Simultaneous reconstruction of activity and attenuation for PET/MR

Bias atlases for segmentation-based PET attenuation correction using PET-CT and MR

This study was to obtain voxel-wise PET accuracy and precision using tissue-segmentation for attenuation correction. We applied multiple thresholds to the CTs of 23 patients to classify tissues. For six of the 23 patients, MR images were also acquired. The MR fat/in-phase ratio images were used for fat segmentation. Segmented tissue classes were used to create attenuation maps, which were used for attenuation correction in PET reconstruction. PET bias images were then computed using the PET reconstructed with the original CT as the reference. We registered the CTs for all the patients and transformed the corresponding bias images accordingly. We then obtained the mean and standard deviation bias atlas using all the registered bias images. Our CT-based study shows that four-class segmentation (air, lungs, fat, other tissues), which is available on most PET-MR scanners, yields 15.1%, 4.1%, 6.6%, and 12.9% RMSE bias in lungs, fat, non-fat soft-tissues, and bones, respectively. An accurate fat identification is achievable using fat/in-phase MR images. Furthermore, we have found that three-class segmentation (air, lungs, other tissues) yields less than 5% standard deviation of bias within the heart, liver, and kidneys. This implies that three-class segmentation can be sufficient to achieve small variation of bias for imaging these three organs. Finally, we have found that inter- and intra-patient lung density variations contribute almost equally to the overall standard deviation of bias within the lungs.

Simultaneous reconstruction of emission activity and attenuation coefficient distribution from TOF data, acquired with external transmission source

The simultaneous PET data reconstruction of emission activity and attenuation coefficient distribution is presented, where the attenuation image is constrained by exploiting an external transmission source. Data are acquired in time-of-flight (TOF) mode, allowing in principle for separation of emission and transmission data. Nevertheless, here all data are reconstructed at once, eliminating the need to trace the position of the transmission source in sinogram space. Contamination of emission data by the transmission source and vice versa is naturally modeled. Attenuated emission activity data also provide additional information about object attenuation coefficient values. The algorithm alternates between attenuation and emission activity image updates. We also proposed a method of estimation of spatial scatter distribution from the transmission source by incorporating knowledge about the expected range of attenuation map values. The reconstruction of experimental data from the Siemens mCT scanner suggests that simultaneous reconstruction improves attenuation map image quality, as compared to when data are separated. In the presented example, the attenuation map image noise was reduced and non-uniformity artifacts that occurred due to scatter estimation were suppressed. On the other hand, the use of transmission data stabilizes attenuation coefficient distribution reconstruction from TOF emission data alone. The example of improving emission images by refining a CT-based patient attenuation map is presented, revealing potential benefits of simultaneous CT and PET data reconstruction.

Completion of a truncated attenuation image from the attenuated PET emission data

Positron emission tomographs (PETs) are currently almost exclusively designed as hybrid systems. The current standard is the PET/CT combination, while prototype PET/MRI systems are being studied by several research groups. One problem in these systems is that the transaxial field-of-view of the second system is smaller than that of the PET camera and does not provide complete attenuation data. Because this second system provides the image for PET attenuation and scatter correction, the smaller FOV causes truncation of the attenuation map, producing bias in the attenuation corrected activity image. In this paper, we propose a maximum-a-posteriori algorithm for estimating the missing part of the attenuation map from the PET emission data. The method is evaluated on five artificially truncated 18F-FDGPET/CT studies, where it reduced the error on the reconstructed PET activities from 20% to less than 7%. The results on a PET/MRI patient study with 18F-FDG are presented as well.

Simultaneous reconstruction of activity and attenuation in time-of-flight PET

In positron emission tomography (PET) and single photon emission tomography (SPECT), attenuation correction is necessary for quantitative reconstruction of the tracer distribution. Previously, several attempts have been made to estimate the attenuation coefficients from emission data only. These attempts had limited success, because the problem does not have a unique solution, and severe and persistent "cross-talk" between the estimated activity and attenuation distributions was observed. In this paper, we show that the availability of time-of-flight (TOF) information eliminates the cross-talk problem by destroying symmetries in the associated Fisher information matrix. We propose a maximum-a-posteriori reconstruction algorithm for jointly estimating the attenuation and activity distributions from TOF PET data. The performance of the algorithm is studied with 2-D simulations, and further illustrated with phantom experiments and with a patient scan. The estimated attenuation image is robust to noise, and does not suffer from the cross-talk that was observed in non-TOF PET. However, some constraining is still mandatory, because the TOF data determine the attenuation sinogram only up to a constant offset.

A self-normalization reconstruction technique for PET scans using the positron emission data

Positron emission tomography (PET) image quality in both clinical and preclinical environments highly depends on an accurate knowledge of the detector hardware to correct for image quality degrading effects like gain, temperature, and photon detection efficiency variations of the individual crystals. In conventional PET systems some of these variations are typically corrected using a dedicated calibration scan in which the scanner performance for a well-known activity source is measured. We propose an alternative method for estimating the relative sensitivity of each detector pixel using the coincidences as well as the singles emission data of each PET scan. The overall idea is to compare the total sum of all measured single photons before coincidence processing in each crystal with a steadily low-frequent distribution that can normally be expected. Both the estimated activity and the estimated detector sensitivity are simultaneously improved by using an extended iterative reconstruction scheme. This way we ensure the use of an optimal calibration correction (with the exception of a global factor) for each data set, even if the scanner performance has changed between two scans. Data measured with a preclinical PET scanner (HYPERIon-I) which uses analog silicon photomultipliers in combination with a custom-made ASIC shows a significant increase of image quality and homogeneity using the proposed method.

Simultaneous PET-MRI in oncology: a solution looking for a problem?

With the recent development of integrated positron emission tomography-magnetic resonance imaging (PET-MRI) scanners, new possibilities for quantitative molecular imaging of cancer are realized. However, the practical advantages and potential clinical benefits of the ability to record PET and MRI data simultaneously must be balanced against the substantial costs and other requirements of such devices. In this review, we highlight several of the key areas where integrated PET-MRI measurements, obtained simultaneously, are anticipated to have a significant impact on clinical and/or research studies. These areas include the use of MR-based motion corrections and/or a priori anatomical information for improved reconstruction of PET data, improved arterial input function characterization for PET kinetic modeling, the use of dual-modality contrast agents, and patient comfort and practical convenience. For widespread acceptance, a compelling case could be made if the combination of quantitative MRI and specific PET biomarkers significantly improves our ability to assess tumor status and response to therapy, and some likely candidates are now emerging. We consider the relative advantages and disadvantages afforded by PET-MRI and summarize current opinions and evidence as to the likely value of PET-MRI in the management of cancer.

Molecular imaging in the management of cervical cancer

Positron emission tomography (PET), magnetic resonance imaging (MRI), and integrated 18-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography are valuable techniques for assessing prognosis, treatment response after the completion of concurrent chemoradiation, suspicious or documented recurrence, unexplained post therapy elevations in tumor markers, and the response to salvage treatment when managing cervical cancer. However, PET plays a limited role in the primary staging of MRI-defined node-negative patients. Currently, (18)F-FDG is still the only tracer approved for routine use, but several novel targeting PET compounds, high-Tesla MRI machines, diffusion-weighted imaging without contrast, and dynamic nuclear polarized-enhanced (13)C-MR spectroscopic imaging may hold promising applications.

First clinical experience with integrated whole-body PET/MR: comparison to PET/CT in patients with oncologic diagnoses

The recently introduced first integrated whole-body PET/MR scanner allows simultaneous acquisition of PET and MRI data in humans and, thus, may offer new opportunities, particularly regarding diagnostics in oncology. This scanner features major technologic differences from conventional PET/CT devices, including the replacement of photomultipliers with avalanche photodiodes and the need for MRI-based attenuation correction. The aim of this study was to evaluate the comparability of clinical performance between conventional PET/CT and PET/MR in patients with oncologic diseases.

METHODS

Thirty-two patients with different oncologic diagnoses underwent a single-injection, dual-imaging protocol consisting of a PET/CT and subsequent PET/MR scan. PET/CT scans were performed according to standard clinical protocols (86 ± 8 min after injection of 401 ± 42 MBq of (18)F-FDG, 2 min/bed position). Subsequently (140 ± 24 min after injection), PET/MR was performed (4 min/bed position). PET images of both modalities were reconstructed iteratively. Attenuation and scatter correction as well as regional allocation of PET findings were performed using low-dose CT data for PET/CT and Dixon MRI sequences for PET/MR. PET/MR and PET/CT were compared visually by 2 teams of observers by rating the number and location of lesions suspicious for malignancy, as well as image quality and alignment. For quantitative comparison, standardized uptake values (SUVs) of the detected lesions and of different tissue types were assessed.

RESULTS

Simultaneous PET/MR acquisition was feasible with high quality in short acquisition time (≤ 20 min). No significant difference was found between the numbers of suspicious lesions (n = 80) or lesion-positive patients (n = 20) detected with PET/MR or PET/CT. Anatomic allocation of PET/MR findings by means of the Dixon MRI sequence was comparable to allocation of PET/CT findings by means of low-dose CT. Quantitative evaluation revealed a high correlation between mean SUVs measured with PET/MR and PET/CT in lesions (ρ = 0.93) and background tissue (ρ = 0.92).

CONCLUSION

This study demonstrates, for what is to our knowledge the first time, that integrated whole-body PET/MR is feasible in a clinical setting with high quality and in a short examination time. The reliability of PET/MR was comparable to that of PET/CT in allowing the detection of hypermetabolic lesions suspicious for malignancy in patients with oncologic diagnoses. Despite different attenuation correction approaches, tracer uptake in lesions and background correlated well between PET/MR and PET/CT. The Dixon MRI sequences acquired for attenuation correction were found useful for anatomic allocation of PET findings obtained by PET/MR in the entire body. These encouraging results may form the foundation for future studies aiming to define the added value of PET/MR over PET/CT.

MRI-based attenuation correction for hybrid PET/MRI systems: a 4-class tissue segmentation technique using a combined ultrashort-echo-time/Dixon MRI sequence

Accurate γ-photon attenuation correction (AC) is essential for quantitative PET/MRI as there is no simple relation between MR image intensity and attenuation coefficients. Attenuation maps (μ-maps) can be derived by segmenting MR images and assigning attenuation coefficients to the compartments. Ultrashort-echo-time (UTE) sequences have been used to separate cortical bone and air, and the Dixon technique has enabled differentiation between soft and adipose tissues. Unfortunately, sequential application of these sequences is time-consuming and complicates image registration.

METHODS

A UTE triple-echo (UTILE) MRI sequence is proposed, combining UTE sampling for bone detection and gradient echoes for Dixon water-fat separation in a radial 3-dimensional acquisition (repetition time, 4.1 ms; echo times, 0.09/1.09/2.09 ms; field strength, 3 T). Air masks are derived mainly from the phase information of the first echo; cortical bone is segmented using a dual-echo technique. Soft-tissue and adipose-tissue decomposition is achieved using a 3-point Dixon-like decomposition. Predefined linear attenuation coefficients are assigned to classified voxels to generate MRI-based μ-maps. The results of 6 patients are obtained by comparing μ-maps, reciprocal sensitivity maps, reconstructed PET images, and brain region PET activities based on either CT AC, two 3-class MRI AC techniques, or the proposed 4-class UTILE AC.

RESULTS

Using the UTILE MRI sequence, an acquisition time of 214 s was achieved for the head-and-neck region with 1.75-mm isotropic resolution, compared with 164 s for a single-echo UTE scan. MRI-based reciprocal sensitivity maps show a high correlation with those derived from CT scans (R(2) = 0.9920). The same is true for PET activities (R(2) = 0.9958). An overall voxel classification accuracy (compared with CT) of 81.1% was reached. Bone segmentation is inaccurate in complex regions such as the paranasal sinuses, but brain region activities in 48 regions across 6 patients show a high correlation after MRI-based and CT-based correction (R(2) = 0.9956), with a regression line slope of 0.960. All overall correlations are higher and brain region PET activities more accurate in terms of mean and maximum deviations for the 4-class technique than for 3-class techniques.

CONCLUSION

The UTILE MRI sequence enables the generation of MRI-based 4-class μ-maps without anatomic priors, yielding results more similar to CT-based results than can be obtained with 3-class segmentation only.

Time-of-flight PET data determine the attenuation sinogram up to a constant

In positron emission tomography (PET), a quantitative reconstruction of the tracer distribution requires accurate attenuation correction. We consider situations where a direct measurement of the attenuation coefficient of the tissues is not available or is unreliable, and where one attempts to estimate the attenuation sinogram directly from the emission data by exploiting the consistency conditions that must be satisfied by the non-attenuated data. We show that in time-of-flight PET, the attenuation sinogram is determined by the emission data except for a constant and that its gradient can be estimated efficiently using a simple analytic algorithm. The stability of the method is illustrated numerically by means of a 2D simulation.

An outlook on future design of hybrid PET/MRI systems

Early diagnosis and therapy increasingly operate at the cellular, molecular, or even at the genetic level. As diagnostic techniques transition from the systems to the molecular level, the role of multimodality molecular imaging becomes increasingly important. Positron emission tomography (PET) and magnetic resonance imaging (MRI) are powerful techniques for in vivo molecular imaging. The inability of PET to provide anatomical information is a major limitation of standalone PET systems. Combining PET and CT proved to be clinically relevant and successfully reduced this limitation by providing the anatomical information required for localization of metabolic abnormalities. However, this technology still lacks the excellent soft-tissue contrast provided by MRI. Standalone MRI systems reveal structure and function but cannot provide insight into the physiology and/or the pathology at the molecular level. The combination of PET and MRI, enabling truly simultaneous acquisition, bridges the gap between molecular and systems diagnosis. MRI and PET offer richly complementary functionality and sensitivity; fusion into a combined system offering simultaneous acquisition will capitalize the strengths of each, providing a hybrid technology that is greatly superior to the sum of its parts. A combined PET/MRI system provides both the anatomical and structural description of MRI simultaneously with the quantitative capabilities of PET. In addition, such a system would allow exploiting the power of MR spectroscopy (MRS) to measure the regional biochemical content and to assess the metabolic status or the presence of neoplasia and other diseases in specific tissue areas. This paper briefly summarizes state-of-the-art developments and latest advances in dedicated hybrid PET/MRI instrumentation. Future prospects and potential clinical applications of this technology will also be discussed.