Total-Body PET: Maximizing Sensitivity to Create New Opportunities for Clinical Research and Patient Care

Reducing pediatric total-body PET/CT imaging scan time with multimodal artificial intelligence technology

OBJECTIVES

This study aims to decrease the scan time and enhance image quality in pediatric total-body PET imaging by utilizing multimodal artificial intelligence techniques.

METHODS

A total of 270 pediatric patients who underwent total-body PET/CT scans with a uEXPLORER at the Sun Yat-sen University Cancer Center were retrospectively enrolled. 18F-fluorodeoxyglucose (18F-FDG) was administered at a dose of 3.7 MBq/kg with an acquisition time of 600 s. Short-term scan PET images (acquired within 6, 15, 30, 60 and 150 s) were obtained by truncating the list-mode data. A three-dimensional (3D) neural network was developed with a residual network as the basic structure, fusing low-dose CT images as prior information, which were fed to the network at different scales. The short-term PET images and low-dose CT images were processed by the multimodal 3D network to generate full-length, high-dose PET images. The nonlocal means method and the same 3D network without the fused CT information were used as reference methods. The performance of the network model was evaluated by quantitative and qualitative analyses.

RESULTS

Multimodal artificial intelligence techniques can significantly improve PET image quality. When fused with prior CT information, the anatomical information of the images was enhanced, and 60 s of scan data produced images of quality comparable to that of the full-time data.

CONCLUSION

Multimodal artificial intelligence techniques can effectively improve the quality of pediatric total-body PET/CT images acquired using ultrashort scan times. This has the potential to decrease the use of sedation, enhance guardian confidence, and reduce the probability of motion artifacts.

The role of dynamic, static, and delayed total-body PET imaging in the detection and differential diagnosis of oncological lesions

OBJECTIVES

Commercialized total-body PET scanners can provide high-quality images due to its ultra-high sensitivity. We compared the dynamic, regular static, and delayed 18F-fluorodeoxyglucose (FDG) scans to detect lesions in oncologic patients on a total-body PET/CT scanner.

MATERIALS & METHODS

In all, 45 patients were scanned continuously for the first 60 min, followed by a delayed acquisition. FDG metabolic rate was calculated from dynamic data using full compartmental modeling, whereas regular static and delayed SUV images were obtained approximately 60- and 145-min post-injection, respectively. The retention index was computed from static and delayed measures for all lesions. Pearson's correlation and Kruskal-Wallis tests were used to compare parameters.

RESULTS

The number of lesions was largely identical between the three protocols, except MRFDG and delayed images on total-body PET only detected 4 and 2 more lesions, respectively (85 total). FDG metabolic rate (MRFDG) image-derived contrast-to-noise ratio and target-to-background ratio were significantly higher than those from static standardized uptake value (SUV) images (P < 0.01), but this is not the case for the delayed images (P > 0.05). Dynamic protocol did not significantly differentiate between benign and malignant lesions just like regular SUV, delayed SUV, and retention index.

CONCLUSION

The potential quantitative advantages of dynamic imaging may not improve lesion detection and differential diagnosis significantly on a total-body PET/CT scanner. The same conclusion applied to delayed imaging. This suggested the added benefits of complex imaging protocols must be weighed against the complex implementation in the future.

CLINICAL RELEVANCE

Total-body PET/CT was known to significantly improve the PET image quality due to its ultra-high sensitivity. However, whether the dynamic and delay imaging on total-body scanner could show additional clinical benefits is largely unknown. Head-to-head comparison between two protocols is relevant to oncological management.

Ultra-low dose CT scanning for PET/CT

BACKGROUND

The use of computed tomography (CT) for attenuation correction (AC) in whole-body PET/CT can result in a significant contribution to radiation exposure. This can become a limiting factor for reducing considerably the overall radiation exposure of the patient when using the new long axial field of view (LAFOV) PET scanners. However, recent CT technology have introduced features such as the tin (Sn) filter, which can substantially reduce the CT radiation dose.

PURPOSE

The purpose of this study was to investigate the ultra-low dose CT for attenuation correction using the Sn filter together with other dose reduction options such as tube current (mAs) reduction. We explore the impact of dose reduction in the context of AC-CT and how it affects PET image quality.

METHODS

The study evaluated a range of ultra-low dose CT protocols using five physical phantoms that represented a broad collection of tissue electron densities. A long axial field of view (LAFOV) PET/CT scanner was used to scan all phantoms, applying various CT dose reduction parameters such as reducing tube current (mAs), increasing the pitch value, and applying the Sn filter. The effective dose resulting from the CT scans was determined using the CTDIVol reported by the scanner. Several voxel-based and volumes of interest (VOI)-based comparisons were performed to compare the ultra-low dose CT images, the generated attenuation maps, and corresponding PET images against those images acquired with the standard low dose CT protocol. Finally, two patient datasets were acquired using one of the suggested ultra-low dose CT settings.

RESULTS

By incorporating the Sn filter and adjusting mAs to the lowest available value, the radiation dose in CT images of PBU-60 phantom was significantly reduced; resulting in an effective dose of nearly 2% compared to the routine low dose CT protocols currently in clinical use. The assessment of PET images using VOI and voxel-based comparisons indicated relative differences (RD%) of under 6% for mean activity concentration (AC) in the torso phantom and patient dataset and under 8% for a source point in the CIRS phantom. The maximum RD% value of AC was 14% for the point source in the CIRS phantom. Increasing the tube current from 6 mAs to 30 mAs in patients with high BMI, or with arms down, can suppress the photon starvation artifact, whilst still preserving a dose reduction of 90%.

CONCLUSIONS

Introducing a Sn filter in CT imaging lowers radiation dose by more than 90%. This reduction has minimal effect on PET image quantification at least for patients without Body Mass Index (BMI) higher than 30. Notably, this study results need validation using a larger clinical PET/CT dataset in the future, including patients with higher BMI.

PET System Technology: Theoretical Aspects and Experimental Methodology

Positron emission tomography (PET) imaging provides unique information of the cellular and molecular pathways of disease occurring within the human body, using measurements made from outside the body, which has shown utility in a variety of studies from basic research to clinical applications. This chapter describes some of the most relevant PET system parameters that impact its imaging performance such as 3D spatial, energy, and coincidence timing resolutions and the methodology typically used to evaluate those parameters. In addition, the physical principles underlying PET imaging, PET photon detector technology, and coincidence detection are also described. As a closing remark, the future perspectives of PET imaging and its simultaneous use with anatomical imaging techniques (e.g., computed tomography [CT] and magnetic resonance imaging [MRI]) are outlined.

New Horizons in Brain PET Instrumentation

Dedicated brain PET scanners are optimized to provide high sensitivity and high spatial resolution compared with existing whole-body PET systems, and they can be much cheaper to produce and install in various clinical and research settings. Advancements in detector technology over the past few years have placed several standalone PET, PET/computed tomography, and PET/MR systems on or near the commercial market; the features and capabilities of these systems will be reviewed here.

Single-Cell PET Imaging and Tracking

Positron emission tomography (PET) is one of the most sensitive whole-body molecular imaging techniques available in the clinic, able to detect picomolar levels of probe. As such, it was recently demonstrated that PET could also be used to track single radiolabeled cells in small animals. In this protocol, we present detailed procedures for radiolabeling cells using mesoporous silica nanoparticles (MSNs) and for tracking these cells in real time using in vivo PET. This includes static imaging of single cells as well as dynamic tracking of moving cells directly from the list-mode data. The protocol provides detailed instructions and examples for each step.

Imaging the master regulator of the antioxidant response in non-small cell lung cancer with positron emission tomography

Mutations in the NRF2-KEAP1 pathway are common in non-small cell lung cancer (NSCLC) and confer broad-spectrum therapeutic resistance, leading to poor outcomes. The cystine/glutamate antiporter, system xc-, is one of the >200 cytoprotective proteins controlled by NRF2, which can be non-invasively imaged by (S)-4-(3-18F-fluoropropyl)-l-glutamate ([18F]FSPG) positron emission tomography (PET). Through genetic and pharmacologic manipulation, we show that [18F]FSPG provides a sensitive and specific marker of NRF2 activation in advanced preclinical models of NSCLC. We validate imaging readouts with metabolomic measurements of system xc- activity and their coupling to intracellular glutathione concentration. A redox gene signature was measured in patients from the TRACERx 421 cohort, suggesting an opportunity for patient stratification prior to imaging. Furthermore, we reveal that system xc- is a metabolic vulnerability that can be therapeutically targeted for sustained tumour growth suppression in aggressive NSCLC. Our results establish [18F]FSPG as predictive marker of therapy resistance in NSCLC and provide the basis for the clinical evaluation of both imaging and therapeutic agents that target this important antioxidant pathway.

Attenuation Correction of Long Axial Field-of-View Positron Emission Tomography Using Synthetic Computed Tomography Derived from the Emission Data: Application to Low-Count Studies and Multiple Tracers

Recent advancements in PET/CT, including the emergence of long axial field-of-view (LAFOV) PET/CT scanners, have increased PET sensitivity substantially. Consequently, there has been a significant reduction in the required tracer activity, shifting the primary source of patient radiation dose exposure to the attenuation correction (AC) CT scan during PET imaging. This study proposes a parameter-transferred conditional generative adversarial network (PT-cGAN) architecture to generate synthetic CT (sCT) images from non-attenuation corrected (NAC) PET images, with separate networks for [18F]FDG and [15O]H2O tracers. The study includes a total of 1018 subjects (n = 972 [18F]FDG, n = 46 [15O]H2O). Testing was performed on the LAFOV scanner for both datasets. Qualitative analysis found no differences in image quality in 30 out of 36 cases in FDG patients, with minor insignificant differences in the remaining 6 cases. Reduced artifacts due to motion between NAC PET and CT were found. For the selected organs, a mean average error of 0.45% was found for the FDG cohort, and that of 3.12% was found for the H2O cohort. Simulated low-count images were included in testing, which demonstrated good performance down to 45 s scans. These findings show that the AC of total-body PET is feasible across tracers and in low-count studies and might reduce the artifacts due to motion and metal implants.

Short-axis PET image quality improvement based on a uEXPLORER total-body PET system through deep learning

PURPOSE

The axial field of view (AFOV) of a positron emission tomography (PET) scanner greatly affects the quality of PET images. Although a total-body PET scanner (uEXPLORER) with a large AFOV is more sensitive, it is more expensive and difficult to widely use. Therefore, we attempt to utilize high-quality images generated by uEXPLORER to optimize the quality of images from short-axis PET scanners through deep learning technology while controlling costs.

METHODS

The experiments were conducted using PET images of three anatomical locations (brain, lung, and abdomen) from 335 patients. To simulate PET images from different axes, two protocols were used to obtain PET image pairs (each patient was scanned once). For low-quality PET (LQ-PET) images with a 320-mm AFOV, we applied a 300-mm FOV for brain reconstruction and a 500-mm FOV for lung and abdomen reconstruction. For high-quality PET (HQ-PET) images, we applied a 1940-mm AFOV during the reconstruction process. A 3D Unet was utilized to learn the mapping relationship between LQ-PET and HQ-PET images. In addition, the peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) were employed to evaluate the model performance. Furthermore, two nuclear medicine doctors evaluated the image quality based on clinical readings.

RESULTS

The generated PET images of the brain, lung, and abdomen were quantitatively and qualitatively compatible with the HQ-PET images. In particular, our method achieved PSNR values of 35.41 ± 5.45 dB (p < 0.05), 33.77 ± 6.18 dB (p < 0.05), and 38.58 ± 7.28 dB (p < 0.05) for the three beds. The overall mean SSIM was greater than 0.94 for all patients who underwent testing. Moreover, the total subjective quality levels of the generated PET images for three beds were 3.74 ± 0.74, 3.69 ± 0.81, and 3.42 ± 0.99 (the highest possible score was 5, and the minimum score was 1) from two experienced nuclear medicine experts. Additionally, we evaluated the distribution of quantitative standard uptake values (SUV) in the region of interest (ROI). Both the SUV distribution and the peaks of the profile show that our results are consistent with the HQ-PET images, proving the superiority of our approach.

CONCLUSION

The findings demonstrate the potential of the proposed technique for improving the image quality of a PET scanner with a 320 mm or even shorter AFOV. Furthermore, this study explored the potential of utilizing uEXPLORER to achieve improved short-axis PET image quality at a limited economic cost, and computer-aided diagnosis systems that are related can help patients and radiologists.

Investigation of the quarter-dose 18 F-FDG total-body PET in routine clinical practice and its clinical value

OBJECTIVE

The purpose of the study was to evaluate the routine clinical application of total-body PET with quarter-dose 18 F-FDG.

METHODS

The contrast recovery coefficient (CRC) and coefficient of variation (COV) were evaluated among full-, half-, and quarter-dose groups with an acquisition duration of 10-, 5-, 3-, and 1-min in the NEMA (IQ) phantom test. Fifty patients undergoing total-body PET/CT with quarter-dose (0.925MBq/kg) of 18 F-FDG were included in the prospective study. The acquisition time was 10 min, divided into duration groups of 5-, 3-, and 1-min, referred to as G10, G5, G3, and G1. Visual scores were assessed based on overall visual assessment, noise scoring, and lesion conspicuity. Lesion SUV max and TBR were evaluated in semi-quantitative analysis. G10 was used as the gold reference to evaluate lesion detectability.

RESULTS

In the phantom study, the COV value of the images with quarter-dose 18 F-FDG and 10-min acquisition time was 11.52%. For spheres with 10 mm diameter, the CRC of quarter-dose PET images was relatively stable compared to that of full-dose groups with all acquisition durations. In the human study, the visual score in G10, G5, and G3 was significantly higher than that in G1. The differences in lesion SUV max and TBR for G1-G10 were significantly higher than that for G5-G10 and G3-G10. All lesions in G10 could be identified in G5 and G3.

CONCLUSION

The phantom and human findings demonstrated the feasibility of quarter-dose 18 F-FDG PET with 3-min acquisition time, which can maintain image quality with reduced radiation dose.

Phenomic Imaging

Human phenomics is defined as the comprehensive collection of observable phenotypes and characteristics influenced by a complex interplay among factors at multiple scales. These factors include genes, epigenetics at the microscopic level, organs, microbiome at the mesoscopic level, and diet and environmental exposures at the macroscopic level. "Phenomic imaging" utilizes various imaging techniques to visualize and measure anatomical structures, biological functions, metabolic processes, and biochemical activities across different scales, both in vivo and ex vivo. Unlike conventional medical imaging focused on disease diagnosis, phenomic imaging captures both normal and abnormal traits, facilitating detailed correlations between macro- and micro-phenotypes. This approach plays a crucial role in deciphering phenomes. This review provides an overview of different phenomic imaging modalities and their applications in human phenomics. Additionally, it explores the associations between phenomic imaging and other omics disciplines, including genomics, transcriptomics, proteomics, immunomics, and metabolomics. By integrating phenomic imaging with other omics data, such as genomics and metabolomics, a comprehensive understanding of biological systems can be achieved. This integration paves the way for the development of new therapeutic approaches and diagnostic tools.

A simulation study of the system characteristics for a long axial FOV PET design based on monolithic BGO flat panels compared with a pixelated LSO cylindrical design

BACKGROUND

Although a new generation of tomographs with a longer axial field-of-view called total-body PET have been developed, they are not widely utilized due to their high cost compared to conventional scanners. The newly designed walk-through total-body PET scanner is introduced as a high-throughput and cost-efficient alternative to total-body PET scanners, by making use of a flat panel geometry and lower cost, depth-of-interaction capable, monolithic BGO detectors. The main aim of the presented study is to evaluate through Monte Carlo simulation the system characteristics of the walk-through total-body PET scanner by comparing it with a Quadra-like total-body PET of similar attributes to the Siemens Biograph Vision Quadra.

METHODS

The walk-through total-body PET is comprised of two flat detector panels, spaced 50 cm apart. Each panel, 70 [Formula: see text] 106 cm[Formula: see text] in size, consists of 280 BGO-based monolithic detectors. The Quadra-like TB-PET has been simulated based on the characteristics of the Biograph Vision Quadra, one of the most common total-body PET scanners with 106 cm of axial field-of-view, which is constructed with pixelated LSO scintillation crystals. The spatial resolution, sensitivity, count rate performance, scatter fractions, and image quality of both scanners are simulated in the GATE simulation toolkit for comparison.

RESULTS

Due to the DOI-capable detectors used in the walk-through total-body PET, the values of the spatial resolution of this scanner were all below 2 mm along directions parallel to the panels, and reached a maximum of 3.36 mm in the direction perpendicular to the panels. This resolution is a large improvement compared to the values of the Quadra-like TB-PET. The walk-through total-body PET uses its maximum sensitivity (154 cps/kBq) for data acquisition and image reconstruction.

CONCLUSION

Based on the combination of very good spatial resolution and high sensitivity of the walk-through total-body PET, along with a 2.2 times lower scintillation crystal volume and 1.8 times lower SiPM surface, this scanner can be a very cost-efficient alternative for total-body PET scanners in cases where concomitant CT is not required.

New research progress on 18F-FDG PET/CT radiomics for EGFR mutation prediction in lung adenocarcinoma: a review

Lung cancer, the most frequently diagnosed cancer worldwide, is the leading cause of cancer-associated deaths. In recent years, significant progress has been achieved in basic and clinical research concerning the epidermal growth factor receptor (EGFR), and the treatment of lung adenocarcinoma has also entered a new era of individualized, targeted therapies. However, the detection of lung adenocarcinoma is usually invasive. 18F-FDG PET/CT can be used as a noninvasive molecular imaging approach, and radiomics can acquire high-throughput data from standard images. These methods play an increasingly prominent role in diagnosing and treating cancers. Herein, we reviewed the progress in applying 18F-FDG PET/CT and radiomics in lung adenocarcinoma clinical research and how these data are analyzed via traditional statistics, machine learning, and deep learning to predict EGFR mutation status, all of which achieved satisfactory results. Traditional statistics extract features effectively, machine learning achieves higher accuracy with complex algorithms, and deep learning obtains significant results through end-to-end methods. Future research should combine these methods to achieve more accurate predictions, providing reliable evidence for the precision treatment of lung adenocarcinoma. At the same time, facing challenges such as data insufficiency and high algorithm complexity, future researchers must continuously explore and optimize to better apply to clinical practice.

Inverse shielding and mutual exclusion for PET-MR hybrid imaging concerning induced positronium hyperfine splits radiations

Prevalent PET imaging reconstructs 2γ-photon pairs emitted after an annihilation from para-positronium (p-Ps) and rejects 3γ events from ortho-positronium (o-Ps) as noises. The 3γ/2γ decay ratio is ~ 3/7 in human body theoretically but in fact significantly lower due to pick-off process, hence PET imaging quality is well controlled. In a PET-MR hybrid unit, the MR magnetic field alters positronium decay patterns through magnetic quenching: all o-Ps and excited p-Ps states are split into finer quantum states under strong magnetic field, thus transitions between some triplet and singlet finer states (mz = 0) were no longer forbidden, thus some o-Ps converts to p-Ps spontaneously by emitting hyperfine split (HFS) photons, which also drops 3γ/2γ ratio hence helps PET imaging quality. However, inverse magnetic quenching might also occur if any external source of HFS frequencies is nearby, thus many p-Ps convert to o-Ps by absorbing those HFS photons (induced HFS transitions). This will dramatically increase 3γ/2γ ratio and hence degrade PET imaging quality instantaneously. The HFS spectrum lies in a broad range of microwaves, from 0.02 to 200 GHz. To prevent inverse magnetic quenching, it is necessary to block external microwave sources outside the hybrid vault, by adding a thin metal layer at all directions of the vault. This could be achieved by adopting the metallic Faraday Cage, which was originally for MR shielding, with possible amendment if necessary. The frequencies of excitation pulses in MR imaging overlap with HFS spectrum, however, the chance for mutual interference during hybrid imaging is small, hence there seems no need to veto each other during hybrid scans.

Precise visualization and ROS-dependent photodynamic therapy of colorectal cancer with a novel mitochondrial viscosity photosensitive fluorescent probe

BACKGROUND

Colorectal cancer (CRC) is a prominent global cancer with high mortality rates among human beings. Efficient diagnosis and treatment have always been a challenge for CRC management. Fluorescence guided cancer therapy, which combines diagnosis with therapy into one platform, has brought a new chance for achieving precise cancer theranostics. Among this, photosensitizers, applied in photodynamic therapy (PDT), given the integration of real-time imaging capacity and efficacious treatment feasibility, show great potential to serve as remarkable tools. Although much effort has been put into constructing photosensitizers for locating and destroying CRC cells, it is still in high need to develop novel photosensitizers to attain specific detection and fulfil effective therapy.

METHODS

Probe HTI was rational synthesized for the diagnosis and treatment of CRC. Spectrometric determination was carried out first, followed by the 1O2 generation ability test. Then, HTI was displayed in distinguishing CRC cells from normal cells Further, the PDT effect of the photosensitizer was studied in vitro. Additionally, HTI was used in CRC BALB/c nude mice model to validate its viscosity labelling and tumor suppression characteristics.

RESULTS

We successfully fabricated a mitochondrial targeting probe, HTI, together with remarkable viscosity sensitivity, ultralow background interference, and excellent 1O2 generation capacity. HTI was favorably applied to the viscosity detection, displaying a 11-fold fluorescent intensity enhancement in solvents from 1.57 cp to 2043 cp. Then, it was demonstrated that HTI could distinguish CRC cells from normal cells upon the difference in mitochondrial viscosity. Moreover, HTI was qualified for producing 1O2 with high efficiency in cells, supported by the sparkling signals of DCFH after incubation with HTI under light irradiation. More importantly, the viscosity labelling and tumor suppression performance in CRC CDX model was determined, enriching the multifunctional validation of HTI in vivo.

CONCLUSIONS

In this study, HTI was demonstrated to show a sensitive response to mitochondrial viscosity and possess a high 1O2 generation capacity. Both in vitro cell imaging and in vivo tumor treatment trials proved that HTI was effectively served as a robust scaffold for tumor labeling and CRC cells clearance. This breakthrough discovery held immense potential for advancing the early diagnosis and management of CRC through PDT. By leveraging HTI's properties, medical professionals could benefit from improved diagnostic accuracy and targeted treatment in CRC management, ultimately leading to enhanced patient outcomes.

Accurate modeling and performance evaluation of a total-body pet scanner using Monte Carlo simulations

BACKGROUND

The limited axial field-of-view (FOV) of conventional clinical positron emission tomography (PET) scanners (∼15 to 26 cm) allows detecting only 1% of all coincidence photons, hence limiting significantly their sensitivity. To overcome this limitation, the EXPLORER consortium developed the world's first total-body PET/CT scanner that significantly increased the sensitivity, thus enabling to decrease the scan duration or injected dose.

PURPOSE

The purpose of this study is to perform and validate Monte Carlo simulations of the uEXPLORER PET scanner, which can be used to devise novel conceptual designs and geometrical configurations through obtaining features that are difficult to obtain experimentally.

METHODS

The total-body uEXPLORER PET scanner was modeled using GATE Monte Carlo (MC) platform. The model was validated through comparison with experimental measurements of various performance parameters, including spatial resolution, sensitivity, count rate performance, and image quality, according to NEMA-NU2 2018 standards. Furthermore, the effects of the time coincidence window and maximum ring difference on the count rate and noise equivalent count rate (NECR) were evaluated.

RESULTS

Overall, the validation study showed that there was a good agreement between the simulation and experimental results. The differences between the simulated and experimental total sensitivity for the NEMA and extended phantoms at the center of the FOV were 2.3% and 0.0%, respectively. The difference in peak NECR was 9.9% for the NEMA phantom and 1.0% for the extended phantom. The average bias between the simulated and experimental results of the full-width-at-half maximum (FWHM) for six different positions and three directions was 0.12 mm. The simulations showed that using a variable coincidence time window based on the maximum ring difference can reduce the effect of random coincidences and improve the NECR compared to a constant time coincidence window. The NECR corresponding to 252-ring difference was 2.11 Mcps, which is larger than the NECR corresponding to 336-ring difference (2.04 Mcps).

CONCLUSION

The developed MC model of the uEXPLORER PET scanner was validated against experimental measurements and can be used for further assessment and design optimization of the scanner.

Head-to-head intra-individual comparison of total-body 2-[18F]FDG PET/CT and digital PET/CT in patients with malignant tumor: how sensitive could it be?

OBJECTIVES

To comparatively evaluate the lesion-detecting ability of 2-[18F]FDG total-body PET/CT (TB PET/CT) and conventional digital PET/CT.

METHODS

This study enrolled 67 patients (median age, 65 years; 24 female and 43 male patients) who underwent a TB PET/CT scan and a conventional digital PET/CT scan after a single 2-[18F]FDG injection (3.7 MBq/kg). Raw PET data for TB PET/CT were acquired over the course of 5 min, and images were reconstructed using data from the first 1, 2, 3, and 4 min and the entire 5 min (G1, G2, G3, G4, and G5, respectively). The conventional digital PET/CT scan acquired in 2-3 min per bed (G0). Two nuclear medicine physicians independently assessed subjective image quality using a 5-point Likert scale and recorded the number of 2-[18F]FDG-avid lesions.

RESULTS

A total of 241 lesions (69 primary lesions; 32 liver, lung, and peritoneum metastases; and 140 regional lymph nodes) among 67 patients with various types of cancer were analyzed. The subjective image quality score and SNR (signal-to-noise ratio) increased gradually from G1 to G5, and these values were significantly higher than the values at G0 (all p < 0.05). Compared to conventional PET/CT, G4 and G5 of TB PET/CT detected an additional 15 lesions (2 primary lesions; 5 liver, lung, and peritoneum lesions; and 8 lymph node metastases).

CONCLUSION

TB PET/CT was more sensitive than conventional whole-body PET/CT in detecting small (4.3 mm, maximum standardized uptake value (SUVmax) of 1.0) or low-uptake (tumor-to-liver ratio of 1.6, SUVmax of 4.1) lesions.

CLINICAL RELEVANCE STATEMENT

This study explored the gain of the image quality and lesion detectability of TB PET/CT, compared to conventional PET/CT, and recommended the appropriate acquisition time for TB PET/CT in clinical practice with an ordinary 2-[18F] FDG dose.

KEY POINTS

• TB PET/CT increases the effective sensitivity to approximately 40 times that of conventional PET scanners. • The subjective image quality score and signal-to-noise ratio of TB PET/CT from G1 to G5 were better than those of conventional PET/CT. • 2-[18F]FDG TB PET/CT with a 4-min acquisition time at a regular tracer dose detected an additional 15 lesions compared to conventional PET/CT.

Investigating the influence of long-axial versus short-axial field of view PET/CT on stage migration in lymphoma and non-small cell lung cancer

OBJECTIVES

The objective of this study was to evaluate the influence of a long-axial field-of-view (LAFOV) on stage migration using a large single-centre retrospective cohort in lymphoma and non-small cell lung cancer (NSCLC).

METHODS

A retrospective study is performed for patients undergoing PET/computed tomography (CT) on either a short-axial field-of-view (SAFOV) or LAFOV PET/CT system for the staging of known or suspected NSCLC or for therapeutic response in lymphoma. The primary endpoint was the Deauville therapy response score for patients with lymphoma for the two systems. Secondary endpoints were the American Joint Committee on Cancer stage for NSCLC, the frequency of cN3 and cM1 findings, the probability for a positive nodal staging (cN1-3) for NSCLC and the diagnostic accuracy for nodal staging in NSCLC.

RESULTS

One thousand two hundred eighteen records were screened and 597 patients were included for analysis ( N  = 367 for lymphoma and N  = 291 for NSCLC). For lymphoma, no significant differences were found in the proportion of patients with complete metabolic response versus non-complete metabolic response Deauville response scores ( P  = 0.66). For NSCLC no significant differences were observed between the two scanners for the frequency of cN3 and cM1 findings, for positive nodal staging, neither the sensitivity nor the specificity.

CONCLUSIONS

In this study use of a LAFOV system was neither associated with upstaging in lymphoma nor NSCLC compared to a digital SAFOV system. Diagnostic accuracy was comparable between the two systems in NSCLC despite shorter acquisition times for LAFOV.

Longitudinal amyloid and tau PET imaging in Alzheimer's disease: A systematic review of methodologies and factors affecting quantification

Deposition of amyloid and tau pathology can be quantified in vivo using positron emission tomography (PET). Accurate longitudinal measurements of accumulation from these images are critical for characterizing the start and spread of the disease. However, these measurements are challenging; precision and accuracy can be affected substantially by various sources of errors and variability. This review, supported by a systematic search of the literature, summarizes the current design and methodologies of longitudinal PET studies. Intrinsic, biological causes of variability of the Alzheimer's disease (AD) protein load over time are then detailed. Technical factors contributing to longitudinal PET measurement uncertainty are highlighted, followed by suggestions for mitigating these factors, including possible techniques that leverage shared information between serial scans. Controlling for intrinsic variability and reducing measurement uncertainty in longitudinal PET pipelines will provide more accurate and precise markers of disease evolution, improve clinical trial design, and aid therapy response monitoring.

Total-body [68 Ga]Ga-PSMA-11 PET/CT improves detection rate compared with conventional [68 Ga]Ga-PSMA-11 PET/CT in patients with biochemical recurrent prostate cancer

PURPOSE

The purpose of this study was to assess whether total-body [68 Ga]Ga-PSMA-11 PET/CT could improve the detection rate compared with conventional [68 Ga]Ga-PSMA-11 PET/CT in patients with biochemical recurrent prostate cancer.

METHODS

Two hundred biochemical recurrent prostate cancer patients with similar clinicopathological characteristics were included, of whom 100 patients underwent early total-body [68 Ga]Ga-PSMA-11 PET/CT and diuretic-delayed total-body [68 Ga]Ga-PSMA-11 PET/CT, and the other 100 patients received early conventional [68 Ga]Ga-PSMA-11 PET/CT and diuretic-delayed conventional [68 Ga]Ga-PSMA-11 PET/CT. The detection rates of total-body [68 Ga]Ga-PSMA-11 PET/CT and conventional [68 Ga]Ga-PSMA-11 PET/CT were compared using a chi-square test and stratified analysis. The image quality of total-body [68 Ga]Ga-PSMA PET/CT and conventional [68 Ga]Ga-PSMA-11 PET/CT was compared based on subjective scoring and objective parameters. Subjective scoring was conducted from background noise and lesion prominence using a 5-point scale. Objective parameters were evaluated by SUVmax, SUVmean, the standard deviation (SD) of SUV, and the signal-to-noise ratio (SNR) of liver and gluteus maximus. The SUVmax of the recurrent lesions was also measured.

RESULTS

The liver SD of the total-body [68 Ga]Ga-PSMA-11 PET/CT was significantly lower than that of conventional [68 Ga]Ga-PSMA-11 PET/CT, the SNR was significantly higher than that of conventional [68 Ga]Ga-PSMA-11 PET/CT, and the subjective evaluation was significantly better than that of conventional [68 Ga]Ga-PSMA-11 PET/CT. The detection rate of total-body [68 Ga]Ga-PSMA PET/CT for biochemical recurrence of prostate cancer was significantly higher than that of conventional [68 Ga]Ga-PSMA-11 PET/CT (91.0% vs. 74.0%, P = 0.003). Total-body [68 Ga]Ga-PSMA-11 PET/CT had better detection efficiency for patients with a Gleason score ≤ 8 or PSA ≤ 2 ng/ml. The advantages of diuretic-delayed total-body [68 Ga]Ga-PSMA-11 PET/CT were more obvious.

CONCLUSION

Total-body [68 Ga]Ga-PSMA-11 PET/CT could significantly improve the detection rate compared with conventional [68 Ga]Ga-PSMA-11 PET/CT in patients with biochemical recurrent prostate cancer.

Infection Imaging: Focus on New Tracers?

Infections account for relevant morbidity and mortality, especially if the cardiovascular system is affected. Clinical manifestations are often unspecific, resulting in a challenging diagnostic work-up. The use of molecular imaging methods, namely [18F]FDG PET and leukocyte scintigraphy, is increasingly recognized in recently published international guidelines. However, these 2 established methods focus on the host's immune response to the pathogen and are therefore virtually unable to differentiate infection from inflammation. Targeting the microorganism responsible for the infection directly with novel imaging agents is a promising strategy to overcome these limitations. In this review, we discuss clinically approved [18F]FDG PET with its advantages and limitations in cardiovascular infections, followed by new PET-based approaches for the detection of cardiovascular infections by bacteria-specific molecular imaging methods. A multitude of different targeting options has already been preclinically evaluated, but most still lack clinical translation. We give an overview not only on promising tracer candidates for noninvasive molecular imaging of infections but also on issues hampering clinical translation.

Feasibility of acquisitions using total-body PET/CT with a half-dose [68Ga]Ga-FAPI-04 activity in oncology patients

BACKGROUND

[68Ga]Ga-FAPI-04 (gallium-68-labeled fibroblast activation protein inhibitor-04) PET/CT has been widely used in diagnosing malignant tumors. Total-body PET/CT has a long axial field of view and provides higher sensitivity compared to traditional PET/CT. However, whether the reduced injected dose of [68Ga]Ga-FAPI-04 could obtain qualified imaging has not been evaluated.

PURPOSE

To explore the effect of half-dose [68Ga]Ga-FAPI-04 on image quality and tumor detectability in oncology patients.

METHODS

A total of twenty-seven patients with tumors or clinically suspected tumors were included, and all patients were scanned with total-body PET/CT after an injected dose of 0.84-1.14 MBq/kg [68Ga]Ga-FAPI-04. All patients obtained superior image quality with 300 s original acquisition time. Images were reconstructed using 180 s, 120 s, 60 s, 40 s, 30 s, 20 s scanning duration by ordered subset expectation maximization algorithm. The subjective image quality of all patients in each time group was scored using 5-point Likert scale. Mediastinal blood pool, liver, spleen, and muscle were analyzed as background using semi-quantitative parameters maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), standard deviation (SD), and signal to noise ratio (SNR). The lesion detection rate, SUVmax, and tumor-to-background ratio (TBR) were calculated for tumors confirmed by pathology.

RESULTS

The subjective image quality score decreased with the shortening of scanning time; however, both 180 s and 120 s images met the diagnostic requirements in terms of overall quality, lesion conspicuity, and image noise. The SUVmax of background increased with the reduction of scanning time, while the SUVmean was relatively stable. With the shortening of scanning time, the SD gradually increased, and the SNR gradually decreased, which was consistent with subjective image quality scores. In 180 s and 120 s images, all 11 primary lesions and 79 metastatic lesions were detected. The SUVmax of tumor focus showed an increasing trend as same as the background. Compared with 300 s, the TBR muscle had no statistical difference in 180 s and 120 s.

CONCLUSIONS

Half-dose [68Ga]Ga-FAPI-04 in total-body PET/CT imaging can shorten the acquisition time to 120 s with acceptable subjective image quality and 100% tumor detection rate. Total-body PET/CT imaging with a half-dose [68Ga]Ga-FAPI-04 and reduced acquisition time can be used in radiation-sensitive and poor tolerant to prolong horizontal positioning and waiting time populations such as children and gravidas.

Inspired by novel radiopharmaceuticals: Rush hour of nuclear medicine

Nuclear medicine plays an irreplaceable role in the diagnosis and treatment of tumors. Radiopharmaceuticals are important components of nuclear medicine. Among the radiopharmaceuticals approved by the Food and Drug Administration (FDA), radio-tracers targeting prostate-specific membrane antigen (PSMA) and somatostatin receptor (SSTR) have held essential positions in the diagnosis and treatment of prostate cancers and neuroendocrine neoplasms, respectively. In recent years, FDA-approved serials of immune-therapy and targeted therapy drugs targeting programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (HER2), and nectin cell adhesion molecule 4 (Nectin 4). How to screen patients suitable for these treatments and monitor the therapy? Nuclear medicine with specific radiopharmaceuticals can visualize the expression level of those targets in systemic lesions and evaluate the efficacy of treatment. In addition to radiopharmaceuticals, imaging equipment is also a key step for nuclear medicine. Advanced equipment including total-body positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI) has been developed, which contribute to the diagnosis and treatment of tumors, as well as the development of new radiopharmaceuticals. Here, we conclude most recently advances of radiopharmaceuticals in nuclear medicine, and they substantially increase the "arsenal" of clinicians for tumor therapy.

Potential Clinical Impact of LAFOV PET/CT: A Systematic Evaluation of Image Quality and Lesion Detection

We performed a systematic evaluation of the diagnostic performance of LAFOV PET/CT with increasing acquisition time. The first 100 oncologic adult patients referred for 3 MBq/kg 2-[18F]fluoro-2-deoxy-D-glucose PET/CT on the Siemens Biograph Vision Quadra were included. A standard imaging protocol of 10 min was used and scans were reconstructed at 30 s, 60 s, 90 s, 180 s, 300 s, and 600 s. Paired comparisons of quantitative image noise, qualitative image quality, lesion detection, and lesion classification were performed. Image noise (n = 50, 34 women) was acceptable according to the current standard of care (coefficient-of-varianceref < 0.15) after 90 s and improved significantly with increasing acquisition time (PB < 0.001). The same was seen in observer rankings (PB < 0.001). Lesion detection (n = 100, 74 women) improved significantly from 30 s to 90 s (PB < 0.001), 90 s to 180 s (PB = 0.001), and 90 s to 300 s (PB = 0.002), while lesion classification improved from 90 s to 180 s (PB < 0.001), 180 s to 300 s (PB = 0.021), and 90 s to 300 s (PB < 0.001). We observed improved image quality, lesion detection, and lesion classification with increasing acquisition time while maintaining a total scan time of less than 5 min, which demonstrates a potential clinical benefit. Based on these results we recommend a standard imaging acquisition protocol for LAFOV PET/CT of minimum 180 s to maximum 300 s after injection of 3 MBq/kg 2-[18F]fluoro-2-deoxy-D-glucose.

Impact of the maximum ring difference on image quality and noise characteristics of a total-body PET/CT scanner

The sensitivity of a PET system highly depends on the axial acceptance angle or maximum ring difference (MRD), which can be particularly high for total-body scanners due to their larger axial field of views (aFOVs). This study aims to evaluate the impact on image quality (IQ) and noise performance when MRD85 (18°), the current standard for clinical use, is increased to MRD322 (52°) for the Biograph Vision Quadra (Siemens Healthineers).

METHODS

Studies with a cylindrical phantom covering the 106 cm aFOV and an IEC phantom filled with 18F, 68Ga and 89Zr were performed for acquisition times from 60 to 1800 s and activity concentrations from 0.4 to 3 kBq/ml to assess uniformity, contrast recovery coefficients (CRCs) and to characterize noise by coefficient of variation (CV). Spatial resolution was compared for both MRDs by sampling a quadrant of the FOV with a point source. Further IQ, CV, liver SUVmean and SUVmax were compared for a cohort of 5 patients scanned with [18F]FDG (3 MBq/kg, 1 h p.i.) from 30 to 300 s.

RESULTS

CV was improved by a factor of up to 1.49 and is highest for short acquisition times, peaks at the center field of view and mitigates parabolic in axial direction with no difference to MRD85 beyond the central 80 cm. No substantial differences between the two evaluated MRDs in regards to uniformity, SUVmean or CRC for the different isotopes were observed. A degradation of the average spatial resolution of 0.9 ± 0.2 mm in the central 40 cm FOV was determined with MRD322. Depending on the acquisition time MRD322 resulted in a decrease of SUVmax between 23.8% (30 s) and 9.0% (300 s).

CONCLUSION

Patient and phantom studies revealed that scan time could be lowered by approximately a factor of two with MRD322 while maintaining similar noise performance. The moderate degradation in spatial resolution for MRD322 is worth to exploit the full potential of the Quadra by either shorten scan times or leverage noise performance in particular for low count scenarios such as ultra-late imaging or dynamic studies with high temporal resolution.

Marriage of radiotracers and total-body PET/CT rapid imaging system: current status and clinical advances

Radiotracers and medical imaging equipment are the two main keys to molecular imaging. While radiotracers are of great interest to research and industry, medical imaging equipment technology is blossoming everywhere. Total-body PET/CT (TB-PET/CT) has emerged in response to this trend and is rapidly gaining traction in the fields of clinical oncology, cardiovascular medicine, inflammatory/infectious diseases, and pediatric diseases. In addition, the use of a growing number of radiopharmaceuticals in TB-PET/CT systems has shown promising results. Notably, the distinctive features of TB-PET/CT, such as its ultra-long axial field of view (194 cm), ultra-high sensitivity, and capability for low-dose tracer imaging, have enabled enhanced imaging quality while reducing the radiation dose. The envisioned whole-body dynamic imaging, delayed imaging, personalized disease management, and ultrafast acquisition for motion correction, among others, are achieved. This review highlights two key factors affecting molecular imaging, describing the rapid imaging effects of radiotracers allowed at low doses on TB-PET/CT and the improvements offered compared to conventional PET/CT.

Biodistribution of Mesenchymal Stromal Cells Labeled with [89Zr]Zr-Oxine in Local Radiation Injuries in Laboratory Animals

BACKGROUND

Tracking the migration pathways of living cells after their introduction into a patient's body is a topical issue in the field of cell therapy. Questions related to studying the possibility of long-term intravital biodistribution of mesenchymal stromal cells in the body currently remain open.

METHODS

Forty-nine laboratory animals were used in the study. Modeling of local radiation injuries was carried out, and the dynamics of the distribution of mesenchymal stromal cells labeled with [89Zr]Zr-oxine in the rat body were studied.

RESULTS

the obtained results of the labelled cell distribution allow us to assume that this procedure could be useful for visualization of local radiation injury using positron emission tomography. However, further research is needed to confirm this assumption.

CONCLUSIONS

intravenous injection leads to the initial accumulation of cells in the lungs and their subsequent redistribution to the liver, spleen, and kidneys. When locally injected into tissues, mesenchymal stromal cells are not distributed systemically in significant quantities.

Image Quality and Quantitative PET Parameters of Low-Dose [18F]FDG PET in a Long Axial Field-of-View PET/CT Scanner

PET/CT scanners with a long axial field-of-view (LAFOV) provide increased sensitivity, enabling the adjustment of imaging parameters by reducing the injected activity or shortening the acquisition time. This study aimed to evaluate the limitations of reduced [18F]FDG activity doses on image quality, lesion detectability, and the quantification of lesion uptake in the Biograph Vision Quadra, as well as to assess the benefits of the recently introduced ultra-high sensitivity mode in a clinical setting. A number of 26 patients who underwent [18F]FDG-PET/CT (3.0 MBq/kg, 5 min scan time) were included in this analysis. The PET raw data was rebinned for shorter frame durations to simulate 5 min scans with lower activities in the high sensitivity (HS) and ultra-high sensitivity (UHS) modes. Image quality, noise, and lesion detectability (n = 82) were assessed using a 5-point Likert scale. The coefficient of variation (CoV), signal-to-noise ratio (SNR), tumor-to-background ratio (TBR), and standardized uptake values (SUV) including SUVmean, SUVmax, and SUVpeak were evaluated. Subjective image ratings were generally superior in UHS compared to the HS mode. At 0.5 MBq/kg, lesion detectability decreased to 95% (HS) and to 98% (UHS). SNR was comparable at 1.0 MBq/kg in HS (5.7 ± 0.6) and 0.5 MBq/kg in UHS (5.5 ± 0.5). With lower doses, there were negligible reductions in SUVmean and SUVpeak, whereas SUVmax increased steadily. Reducing the [18F]FDG activity to 1.0 MBq/kg (HS/UHS) in a LAFOV PET/CT provides diagnostic image quality without statistically significant changes in the uptake parameters. The UHS mode improves image quality, noise, and lesion detectability compared to the HS mode.

Comparative studies of the sensitivities of sparse and full geometries of Total-Body PET scanners built from crystals and plastic scintillators

BACKGROUND

Alongside the benefits of Total-Body imaging modalities, such as higher sensitivity, single-bed position, low dose imaging, etc., their final construction cost prevents worldwide utilization. The main aim of this study is to present a simulation-based comparison of the sensitivities of existing and currently developed tomographs to introduce a cost-efficient solution for constructing a Total-Body PET scanner based on plastic scintillators.

METHODS

For the case of this study, eight tomographs based on the uEXPLORER configuration with different scintillator materials (BGO, LYSO), axial field-of-view (97.4 cm and 194.8 cm), and detector configurations (full and sparse) were simulated. In addition, 8 J-PET scanners with different configurations, such as various axial field-of-view (200 cm and 250 cm), different cross sections of plastic scintillator, and multiple numbers of plastic scintillator layers (2, 3, and 4), based on J-PET technology have been simulated by GATE software. Furthermore, Siemens' Biograph Vision has been simulated to compare the results with standard PET scans. Two types of simulations have been performed. The first one with a centrally located source with a diameter of 1 mm and a length of 250 cm, and the second one with the same source inside a water-filled cylindrical phantom with a diameter of 20 cm and a length of 183 cm.

RESULTS

With regards to sensitivity, among all the proposed scanners, the ones constructed with BGO crystals give the best performance ([Formula: see text] 350 cps/kBq at the center). The utilization of sparse geometry or LYSO crystals significantly lowers the achievable sensitivity of such systems. The J-PET design gives a similar sensitivity to the sparse LYSO crystal-based detectors while having full detector coverage over the body. Moreover, it provides uniform sensitivity over the body with additional gain on its sides and provides the possibility for high-quality brain imaging.

CONCLUSION

Taking into account not only the sensitivity but also the price of Total-Body PET tomographs, which till now was one of the main obstacles in their widespread clinical availability, the J-PET tomography system based on plastic scintillators could be a cost-efficient alternative for Total-Body PET scanners.

The role of clinical imaging in oncology drug development: progress and new challenges

In 2008, the role of clinical imaging in oncology drug development was reviewed. The review outlined where imaging was being applied and considered the diverse demands across the phases of drug development. A limited set of imaging techniques was being used, largely based on structural measures of disease evaluated using established response criteria such as response evaluation criteria in solid tumours. Beyond structure, functional tissue imaging such as dynamic contrast-enhanced MRI and metabolic measures using [18F]flourodeoxyglucose positron emission tomography were being increasingly incorporated. Specific challenges related to the implementation of imaging were outlined including standardisation of scanning across study centres and consistency of analysis and reporting. More than a decade on the needs of modern drug development are reviewed, how imaging has evolved to support new drug development demands, the potential to translate state-of-the-art methods into routine tools and what is needed to enable the effective use of this broadening clinical trial toolset. In this review, we challenge the clinical and scientific imaging community to help refine existing clinical trial methods and innovate to deliver the next generation of techniques. Strong industry-academic partnerships and pre-competitive opportunities to co-ordinate efforts will ensure imaging technologies maintain a crucial role delivering innovative medicines to treat cancer.

Umbilical cord blood and peripheral blood-derived regulatory T cells therapy: Progress in type 1 diabetes

Regulatory T cells (Tregs) are key regulators for the inflammatory response and play a role in maintaining the immune tolerance. Type 1 diabetes (T1D) is a relatively common autoimmune disease that results from the loss of immune tolerance to β-cell-associated antigens. Preclinical models have demonstrated the safety and efficacy of Tregs given in transplant rejection and autoimmune diseases such as T1D. Adoptive transfer of Tregs has been utilized in clinical trials for over a decade. However, the achievement of the adoptive transfer of Tregs therapy in clinical application remains challenging. In this review, we highlight the characterization of Tregs and compare the differences between umbilical cord blood and adult peripheral blood-derived Tregs. Additionally, we summarize conditional modifications in the expansion of Tregs in clinical trials, especially for the treatment of T1D. Finally, we discuss the existing technical challenges for Tregs in clinical trials for the treatment of T1D.

Utility of a simplified [18F] sodium fluoride PET imaging method to quantify bone metabolic flux for a wide range of clinical applications

We review the rationale, methodology, and clinical utility of quantitative [18F] sodium fluoride ([18F]NaF) positron emission tomography-computed tomography (PET-CT) imaging to measure bone metabolic flux (Ki, also known as bone plasma clearance), a measurement indicative of the local rate of bone formation at the chosen region of interest. We review the bone remodelling cycle and explain what aspects of bone remodelling are addressed by [18F]NaF PET-CT. We explain how the technique works, what measurements are involved, and what makes [18F]NaF PET-CT a useful tool for the study of bone remodelling. We discuss how these measurements can be simplified without loss of accuracy to make the technique more accessible. Finally, we briefly review some key clinical applications and discuss the potential for future developments. We hope that the simplified method described here will assist in promoting the wider use of the technique.

Framing protocol optimization in oncological Patlak parametric imaging with uKinetics

PURPOSE

Total-body PET imaging with ultra-high sensitivity makes high-temporal-resolution framing protocols possible for the first time, which allows to capture rapid tracer dynamic changes. However, whether protocols with higher number of temporal frames can justify the efficacy with substantially added computation burden for clinical application remains unclear. We have developed a kinetic modeling software package (uKinetics) with the advantage of practical, fast, and automatic workflow for dynamic total-body studies. The aim of this work is to verify the uKinetics with PMOD and to perform framing protocol optimization for the oncological Patlak parametric imaging.

METHODS

Six different protocols with 100, 61, 48, 29, 19 and 12 temporal frames were applied to analyze 60-min dynamic 18F-FDG PET scans of 10 patients, respectively. Voxel-based Patlak analysis coupled with automatically extracted image-derived input function was applied to generate parametric images. Normal tissues and lesions were segmented manually or automatically to perform correlation analysis and Bland-Altman plots. Different protocols were compared with the protocol of 100 frames as reference.

RESULTS

Minor differences were found between uKinetics and PMOD in the Patlak parametric imaging. Compared with the protocol with 100 frames, the relative difference of the input function and quantitative kinetic parameters remained low for protocols with at least 29 frames, but increased for the protocols with 19 and 12 frames. Significant difference of lesion Ki values was found between the protocols with 100 frames and 12 frames.

CONCLUSION

uKinetics was proved providing equivalent oncological Patlak parametric imaging comparing to PMOD. Minor differences were found between protocols with 100 and 29 frames, which indicated that 29-frame protocol is sufficient and efficient for the oncological 18F-FDG Patlak applications, and the protocols with more frames are not needed. The protocol with 19 frames yielded acceptable results, while that with 12 frames is not recommended.

A proper protocol for routine 18F-FDG uEXPLORER total-body PET/CT scans

BACKGROUND

Conventional clinical PET scanners typically have an axial field of view (AFOV) of 15-30 cm, resulting in limited coverage and relatively low photon detection efficiency. Taking advantage of the development of long-axial PET/CT, the uEXPLORER PET/CT scanner with an axial coverage of 194 cm increases the effective count rate by approximately 40 times compared to that of conventional PET scanners. Ordered subset expectation maximization (OSEM) is the most widely used iterative algorithm in PET. The major drawback of OSEM is that the iteration process must be stopped before convergence to avoid image degradation due to excessive noise. A new Bayesian penalized-likelihood iterative PET reconstruction, named HYPER iterative, was developed and is now available on the uEXPLORER total-body PET/CT, which incorporates a noise control component by using a penalty function in each iteration and finds the maximum likelihood solution through repeated iterations. To date, its impact on lesion visibility in patients with a full injected dose or half injected dose is unclear. The goal of this study was to determine a proper protocol for routine 18F-FDG uEXPLORER total-body PET/CT scans.

RESULTS

The uEXPLORER total-body PET/CT images reconstructed using both OSEM and HYPER iterative algorithms of 20 tumour patients were retrospectively reviewed. The quality of the 5 min PET image was excellent (score 5) for all of the dose and reconstruction methods. Using the HYPER iterative method, the PET images reached excellent quality at 1 min with full-dose PET and at 2 min with half-dose PET. The PET image reached a similar excellent quality at 2 min with a full dose and at 3 min with a half dose using OSEM. The noise in the OSEM reconstruction was higher than that in the HYPER iterative. Compared to OSEM, the HYPER iterative had a slightly higher SUVmax and TBR of the lesions for large positive lesions (≥ 2 cm) (SUVmax: up to 9.03% higher in full dose and up to 12.52% higher in half dose; TBR: up to 8.69% higher in full dose and up to 23.39% higher in half dose). For small positive lesions (≤ 10 mm), the HYPER iterative had an obviously higher SUVmax and TBR of the lesions (SUVmax: up to 45.21% higher in full dose and up to 74.96% higher in half dose; TBR: up to 44.91% higher in full dose and up to 93.73% higher in half dose).

CONCLUSIONS

A 1 min scan with a full dose and a 2 min scan with a half dose are optimal for clinical diagnosis using the HYPER iterative and 2 min and 3 min for OSEM. For quantification of the small lesions, HYPER iterative reconstruction is preferred.

Different hydration protocols for the quantification of healthy tissue uptake of half-dose 18F-FDG total-body positron emission tomography-computed tomography: a prospective study

Background

This study aimed to investigate the effects of the volume and time of hydration on the quantification of healthy tissue uptake for 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) total-body positron emission tomography (PET)-computed tomography (CT) with half-dose activity.

Methods

This study prospectively enrolled 180 patients who underwent a total-body PET-CT scan 10 min after injection of a half-dose (1.85 MBq/kg) of 18F-FDG. These patients were placed in hydration groups (30 patients in each group) according to different hydration volumes and times: oral hydration with 500 mL of water 20 min before (G1), 5 min after (G2), and 30 min after (G3) the 18F-FDG injection; and oral hydration with 200 mL of water 20 min before (G4), 5 min after (G5), and 30 min after (G6) the 18F-FDG injection. Another 30 patients underwent dynamic imaging without hydration and were used a nonhydration group. The analysis of quantification of healthy tissue uptake included the maximum standardized uptake value (SUVmax) and the mean SUV (SUVmean) of the blood pool and muscle, as well as the SUVmax, SUVmean, and signal-to-noise ratio (SNR) of the liver.

Results

The SUVmax of the blood pool (2.33±0.36), liver (3.03±0.42), and muscle (0.81±0.15) was significantly higher in the nonhydration group than in any of the 6 hydrated groups (P<0.05 for all hydration groups vs. nonhydration group). Muscle SUVmax and SUVmean were significantly (P<0.05) lower in G1 and G2 than in G3 and were lower in G4 and G5 than in G6. The SUVmax and SUVmean of the blood pool were significantly (P<0.05) lower in G1 than in G3 and G4 and lower in G3 than in G6.

Conclusions

When total-body PET-CT with a half dose of 18F-FDG activity is performed, hydration can significantly affect the quantification of healthy tissue uptake. Oral administration of 500 mL of water 20 min before injection could reduce background radioactivity.

The potential advantages and workflow challenges of long axial field of view PET/CT

Recently developed Long (≥100 cm) axial field of view (AFOV) PET/CT scanners are capable of producing images with higher signal-to-noise ratio, or performing faster whole-body acquisitions, or scanning with lower radiation dose to the patient, compared with conventional PET/CT scanners. These benefits, which arise due to their substantially higher, by more than an order of magnitude, geometric efficiency, have been well described in the recent literature. The introduction of Long AFOV PET/CT technology into the clinic also has important implications for the design and workflow of PET/CT facilities and their effects on radiation exposure to staff and patients. Maximising the considerable benefits of this technology requires a thorough understanding of the relationships between these factors to optimise workflows while appropriately managing radiation exposure. This article reviews current knowledge on PET/CT facility design, workflows and their effects on radiation exposure, identifies gaps in the literature and discusses the challenges that need to be considered with the introduction of Long AFOV PET/CT into the clinic.

Redefining Radiology: A Review of Artificial Intelligence Integration in Medical Imaging

This comprehensive review unfolds a detailed narrative of Artificial Intelligence (AI) making its foray into radiology, a move that is catalysing transformational shifts in the healthcare landscape. It traces the evolution of radiology, from the initial discovery of X-rays to the application of machine learning and deep learning in modern medical image analysis. The primary focus of this review is to shed light on AI applications in radiology, elucidating their seminal roles in image segmentation, computer-aided diagnosis, predictive analytics, and workflow optimisation. A spotlight is cast on the profound impact of AI on diagnostic processes, personalised medicine, and clinical workflows, with empirical evidence derived from a series of case studies across multiple medical disciplines. However, the integration of AI in radiology is not devoid of challenges. The review ventures into the labyrinth of obstacles that are inherent to AI-driven radiology-data quality, the 'black box' enigma, infrastructural and technical complexities, as well as ethical implications. Peering into the future, the review contends that the road ahead for AI in radiology is paved with promising opportunities. It advocates for continuous research, embracing avant-garde imaging technologies, and fostering robust collaborations between radiologists and AI developers. The conclusion underlines the role of AI as a catalyst for change in radiology, a stance that is firmly rooted in sustained innovation, dynamic partnerships, and a steadfast commitment to ethical responsibility.

Improved [68Ga]Ga-PSMA-11 image qualities reconstructed by total variation regularized expectation maximization on total-body PET/CT

Background

Total variation regularized expectation maximization (TVREM) reconstruction algorithm on the image quality of gallium (68GA) prostate-specific membrane antigen-11 ([68Ga]Ga-PSMA-11) total-body positron emission tomography/computed tomography (PET/CT).

Methods

Images of a phantom with small hot sphere inserts and the total-body PET/CT scans of 51 prostate cancer patients undergoing [68Ga]Ga-PSMA-11 were reconstructed using TVREM with 5 different penalization factors between 0.09 and 0.45 and for 20-, 40-, 60-, 120-, and 300-second acquisition, respectively. As a comparison, the same data were also reconstructed using the ordered subset expectation maximization (OSEM) with 3 iterations, 20 subsets, and 300 second acquisition. The contrast recovery coefficients (CRC) and background variability (BV) of the phantom, the tumor-to-background ratios (TBR), the contrast recovery (CR) ratio, the image noise of the liver, and maximum standard uptake value (SUVmax) of the lesions were calculated to evaluate the image quality. The clinical performance of the images was evaluated by 2 radiologists with a 5-point scale (1-poor, 5-excellent).

Results

The TVREM reconstructions groups fwith 120 second acquisition and the penalization of 0.27 to 0.45 showed the best performance in terms of CR, TBR, image noise, and the gain of SUVmax compared to that obtained in the OSEM 300 second group. Even the image noise of the TVREM 120 second group with a penalization factor of 0.27 and 0.36 was comparable to the OSEM 300 second group; the lesions' SUVmax increased by 28% whereas the image noise decreased by 5% and 14%, respectively. The TVREM 120 second group with a penalization factor of 0.36 (5.00±0.00) had the highest qualitative score that equaled OSEM and TVREM for the 300 second (P>0.05) group.

Conclusions

Our study has shown the potential of the TVREM reconstruction algorithm with optimized penalization factors to achieve comparable [68Ga]Ga-PSMA-11 total-body PET/CT image quality with a shorter acquisition time, compared with the conventional OSEM reconstruction algorithm.

Biodistribution and radiation dosimetry of multiple tracers on total-body positron emission tomography/computed tomography

Background

[18F]F-FDG, [68Ga]Ga-PSMA-11, and [68Ga]Ga-FAPI-04 have achieved good results in multiple clinical trials and clinical practice, but the imaging of these tracers is limited to traditional short-axis positron emission tomography/computed tomography (PET/CT). Therefore, we aimed to use total-body PET/CT dynamic scanning to describe whole-body biodistribution of these three tracers and to calculate more precise radiation doses.

Methods

Total-body PET/CT (uExplorer, United Imaging Healthcare) dynamic scanning was performed on 54 patients, including 30 patients with [18F]F-FDG, 10 patients with [68Ga]Ga-PSMA-11, and 14 patients with [68Ga]Ga-FAPI-04. A 60-minute dynamic scanning of whole body was performed simultaneously after bedside bolus injection of the corresponding tracers. The dynamic sequence of 92 frames was quantitatively analyzed by the Pmod4.0 software. Whole body biodistribution was calculated as time-activity curves (TACs) describing dynamic uptake patterns in the subject's major organs, followed by calculation of tracer kinetics and cumulative organ activity. Finally, combined with the OLINDA/EXM software, effective doses of the different tracers and individual organ doses were calculated.

Results

In a systematic TAC analysis of three tracers, we identified distinct biodistribution patterns in major organs. [68Ga]Ga-PSMA-11 showed a trend of rapid increasing and slow decreasing in liver, spleen, muscle, and bone. In the heart, stomach, brain, and lung, tracer decreased rapidly after rapid increasing. Similarly, tracer uptake in the kidney and urinary bladder increased gradually. [68Ga]Ga-FAPI-04 showed a rapid increasing and rapid decreasing trend in brain, lung, liver, spleen, bone, heart, kidney, and stomach. The mean effective dose of [68Ga]Ga-PSMA-11 was 1.47E-02 mSv/MBq, and the mean effective doses of [18F]F-FDG and [68Ga]Ga-FAPI-04 were comparable (2.52E-02 mSv/MBq and 2.23E-02 mSv/MBq). The mean effective dose of [18F]F-FDG was lower than that reported in the literature measured by previous short-axis PET, while both [68Ga]Ga-PSMA-11 and [68Ga]Ga-FAPI-04 had higher value than previously reported value.

Conclusions

[18F]F-FDG, [68Ga]Ga-PSMA-11 and [68Ga]Ga-FAPI-04 have good biodistribution in human organs. Real-time high-sensitivity dynamic scanning with total-body PET/CT is a very effective way to accurately calculate biodistribution and effective dose of positron-labeled radiopharmaceuticals.

A time-based double-sided readout concept of 100 mm LYSO:Ce,Ca fibres for future axial TOF-PET

BACKGROUND

Positron emission tomography (PET) requires a high signal-to-noise ratio (SNR) to improve image quality, with time-of-flight (TOF) being an effective way to boost the SNR. However, the scanner sensitivity and resolution must be maintained. The use of axially aligned 100-mm LYSO:Ce,Ca scintillation crystals with double-sided readout has the potential of ground-breaking TOF and sensitivity, while reducing parallax errors through depth-of-interaction (DOI) estimation, and also allowing a reduction in the number of readout channels required, resulting in cost benefits. Due to orientation, these fibres may also facilitate the integration of TOF-PET with magnetic resonance imaging (MRI) in hybrid imaging systems. The challenge of achieving a good spatial resolution with such long axial fibres is directly related to the achievable TOF resolution. In this study, the timing performance and DOI resolution of emerging high-performance materials were investigated to assess the merits of this approach in organ-dedicated or total-body/large-scale PET imaging systems.

METHODS

LYSO:Ce,Ca scintillation fibres of 20 mm and 100 mm length were tested in various operating and readout configurations to determine the best achievable coincidence time resolution (CTR) and DOI resolution. The tests were performed using state-of-the-art high-frequency (HF) readout and commercially available silicon photomultipliers (SiPMs) from Broadcom Inc.

RESULTS

For the 100-mm fibre, an average CTR performance of [Formula: see text] ps FWHM and an average depth-of-interaction resolution within the fibre of [Formula: see text] mm FWHM could be obtained. The 20-mm fibre showed a sub-100 ps CTR of [Formula: see text] ps FWHM and a fibre resolution of [Formula: see text] mm FWHM in the double-sided readout configuration.

CONCLUSION

With modern SiPMs and crystals, a double-sided readout of long fibres can achieve excellent timing resolution and field-advancing TOF resolution, outperforming commercial PET systems. With 100-mm fibres, an electronic channel reduction of about a factor 2.5 is inherent, with larger reduction factors conceivable, which can lead to lower production costs. The spatial resolution was shown to be limited in the axial direction with 12 mm, but is defined to 3 mm in all other directions. Recent SiPM and scintillator developments are expected to improve on the time and spatial resolution to be investigated in future prototypes.

An exploration of the feasibility and clinical value of half-dose 5-h total-body 18F-FDG PET/CT scan in patients with Takayasu arteritis

PURPOSE

To explore the feasibility and clinical value of 5-h delayed 18F-fluorodeoxyglucose (18F-FDG) total-body (TB) positron emission tomography/computed tomography (PET/CT) in patients with Takayasu arteritis (TA).

METHODS

This study included nine healthy volunteers who underwent 1-, 2.5-, and 5-h triple-time TB PET/CT scans and 55 patients with TA who underwent 2- and 5-h dual-time TB PET/CT scans with 1.85 MBq/kg 18F-FDG. The liver, blood pool, and gluteus maximus muscle signal-to-noise ratios (SNRs) were calculated by dividing the SUVmean by its standard deviation to evaluate imaging quality. TA lesions' 18F-FDG uptake was graded on a three-point scale (I, II, III), with grades II and III considered positive lesions. Lesion-to-blood maximum standardised uptake value (SUVmax) ratio (LBR) was calculated by dividing the lesion SUVmax by the blood pool SUVmax.

RESULTS

The liver, blood pool, and muscle SNR of the healthy volunteers at 2.5- and 5-h were similar (0.117 and 0.115, respectively, p = 0.095). We detected 415 TA lesions in 39 patients with active TA. The average 2- and 5-h scan LBRs were 3.67 and 7.59, respectively (p < 0.001). Similar TA lesion detection rates were noted in the 2-h (92.0%; 382/415) and 5-h (94.2%; 391/415) scans (p = 0.140). We detected 143 TA lesions in 19 patients with inactive TA. The 2- and 5-h scan LBRs were 2.99 and 5.71, respectively (p < 0.001). Similar positive detection rates in inactive TA were noted in the 2-h (97.9%; 140/143) and 5-h (98.6%; 141/143) scans (p = 0.500).

CONCLUSION

The 2- and 5-h 18F-FDG TB PET/CT scans had similar positive detection rates, but both combined could better detect inflammatory lesions in patients with TA.

Radiology's Ionising Radiation Paradox: Weighing the Indispensable Against the Detrimental in Medical Imaging

Ionising radiation stands as an indispensable protagonist in the narrative of medical imaging, underpinning diagnostic evaluations and therapeutic interventions across an array of medical conditions. However, this protagonist poses a paradox - its inestimable service to medicine coexists with an undercurrent of potential health risks, primarily DNA damage and subsequent oncogenesis. The narrative of this comprehensive review unfurls around this intricate enigma, delicately balancing the indispensable diagnostic utility against the non-negotiable commitment to patient safety. In this critical discourse, the intricacies of ionising radiation are dissected, illuminating not only its sources but also the associated biological and health hazards. The exploration delves into the labyrinth of strategies currently deployed to minimise exposure and safeguard patients. By casting light on the scientific nuances of X-rays, computed tomography (CT), and nuclear medicine, it traverses the complex terrain of radiation use in radiology, to promote safer medical imaging practices, and to facilitate an ongoing dialogue about diagnostic necessity and risk. Through a rigorous examination, the pivotal relationship between radiation dose and dose response is elucidated, unravelling the mechanisms of radiation injury and distinguishing between deterministic and stochastic effects. Moreover, protection strategies are illuminated, demystifying concepts such as justification, optimisation, the As Low As Reasonably Achievable (ALARA) principle, dose and diagnostic reference levels, along with administrative and regulatory approaches. With an eye on the horizon, promising avenues of future research are discussed. These encompass low-radiation imaging techniques, long-term risk assessment in large patient cohorts, and the transformative potential of artificial intelligence in dose optimisation. This exploration of the nuanced complexities of radiation use in radiology aims to foster a collaborative impetus towards safer medical imaging practices. It underscores the need for an ongoing dialogue around diagnostic necessity and risk, thereby advocating for a continual reassessment in the narrative of medical imaging.

The historical progression of positron emission tomography research in neuroendocrinology

The rapid and continual development of a number of radiopharmaceuticals targeting different receptor, enzyme and small molecule systems has fostered Positron Emission Tomography (PET) imaging of endocrine system actions in vivo in the human brain for several decades. PET radioligands have been developed to measure changes that are regulated by hormone action (e.g., glucose metabolism, cerebral blood flow, dopamine receptors) and actions within endocrine organs or glands such as steroids (e.g., glucocorticoids receptors), hormones (e.g., estrogen, insulin), and enzymes (e.g., aromatase). This systematic review is targeted to the neuroendocrinology community that may be interested in learning about positron emission tomography (PET) imaging for use in their research. Covering neuroendocrine PET research over the past half century, researchers and clinicians will be able to answer the question of where future research may benefit from the strengths of PET imaging.

The changing landscape of nuclear medicine and a new era: the "NEW (Nu) CLEAR Medicine": a framework for the future

Nuclear Medicine is witnessing a revolution across a large spectrum of patient care applications, hardware, software and novel radiopharmaceuticals. We propose to offer a framework of the nuclear medicine practice of the future that incorporates multiple novelties and coined as the NEW (nu) Clear medicine. All these new developments offer a significant clarity and real clinical impact, and we need a concerted effort from all stakeholders in the field for bedside implementation and success.

Monte Carlo simulation of the system performance of a long axial field-of-view PET based on monolithic LYSO detectors

BACKGROUND

In light of the milestones achieved in PET design so far, further sensitivity improvements aim to optimise factors such as the dose, throughput, and detection of small lesions. While several longer axial field-of-view (aFOV) PET systems based on pixelated detectors have been installed, continuous monolithic scintillation detectors recently gained increased attention due to their depth of interaction capability and superior intrinsic resolution. As a result, the aim of this work is to present and evaluate the performance of two long aFOV, monolithic LYSO-based PET scanner designs.

METHODS

Geant4 Application for Tomographic Emission (GATE) v9.1 was used to perform the simulations. Scanner designs A and B have an aFOV of 36.2 cm (7 rings) and 72.6 cm (14 rings), respectively, with 40 detector modules per ring each and a bore diameter of 70 cm. Each module is a 50 × 50 × 16 mm3 monolithic LYSO crystal. Sensitivity, noise equivalent count rate (NECR), scatter fraction, spatial resolution, and image quality tests were performed based on NEMA NU-2018 standards.

RESULTS

The sensitivity of design A was calculated to be 29.2 kcps/MBq at the centre and 27 kcps/MBq at 10 cm radial offset; similarly, the sensitivity of design B was found to be 106.8 kcps/MBq and 98.3 kcps/MBq at 10 cm radial offset. NECR peaks were reached at activity concentrations beyond the range of activities used for clinical studies. In terms of spatial resolution, the values for the point sources were below 2 mm for the radial, tangential, and axial full width half maximum. The contrast recovery coefficient ranged from 53% for design B and 4:1 contrast ratio to 90% for design A and 8:1 ratio, with a reasonably low background variability.

CONCLUSIONS

Longer aFOV PET designs using monolithic LYSO have superior spatial resolution compared to current pixelated total-body PET (TB-PET) scanners. These systems combine high sensitivity with improved contrast recovery.

Noninvasive In Vivo Coronary Artery Thrombus Imaging

BACKGROUND

The diagnosis and management of myocardial infarction are increasingly complex, and establishing the presence of intracoronary thrombosis has major implications for both the classification and treatment of myocardial infarction.

OBJECTIVES

The aim of this study was to investigate whether positron emission tomographic (PET) and computed tomographic (CT) imaging could noninvasively detect in vivo thrombus formation in human coronary arteries using a novel glycoprotein IIb/IIIa receptor antagonist-based radiotracer, 18F-GP1.

METHODS

In a single-center observational case-control study, patients with or without acute myocardial infarction underwent coronary 18F-GP1 PET/CT angiography. Coronary artery 18F-GP1 uptake was assessed visually and quantified using maximum target-to-background ratios.

RESULTS

18F-GP1 PET/CT angiography was performed in 49 patients with and 50 patients without acute myocardial infarction (mean age: 61 ± 9 years, 75% men). Coronary 18F-GP1 uptake was apparent in 39 of the 49 culprit lesions (80%) in patients with acute myocardial infarction. False negative results appeared to relate to time delays to scan performance and low thrombus burden in small-caliber distal arteries. On multivariable regression analysis, culprit vessel status was the only independent variable associated with higher 18F-GP1 uptake. Extracoronary cardiac 18F-GP1 findings included a high frequency of infarct-related intramyocardial uptake (35%) as well as left ventricular (8%) or left atrial (2%) thrombus.

CONCLUSIONS

Coronary 18F-GP1 PET/CT angiography is the first noninvasive selective technique to identify in vivo coronary thrombosis in patients with acute myocardial infarction. This novel approach can further define the role and location of thrombosis within the heart and has the potential to inform the diagnosis, management, and treatment of patients with acute myocardial infarction. (In-Vivo Thrombus Imaging With 18F-GP1, a Novel Platelet PET Radiotracer [iThrombus]; NCT03943966).

Characterization of the partial volume effect along the axial field-of-view of the Biograph Vision Quadra total-body PET/CT system for multiple isotopes

BACKGROUND

Total-body PET scanners with axial field of views (FOVs) longer than 1 m enable new applications to study multiple organs (e.g., the brain-gut-axis) simultaneously. As the spatial resolution and the associated partial volume effect (PVE) can vary significantly along the FOV, detailed knowledge of the contrast recovery coefficients (CRCs) is a prerequisite for image analysis and interpretation of quantitative results. The aim of this study was to determine the CRCs, as well as voxel noise, for multiple isotopes throughout the 1.06 m axial FOV of the Biograph Vision Quadra PET/CT system (Siemens Healthineers).

MATERIALS AND METHODS

Cylindrical phantoms equipped with three different sphere sizes (inner diameters 7.86 mm, 28 and 37 mm) were utilized for the PVE evaluation. The 7.86 mm sphere was filled with F-18 (8:1 and 4:1), Ga-68 (8:1) and Zr-89 (8:1). The 28 mm and 37 mm spheres were filled with F-18 (8:1). Background concentration in the respective phantoms was of ~ 3 kBq/ml. The phantoms were measured at multiple positions in the FOV (axial: 0, 10, 20, 30, 40 and 50 cm, transaxial: 0, 10, 20 cm). The data were reconstructed with the standard clinical protocol, including PSF correction and TOF information with up to 10 iterations for maximum ring differences (MRDs) of 85 and 322; CRCs, as well as voxel noise levels, were determined for each position.

RESULTS

F-18 CRCs (SBR 8:1 and 4:1) of the 7.86 mm sphere decreased up to 18% from the center FOV (cFOV) toward the transaxial edge and increased up to 17% toward the axial edge. Noise levels were below 15% for the default clinical reconstruction parameters. The larger spheres exhibited a similar pattern. Zr-89 revealed ~ 10% lower CRCs than F-18 but larger noise (9.1% (F-18), 19.1% (Zr-89); iteration 4, cFOV) for the default reconstruction. Zr-89 noise levels in the cFOV significantly decreased (~ 28%) when reconstructing the data with MRD322 compared with MRD85 along with a slight decrease in CRC values. Ga-68 exhibited the lowest CRCs for the three isotopes and noise characteristics comparable to those of F-18.

CONCLUSIONS

Distinct differences in the PVE within the FOV were detected for clinically relevant isotopes F-18, Ga-68 and Zr-89, as well as for different sphere sizes. Depending on the positions inside the FOV, the sphere-to-background ratios, count statistics and isotope used, this can result in an up to 50% difference between CRCs. Hence, these changes in PVE can significantly affect the quantitative analysis of patient data. MRD322 resulted in slightly lower CRC values, especially in the center FOV, whereas the voxel noise significantly decreased compared with MRD85.

Role of breath-hold lung PET in stage IA pulmonary adenocarcinoma

BACKGROUND

Respiratory motion during PET acquisition may result in image blurring and resolution loss, reduced measurement of radiotracer uptake, and consequently, inaccurate lesion quantification and description. With the introduction of the total-body PET system, short-time PET acquisition is feasible due to its high sensitivity and spatial resolution. The purpose of this study was to evaluate the additional value of 20-s breath-hold (BH) lung PET in patients with stage IA pulmonary adenocarcinoma.

METHODS

Forty-seven patients with confirmed stage IA pulmonary adenocarcinoma were enrolled in this retrospective study. All patients underwent a 300-s FB whole-body PET, followed by a BH lung PET. The SUV_max, TBR of the lesions and the percentage difference in nodule SUV_max (%ΔSUV_max) and TBR (%ΔTBR) between the two acquisitions was also calculated. The lesions were further divided by distance from pleura for subgroup analysis. The lesion detectability on PET images was the percentage of FDG-positive lesions.

RESULTS

Among 47 patients, the BH lung PET images identified all lung nodules, and there was a significant difference in overall nodule SUV_max and TBR between BH PET and FB PET (both p < 0.01). The %ΔSUV_max and %ΔTBR were significantly higher in nodules adjacent to pleura (≤ 10 mm in distance) than those away from pleura (both p < 0.05). The lesion detectability of BH lung PET was significantly higher than that of FB PET (p < 0.01).

CONCLUSION

BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.

CRITICAL RELEVANCE STATEMENT

BH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.