly approach the physical performance limits while remaining mindful of imaging time, radiation dose, and cost. However, other key endeavors, which are not covered here, including innovations in reconstruction and modeling methodology, radiotracer development, and expanding the range of clinical and research applications, also will play an equally important, if not more important, role in defining the future of the field.

Clinical PET/MRI: 2018 Update

OBJECTIVE

The purpose of this article is to provide an update on clinical PET/MRI, including current and developing clinical indications and technical developments.

CONCLUSION

PET/MRI is evolving rapidly, transitioning from a predominant research focus to exciting clinical practice. Key technical obstacles have been overcome, and further technical advances promise to herald significant advancements in image quality. Further optimization of protocols to address challenges posed by this hybrid modality will ensure the long-term success of PET/MRI.

Noninvasive method for measurement of cerebral blood flow using O-15 water PET/MRI with ASL correlation

PURPOSE

A noninvasive image derived input function (IDIF) method was applied to estimate arterial input function from brain H₂¹⁵O-PET/MRI images for the measurement of cerebral blood flow (CBF) because of difficulty in arterial blood sampling during PET/MRI scans. To evaluate accuracy and reproducibility of radioactivity in the internal carotid arteries (ICA) for the IDIF method, a new phantom using a skull bone was applied in the cross-calibration process between the scanner and a gamma-well counter.

METHODS

Eleven healthy volunteers (9 males, 43.9 ± 10.9y) underwent PET/MRI studies with a 3-min H₂¹⁵O-PET and several MRI scans including arterial spin labeling (ASL) perfusion MRI. PET images were reconstructed as dynamic data using two sets of reconstruction parameters, which were determined by basic assessment of radioactivity concentration reproducibility in the tubes of the phantom. The IDIF method extracted the time-activity curves of the ICA from several image slices in the PET data. CBF images were calculated using the autoradiographic (ARG) method and a one-tissue compartment model (1-TCM).

RESULTS

The global means of CBF from the ARG, 1-TCM, and ASL-MRI were 44.8 ± 4.3, 47.9 ± 5.9 and 57.9 ± 8.6 (mL/min/100 g), respectively. CBF from ASL-MRI was significantly greater compared with CBF from H₂¹⁵O-PET (P < 0.001). However, these CBF values were significantly correlated with each other in the scatter plots (P < 0.05).

CONCLUSIONS

Noninvasive measurement of CBF using H₂¹⁵O-PET/MRI and IDIF with the cross-calibration method with a skull phantom experiment provided reasonable quantitative values. The IDIF method allowed reliable estimation of arterial radioactivity concentration, which is useful for clinical application. The ASL-MRI perfusion image from the simultaneous acquisition tended to overestimate CBF.

Technical aspects of cardiac PET/MRI

PET/MRI is a novel modality that enables to combine PET and MR images, and has significant potential to evaluate various cardiac diseases through the combination of PET molecular imaging and MRI functional imaging. Precise management of technical issues, however, is necessary for cardiac PET/MRI. This article describes several technical points, including patient preparation, MR attenuation correction, parallel acquisition of PET with MRI, clinical aspects, and image quality control.

An edge-readout, multilayer detector for positron emission tomography

PURPOSE

We present a novel gamma-ray-detector design based on total internal reflection (TIR) of scintillation photons within a crystal that addresses many limitations of traditional PET detectors. Our approach has appealing features, including submillimeter lateral resolution, DOI positioning from layer thickness, and excellent energy resolution. The design places light sensors on the edges of a stack of scintillator slabs separated by small air gaps and exploits the phenomenon that more than 80% of scintillation light emitted during a gamma-ray event reaches the edges of a thin crystal with polished faces due to TIR. Gamma-ray stopping power is achieved by stacking multiple layers, and DOI is determined by which layer the gamma ray interacts in.

METHOD

The concept of edge readouts of a thin slab was verified by Monte Carlo simulation of scintillation light transport. An LYSO crystal of dimensions 50.8 mm × 50.8 mm × 3.0 mm was modeled with five rectangular SiPMs placed along each edge face. The mean-detector-response functions (MDRFs) were calculated by simulating signals from 511 keV gamma-ray interactions in a grid of locations. Simulations were carried out to study the influence of choice of scintillator material and dimensions, gamma-ray photon energies, introduction of laser or mechanically induced optical barriers (LIOBs, MIOBs), and refractive indices of optical-coupling media and SiPM windows. We also analyzed timing performance including influence of gamma-ray interaction position and presence of optical barriers. We also modeled and built a prototype detector, a 27.4 mm × 27.4 mm × 3.0 mm CsI(Tl) crystal with 4 SiPMs per edge to experimentally validate the results predicted by the simulations. The prototype detector used CsI(Tl) crystals from Proteus outfitted with 16 Hamamatsu model S13360-6050PE MPPCs read out by an AiT-16-channel readout. The MDRFs were measured by scanning the detector with a collimated beam of 662-keV photons from a ¹³⁷ Cs source. The spatial resolution was experimentally determined by imaging a tungsten slit that created a beam of 0.44 mm (FWHM) width normal to the detector surface. The energy resolution was evaluated by analyzing list-mode data from flood illumination by the ¹³⁷ Cs source.

RESULT

We find that in a block-detector-sized LYSO layer read out by five SiPMs per edge, illuminated by 511-keV photons, the average resolution is 1.49 mm (FWHM). With the introduction of optical barriers, average spatial resolution improves to 0.56 mm (FWHM). The DOI resolution is the layer thickness of 3.0 mm. We also find that optical-coupling media and SiPM-window materials have an impact on spatial resolution. The timing simulation with LYSO crystal yields a coincidence resolving time (CRT) of 200-400 ps, which is slightly position dependent. And the introduction of optical barriers has minimum influence. The prototype CsI(Tl) detector, with a smaller area and fewer SiPMs, was measured to have central-area spatial resolutions of 0.70 and 0.39 mm without and with optical barriers, respectively. These results match well with our simulations. An energy resolution of 6.4% was achieved at 662 keV.

CONCLUSION

A detector design based on a stack of monolithic scintillator layers that uses edge readouts offers several advantages over current block detectors for PET. For example, there is no tradeoff between spatial resolution and detection sensitivity since no reflector material displaces scintillator crystal, and submillimeter resolution can be achieved. DOI information is readily available, and excellent timing and energy resolutions are possible.

PET/MRI Hybrid Systems

Over the last decade, the combination of PET and MRI in one system has proven to be highly successful in basic preclinical research, as well as in clinical research. Nowadays, PET/MRI systems are well established in preclinical imaging and are progressing into clinical applications to provide further insights into specific diseases, therapeutic assessments, and biological pathways. Certain challenges in terms of hardware had to be resolved concurrently with the development of new techniques to be able to reach the full potential of both combined techniques. This review provides an overview of these challenges and describes the opportunities that simultaneous PET/MRI systems can exploit in comparison with stand-alone or other combined hybrid systems. New approaches were developed for simultaneous PET/MRI systems to correct for attenuation of 511 keV photons because MRI does not provide direct information on gamma photon attenuation properties. Furthermore, new algorithms to correct for motion were developed, because MRI can accurately detect motion with high temporal resolution. The additional information gained by the MRI can be employed to correct for partial volume effects as well. The development of new detector designs in combination with fast-decaying scintillator crystal materials enabled time-of-flight detection and incorporation in the reconstruction algorithms. Furthermore, this review lists the currently commercially available systems both for preclinical and clinical imaging and provides an overview of applications in both fields. In this regard, special emphasis has been placed on data analysis and the potential for both modalities to evolve with advanced image analysis tools, such as cluster analysis and machine learning.

Evaluating the repeatability and set-up sensitivity of a large field of view distortion phantom and software for magnetic resonance-only radiotherapy

BACKGROUND AND PURPOSE

Magnetic Resonance (MR)-only radiotherapy requires geometrically accurate MR images over the full scanner Field of View (FoV). This study aimed to investigate the repeatability of distortion measurements made using a commercial large FoV phantom and analysis software and the sensitivity of these measurements to small set-up errors.

MATERIALS AND METHODS

Geometric distortion was measured using a commercial phantom and software with 2D and 3D acquisition sequences on three different MR scanners. Two sets of repeatability measurements were made: three scans acquired without moving the phantom between scans (single set-up) and five scans acquired with the phantom re-set up in between each scan (repeated set-up). The set-up sensitivity was assessed by scanning the phantom with an intentional 1 mm lateral offset and independently an intentional 1° rotation.

RESULTS

The mean standard deviation of distortion for all phantom markers for the repeated set-up scans was < 0.4 mm for all scanners and sequences. For the 1 mm lateral offset scan 90 % of the markers agreed within two standard deviations of the mean of the repeated set-up scan (median of all scanners and sequences, range 78%-93%). For the 1° rotation scan, 80% of markers agreed within two standard deviations of the mean (range 69%-93%).

CONCLUSIONS

Geometric distortion measurements using a commercial phantom and associated software appear repeatable, although with some sensitivity to set-up errors. This suggests the phantom and software are appropriate for commissioning a MR-only radiotherapy workflow.

Variable refocusing flip angle single-shot fast spin echo imaging of liver lesions: increased speed and lesion contrast

PURPOSE

To evaluate acquisition time and clinical image quality of a variable refocusing flip angle (vrf) single-shot fast spin echo (SSFSE) sequence in comparison with a conventional SSFSE sequence for imaging of liver lesions in patients undergoing whole-body PET/MRI for oncologic staging.

METHODS

A vrfSSFSE sequence was acquired in 43 patients with known pancreatic neuroendocrine tumors undergoing ⁶⁸Ga-DOTA-TOC PET on a simultaneous time-of-flight 3.0T PET/MRI. Liver lesions ≥1.5 cm with radionucleotide uptake were analyzed. Contrast-to-noise ratios (CNRs) were measured, and four blinded radiologists assessed overall image quality. Differences in repetition time and CNR were assessed using a paired Student's t test with p < 0.05 considered statistically significant. Inter-reader variability was assessed with Fleiss' kappa statistic.

RESULTS

53 eligible lesions in 27 patients were included for analysis. vrfSSFSE demonstrated higher mean lesion CNR compared to SSFSE (9.9 ± 4.1 vs. 6.7 ± 4.1, p < 0.001). Mean repetition time (TR) was 679 ± 97 ms for the vrfSSFSE sequence compared to 1139 ± 106 ms for SSFSE (p < 0.0001), corresponding to a 1.7-fold decrease in acquisition time. Overall quality of liver lesion and common bile duct images with the vrfSSFSE sequence was graded as superior than or equivalent to the SSFSE sequence for 59% and 67% of patients, respectively.

CONCLUSIONS

Compared to conventional SSFSE, vrfSSFSE resulted in improved lesion contrast on simultaneous PET/MRI in patients with liver metastases. Due to decreased SAR demands, vrfSSFSE significantly decreased TR, allowing coverage of the entire liver in a single twenty-second breath hold. This may have important clinical implications in the setting of PET/MRI, where scan time is limited by the necessity of whole-body image acquisition in addition to bed specific imaging.

Zero TE-based pseudo-CT image conversion in the head and its application in PET/MR attenuation correction and MR-guided radiation therapy planning

PURPOSE

To describe a method for converting Zero TE (ZTE) MR images into X-ray attenuation information in the form of pseudo-CT images and demonstrate its performance for (1) attenuation correction (AC) in PET/MR and (2) dose planning in MR-guided radiation therapy planning (RTP).

METHODS

Proton density-weighted ZTE images were acquired as input for MR-based pseudo-CT conversion, providing (1) efficient capture of short-lived bone signals, (2) flat soft-tissue contrast, and (3) fast and robust 3D MR imaging. After bias correction and normalization, the images were segmented into bone, soft-tissue, and air by means of thresholding and morphological refinements. Fixed Hounsfield replacement values were assigned for air (-1000 HU) and soft-tissue (+42 HU), whereas continuous linear mapping was used for bone.

RESULTS

The obtained ZTE-derived pseudo-CT images accurately resembled the true CT images (i.e., Dice coefficient for bone overlap of 0.73 ± 0.08 and mean absolute error of 123 ± 25 HU evaluated over the whole head, including errors from residual registration mismatches in the neck and mouth regions). The linear bone mapping accounted for bone density variations. Averaged across five patients, ZTE-based AC demonstrated a PET error of -0.04 ± 1.68% relative to CT-based AC. Similarly, for RTP assessed in eight patients, the absolute dose difference over the target volume was found to be 0.23 ± 0.42%.

CONCLUSION

The described method enables MR to pseudo-CT image conversion for the head in an accurate, robust, and fast manner without relying on anatomical prior knowledge. Potential applications include PET/MR-AC, and MR-guided RTP.