Monte Carlo estimation of scatter effects on quantitative myocardial blood flow and perfusable tissue fraction using 3D-PET and15O-water

Improvement in the estimation of perfusable tissue fraction and myocardial flow reserve in the ischemic myocardial lesions using ECG-gated dynamic myocardial PET with 15O-water

OBJECTIVE

Perfusable tissue fraction (PTF) and myocardial flow reserve (MFR) from 15O-water dynamic positron emission tomography (PET) are parameters of myocardial viability. However, myocardial motion causes errors in these values. We aimed to develop accurate estimation of PTF and MFR in ischemic lesions using an electro-cardiogram (ECG)-gated dynamic myocardial PET with 15O-water.

METHODS

Twenty-seven patients with ischemic heart disease were enrolled. All patients underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). List mode 3D PET data and ECG signals were acquired using Philips Gemini TF64 instrument. For each scan, 500 MBq of 15O-water was infused slowly for 2 min, and the dynamic data were scanned for 6 min. Both non-gated dynamic images and ECG-gated diastolic dynamic images were reconstructed. On the myocardial PET images of each patient, the entire myocardial region of interest (ROI) was set and divided into 17 segments. Myocardial blood flow in the resting state (rest MBF), hyperemic state (stress MBF), PTF, and MFR in each segment were estimated from both non-gated and ECG-gated dynamic PET images. Coronary arteriograms were obtained for all patients. In total, 128 normal segments without stenosis and 50 ischemic segments with > 90% stenosis were evaluated.

RESULTS

In the ischemic myocardial segments, the PTF with ECG-gated PET was estimated as significantly lower than that with non-gated PET (0.63 ± 0.09 vs. 0.72 ± 0.08 [mL/mL], p < 0.001). The ECG-gated PET estimated a significantly lower PTF in the ischemic segments than in the normal segments (0.63 ± 0.09 vs. 0.67 ± 0.07 [mL/mL], p < 0.01). In the normal segments, the ECG-gated PET detected no significant difference in MFR compared with those from the non-gated PET (2.15 ± 0.76 vs. 2.24 ± 0.79, p = 0.28). However, in the ischemic myocardial segments, the MFR with ECG-gated PET was estimated as significantly lower than that with the non-gated PET (1.23 ± 0.29 vs. 1.69 ± 0.71, p < 0.001). The ECG-gated PET presented a significantly higher inter-observer reproducibility of PTF and rest MBF than the non-gated PET (p < 0.01). Neither stress MBF nor MFR yielded significant differences in inter-observer reproducibility between the ECG-gated and non-gated PET.

CONCLUSIONS

The ECG-gated dynamic 15O-water PET suppressed the myocardial motion effect and resulted in a lower PTF and MFR in ischemic myocardial lesions than the non-gated PET. The ECG-gated PET seemed to be better than the conventional non-gated dynamic PET for the detection of ischemic myocardial lesion.

Influences of 3D PET scanner components on increased scatter evaluated by a Monte Carlo simulation

Monte Carlo simulation is widely applied to evaluate the performance of three-dimensional positron emission tomography (3D-PET). For accurate scatter simulations, all components that generate scatter need to be taken into account. The aim of this work was to identify the components that influence scatter. The simulated geometries of a PET scanner were: a precisely reproduced configuration including all of the components; a configuration with the bed, the tunnel and shields; a configuration with the bed and shields; and the simplest geometry with only the bed. We measured and simulated the scatter fraction using two different set-ups: (1) as prescribed by NEMA-NU 2007 and (2) a similar set-up but with a shorter line source, so that all activity was contained only inside the field-of-view (FOV), in order to reduce influences of components outside the FOV. The scatter fractions for the two experimental set-ups were, respectively, 45% and 38%. Regarding the geometrical configurations, the former two configurations gave simulation results in good agreement with the experimental results, but simulation results of the simplest geometry were significantly different at the edge of the FOV. From the simulation of the precise configuration, the object (scatter phantom) was the source of more than 90% of the scatter. This was also confirmed by visualization of photon trajectories. Then, the bed and the tunnel were mainly the sources of the rest of the scatter. From the simulation results, we concluded that the precise construction was not needed; the shields, the tunnel, the bed and the object were sufficient for accurate scatter simulations.

Compartment modeling of dynamic brain PET--the impact of scatter corrections on parameter errors

PURPOSE

The aim of this study was to investigate the effect of scatter and its correction on kinetic parameters in dynamic brain positron emission tomography (PET) tumor imaging. The 2-tissue compartment model was used, and two different reconstruction methods and two scatter correction (SC) schemes were investigated.

METHODS

The gate Monte Carlo (MC) software was used to perform 2 × 15 full PET scan simulations of a voxelized head phantom with inserted tumor regions. The two sets of kinetic parameters of all tissues were chosen to represent the 2-tissue compartment model for the tracer 3'-deoxy-3'-((18)F)fluorothymidine (FLT), and were denoted FLT1 and FLT2. PET data were reconstructed with both 3D filtered back-projection with reprojection (3DRP) and 3D ordered-subset expectation maximization (OSEM). Images including true coincidences with attenuation correction (AC) and true+scattered coincidences with AC and with and without one of two applied SC schemes were reconstructed. Kinetic parameters were estimated by weighted nonlinear least squares fitting of image derived time-activity curves. Calculated parameters were compared to the true input to the MC simulations.

RESULTS

The relative parameter biases for scatter-eliminated data were 15%, 16%, 4%, 30%, 9%, and 7% (FLT1) and 13%, 6%, 1%, 46%, 12%, and 8% (FLT2) for K1, k2, k3, k4, Va, and Ki, respectively. As expected, SC was essential for most parameters since omitting it increased biases by 10 percentage points on average. SC was not found necessary for the estimation of Ki and k3, however. There was no significant difference in parameter biases between the two investigated SC schemes or from parameter biases from scatter-eliminated PET data. Furthermore, neither 3DRP nor OSEM yielded the smallest parameter biases consistently although there was a slight favor for 3DRP which produced less biased k3 and Ki estimates while OSEM resulted in a less biased Va. The uncertainty in OSEM parameters was about 26% (FLT1) and 12% (FLT2) larger than for 3DRP although identical postfilters were applied.

CONCLUSIONS

SC was important for good parameter estimations. Both investigated SC schemes performed equally well on average and properly corrected for the scattered radiation, without introducing further bias. Furthermore, 3DRP was slightly favorable over OSEM in terms of kinetic parameter biases and SDs.