1
|
Young P, Heeman F, Axelsson J, Collij LE, Hitzel A, Sanaat A, Niñerola-Baizan A, Perissinotti A, Lubberink M, Frisoni GB, Zaidi H, Barkhof F, Farrar G, Baker S, Gispert JD, Garibotto V, Rieckmann A, Schöll M. Impact of simulated reduced injected dose on the assessment of amyloid PET scans. Eur J Nucl Med Mol Imaging 2024; 51:734-748. [PMID: 37897616 PMCID: PMC10796642 DOI: 10.1007/s00259-023-06481-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE To investigate the impact of reduced injected doses on the quantitative and qualitative assessment of the amyloid PET tracers [18F]flutemetamol and [18F]florbetaben. METHODS Cognitively impaired and unimpaired individuals (N = 250, 36% Aβ-positive) were included and injected with [18F]flutemetamol (N = 175) or [18F]florbetaben (N = 75). PET scans were acquired in list-mode (90-110 min post-injection) and reduced-dose images were simulated to generate images of 75, 50, 25, 12.5 and 5% of the original injected dose. Images were reconstructed using vendor-provided reconstruction tools and visually assessed for Aβ-pathology. SUVRs were calculated for a global cortical and three smaller regions using a cerebellar cortex reference tissue, and Centiloid was computed. Absolute and percentage differences in SUVR and CL were calculated between dose levels, and the ability to discriminate between Aβ- and Aβ + scans was evaluated using ROC analyses. Finally, intra-reader agreement between the reduced dose and 100% images was evaluated. RESULTS At 5% injected dose, change in SUVR was 3.72% and 3.12%, with absolute change in Centiloid 3.35CL and 4.62CL, for [18F]flutemetamol and [18F]florbetaben, respectively. At 12.5% injected dose, percentage change in SUVR and absolute change in Centiloid were < 1.5%. AUCs for discriminating Aβ- from Aβ + scans were high (AUC ≥ 0.94) across dose levels, and visual assessment showed intra-reader agreement of > 80% for both tracers. CONCLUSION This proof-of-concept study showed that for both [18F]flutemetamol and [18F]florbetaben, adequate quantitative and qualitative assessments can be obtained at 12.5% of the original injected dose. However, decisions to reduce the injected dose should be made considering the specific clinical or research circumstances.
Collapse
Affiliation(s)
- Peter Young
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Fiona Heeman
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Jan Axelsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Lyduine E Collij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anne Hitzel
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Amirhossein Sanaat
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
| | - Aida Niñerola-Baizan
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Barcelona, Spain
| | - Andrés Perissinotti
- Nuclear Medicine Department, Hospital Clínic Barcelona, Barcelona, Spain
- Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), ISCIII, Barcelona, Spain
| | - Mark Lubberink
- Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Geneva Memory Center, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, Switzerland
- Geneva University Neurocenter, Geneva University, Geneva, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- UCL Institute of Neurology, London, UK
| | | | - Suzanne Baker
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, USA
- Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, United States
| | - Juan Domingo Gispert
- Barcelona βeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanomedicina, Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva; NIMTLab; Center for Biomedical Imaging (CIBM), University of Geneva, Geneva, Switzerland
| | - Anna Rieckmann
- Institute for Psychology, Universität Der Bundeswehr München, Neubiberg, Germany
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
- Department of Psychiatry and Neurochemistry, Institute of Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden.
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
2
|
Pinto S, Caribé P, Sebastião Matushita C, Bromfman Pianta D, Narciso L, da Silva AMM. Aiming for [ 18F]FDG-PET acquisition time reduction in clinical practice for neurological patients. Phys Med 2023; 112:102604. [PMID: 37429182 DOI: 10.1016/j.ejmp.2023.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/02/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE Positron emission tomography (PET) imaging with [18F]FDG provides valuable information regarding the underlying pathological processes in neurodegenerative disorders. PET imaging for these populations should be as short as possible to limit head movements and improve comfort. This study aimed to validate an optimized [18F]FDG-PET image reconstruction protocol aiming to reduce acquisition time while maintaining adequate quantification accuracy and image quality. METHODS A time-reduced reconstruction protocol (5 min) was evaluated in [18F]FDG-PET retrospective data from healthy individuals and Alzheimer's disease (AD) patients. Standard (8 min) and time-reduced protocols were compared by means of image quality and quantification accuracy metrics, as well as standardized uptake value ratio (SUVR) and Z-scores (pons was used as reference). Images were randomly and blindly presented to experienced physicians and scored in terms of image quality. RESULTS No differences between protocols were identified during the visual assessment. Small differences (p < 0.01) in the pons SUVR were observed between the standard and time-reduced protocols for healthy individuals (-0.002 ± 0.011) and AD patients (-0.007 ± 0.013). Likewise, incorporating the PSF correction in the reconstruction algorithm resulted in small differences (p < 0.01) in SUVR between protocols (healthy individuals: -0.003 ± 0.011; AD patients: -0.007 ± 0.014). CONCLUSION Quality metrics were similar between time-reduced and standard protocols. In the visual assessment of the images, the physicians did not consider the use of PSF adequate, as it degraded the quality image. Shortening the acquisition time is possible by optimizing the image reconstruction parameters while maintaining adequate quantification accuracy and image quality.
Collapse
Affiliation(s)
- Samara Pinto
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil.
| | - Paulo Caribé
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; Medical Imaging and Signal Processing (MEDISIP), Ghent University, Ghent, Belgium
| | | | | | - Lucas Narciso
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; Lawson Health Research Institute, London, Ontario, Canada
| | - Ana Maria Marques da Silva
- Medical Image Computing Laboratory (MEDICOM), PUCRS, Porto Alegre, RS, Brazil; School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
3
|
Kertész H, Traub-Weidinger T, Cal-Gonzalez J, Rausch I, Muzik O, Shyiam Sundar LK, Beyer T. Feasibility of dose reduction for [18F]FDG-PET/MR imaging of patients with non-lesional epilepsy. Nuklearmedizin 2023; 62:200-213. [PMID: 36807894 DOI: 10.1055/a-2015-7785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The aim of the study was to evaluate the effect of reduced injected [18F]FDG activity levels on the quantitative and diagnostic accuracy of PET images of patients with non-lesional epilepsy (NLE).Nine healthy volunteers and nine patients with NLE underwent 60-min dynamic list-mode (LM) scans on a fully-integrated PET/MRI system. Injected FDG activity levels were reduced virtually by randomly removing counts from the last 10-min of the LM data, so as to simulate the following activity levels: 50 %, 35 %, 20 %, and 10 % of the original activity. Four image reconstructions were evaluated: standard OSEM, OSEM with resolution recovery (PSF), the A-MAP, and the Asymmetrical Bowsher (AsymBowsher) algorithms. For the A-MAP algorithms, two weights were selected (low and high). Image contrast and noise levels were evaluated for all subjects while the lesion-to-background ratio (L/B) was only evaluated for patients. Patient images were scored by a Nuclear Medicine physician on a 5-point scale to assess clinical impression associated with the various reconstruction algorithms.The image contrast and L/B ratio characterizing all four reconstruction algorithms were similar, except for reconstructions based on only 10 % of total counts. Based on clinical impression, images with diagnostic quality can be achieved with as low as 35 % of the standard injected activity. The selection of algorithms utilizing an anatomical prior did not provide a significant advantage for clinical readings, despite a small improvement in L/B (< 5 %) using the A-MAP and AsymBowsher reconstruction algorithms.In patients with NLE who are undergoing [18F]FDG-PET/MR imaging, the injected [18F]FDG activity can be reduced to 35 % of the original dose levels without compromising.
Collapse
Affiliation(s)
- Hunor Kertész
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Otto Muzik
- Department of Radiology, Wayne State University School of Medicine, The Detroit Medical Center, Children's Hospital of Michigan, Detroit, United States
| | - Lalith Kumar Shyiam Sundar
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Soret M, Maisonobe JA, Desarnaud S, Bergeret S, Causse-Lemercier V, Berenbaum A, Rozenblum L, Habert MO, Kas A. Ultra-low-dose in brain 18F-FDG PET/MRI in clinical settings. Sci Rep 2022; 12:15341. [PMID: 36097015 PMCID: PMC9467977 DOI: 10.1038/s41598-022-18029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
We previously showed that the injected activity could be reduced to 1 MBq/kg without significantly degrading image quality for the exploration of neurocognitive disorders in 18F-FDG-PET/MRI. We now hypothesized that injected activity could be reduced ten-fold. We simulated a 18F-FDG-PET/MRI ultra-low-dose protocol (0.2 MBq/Kg, PETULD) and compared it to our reference protocol (2 MBq/Kg, PETSTD) in 50 patients with cognitive impairment. We tested the reproducibility between PETULD and PETSTD using SUVratios measurements. We also assessed the impact of PETULD for between-group comparisons and for visual analysis performed by three physicians. The intra-operator agreement between visual assessment of PETSTD and PETULD in patients with severe anomalies was substantial to almost perfect (kappa > 0.79). For patients with normal metabolism or moderate hypometabolism however, it was only moderate to substantial (kappa > 0.53). SUV ratios were strongly reproducible (SUVratio difference ± SD = 0.09 ± 0.08). Between-group comparisons yielded very similar results using either PETULD or PETSTD. 18F-FDG activity may be reduced to 0.2 MBq/Kg without compromising quantitative measurements. The visual interpretation was reproducible between ultra-low-dose and standard protocol for patients with severe hypometabolism, but less so for those with moderate hypometabolism. These results suggest that a low-dose protocol (1 MBq/Kg) should be preferred in the context of neurodegenerative disease diagnosis.
Collapse
Affiliation(s)
- Marine Soret
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France.
- Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, 75006, Paris, France.
| | - Jacques-Antoine Maisonobe
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
- Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, 75006, Paris, France
| | - Serge Desarnaud
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
| | - Sébastien Bergeret
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
| | | | - Arnaud Berenbaum
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
| | - Laura Rozenblum
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
| | - Marie-Odile Habert
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
- Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, 75006, Paris, France
- Centre d'Acquisition et Traitement des Images (CATI), Saclay, France
| | - Aurélie Kas
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, 75013, Paris, France
- Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, CNRS, INSERM, 75006, Paris, France
| |
Collapse
|
5
|
Effect of blood glucose and body weight on image quality in brain [18F]FDG PET imaging. Nucl Med Commun 2021; 41:1265-1274. [PMID: 32858605 DOI: 10.1097/mnm.0000000000001281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aims of the present study were to assess the influence of mild to moderate hyperglycaemia and body weight on brain 2-[F]fluoro-2-deoxy-D-glucose ([F]FDG) PET, and to what extent a simple algorithm for maintaining count density may compensate for these effects. METHODS We prospectively included 63 patients undergoing routine brain [F]FDG PET. Scan time and injected activity were adjusted in patients with hyperglycaemia or increased body weight. Measures of perceived image quality, image noise and image contrast were obtained in both standard scans and intervention scans. RESULTS Elevated blood glucose and increased body weight were associated with reduced count density and increased image noise that in turn were associated with lower scores of perceived image quality. The proposed simple algorithm effectively maintained the image noise level and improved perceived image quality across the full range of elevated blood glucose values and body weights, although the effect of intervention on perceived image quality was attenuated by lower image contrast in patients with moderate hyperglycaemia. In patients with increased body weight or blood glucose, the fraction of scans with poor image quality decreased from 9/29 to 2/29 (P = 0.04) and the fraction with good image quality increased from 7/29 to 20/29 (P = 0.001) when applying the proposed algorithm. CONCLUSIONS Increasing blood glucose and body weight are associated with increased image noise in standard imaging conditions. Improving count density by prolonging scan time and increasing injected activity significantly improves image quality in hyperglycaemic patients, although the image contrast remains reduced in patients with most pronounced hyperglycaemia.
Collapse
|
6
|
Soret M, Maisonobe JA, Payen S, Gaubert A, Brunel S, Rozemblum L, Hubert E, Kas A. Radiation dose of nuclear medicine technicians performing PET/MR. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:861-866. [PMID: 32590378 DOI: 10.1088/1361-6498/aba082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Since october 2015, PET/MR has been used extensively for clinical routine in the nuclear medicine department of the Pitié-Salpêtrière Hospital (Paris, France) with a throughput of 11 to 15 patients each day. While many studies have been conducted to investigate dose reduction strategies to patients with hybrid PET/MR devices, no study has focused on staff radiation safety. Knowing that patient positioning within the scanner takes longer in PET/MR than in PET/CT because of the placement of several local MR receive coils, a retrospective study was carried out to measure the radiation doses to nuclear medicine technologists from the patient. The analysis was conducted during one year on 1332 clinical PET/MR studies performed with the Signa PET/MR system (General Electric Healthcare) in our department. The whole-body exposure of the technologist staff was on average for all PET/MR exams10.3 ± 4 nSv per injected MBq of 18 F. When performing brain PET/MR exams only, the whole-body exposure was on average 8.7 ± 2 nSv per injected MBq of 18 F. Brain PET/MR provides lower radiation dose than whole-body examinations for cancer screening due to a lower injected activity (2 vs. 3 MBq kg-1) and shorter patient positioning (5 vs. 15 min). When starting PET/MR in a nuclear medicine department, an important step is to optimise patient positionning within the scanner to minimise radiation dose received by the technical staff from patients.
Collapse
Affiliation(s)
- Marine Soret
- AP-HP, Hôpital Pitié-Salpêtrière, Médecine Nucléaire, Paris F-75013 France. CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, Paris F-75006 France
| | | | | | | | | | | | | | | |
Collapse
|