Performance evaluation of the PennPET explorer with expanded axial coverage

Nonmaximal entanglement of photons from positron-electron annihilation demonstrated using a plastic PET scanner

In state-of-the-art positron emission tomography (PET), information about annihilation photon polarization is unavailable. Here, we present a PET scanner built from plastic scintillators, where annihilation photons primarily interact via the Compton effect, providing information about both photon polarization and propagation direction. Using this plastic-based PET, we determined the distribution of the relative angle between polarization planes of photons from positron-electron annihilation in a porous polymer. The amplitude of the observed distribution is smaller than predicted for maximally quantum entangled two-photon states but larger than expected for separable photons. This result can be well explained by assuming that photons from pick-off annihilation are not entangled, while photons from direct and parapositronium annihilations are maximally entangled. Our result indicates that the degree of entanglement depends on the annihilation mechanism in matter, opening avenues for exploring polarization correlations in PET as a diagnostic indicator.

The development of a PET radiotracer for imaging alpha synuclein aggregates in Parkinson's disease

M503-1619 was identified as a promising ligand for positron emission tomography (PET) imaging of α-synuclein (α-Syn) pathology in Parkinson's disease (PD). An exemplar for binding site 9 (residues GLY-86, ILE-88, PHE-94 and LYS-96) of α-Syn fibrils was generated. An in silico ultrahigh throughput screening campaign was conducted using a 42 million compound library. Secondary in silico methods followed by visual inspection were used to select 6 compounds as candidates for in vitro binding studies. M503-1619 was found to have a high binding affinity (K i = 6.5 nM versus the site 9 radioligand [3H]BF-2846) to α-Syn fibrils and low affinity for beta amyloid (K i = 390 nM versus [3H]PiB) in competition binding assays. Saturation binding assays of [3H]M503-1619 in human tissues confirmed its high affinity to α-Syn (PD tissue, K D = 2.5 nM; Alzheimer's disease tissue, K D = 37 nM; progressive supranuclear palsy tissue, K D = 55 nM). Autoradiography studies demonstrated a higher binding of this radioligand in PD brain sections than in multiple system atrophy brain sections. PET studies with [11C]M503-1619 showed high brain uptake and rapid washout (whole brain peak to 60 min ratio = 3.2) in non-human primates. The results of this study suggest that [11C]M503-1619 is a lead compound for radiotracer development imaging α-Syn with PET.

Pharmacokinetic effects of a single-dose nutritional ketone ester supplement on brain glucose and ketone metabolism in alcohol use disorder

Acute alcohol intake decreases brain glucose metabolism and increases brain uptake of acetate, a metabolite of alcohol. This shift in energy utilization persists beyond acute intoxication in individuals with alcohol use disorder (AUD), and may contribute to alcohol craving. We recently found that ketone therapies decrease alcohol withdrawal and alcohol craving in AUD. Here, we studied the effects of a single-dose ketone ester (KE) supplement on brain energy metabolism and alcohol craving. Five AUD and five healthy control (HC) participants underwent two 18 F-fluorodeoxyglucose positron emission tomography (PET) scans, after consumption of 395 mg/kg KE or without (baseline), in randomized order. In the AUD group, KE reduced alcohol craving scores compared to baseline. KE decreased blood glucose levels and elevated blood β-hydroxybutyrate (BHB) levels compared to baseline in both groups. Whole-brain voxel-wise maps of the cerebral metabolic rate of glucose (CMRglc) decreased by 17% in both groups, with the largest KE-induced CMRglc reductions in the frontal, occipital, and cingulate cortices, hippocampus, amygdala, and insula. There were no group differences between AUD and HC in blood or FDG measures, and no correlations between reductions in craving with CMRglc. Cingulate BHB levels, as assessed with 1 H-magnetic resonance spectroscopy in 5 participant with AUD, increased 3-fold with KE compared to baseleline. In sum, administration of a single dose of KE rapidly shifted brain energetics from glucose to ketone metabolism in HC and AUD. KE also reduced ratings of alcohol craving, demonstrating its potential clinical effectiveness for supporting brain health and alcohol craving in AUD.

Total-Body PET System Designs with Axial and Transverse Gaps: A Study of Lesion Quantification and Detectability

High-sensitivity total-body PET enables faster scans, lower doses, and dynamic multiorgan imaging. However, the higher system cost of a scanner with a long axial field of view (AFOV) hinders its wider application. This paper investigates the impact on the lesion quantification and detectability of cost-effective total-body PET sparse designs. Methods: Using the PennPET Explorer (PPEx) as a model, 3 sparse configurations with the same 142-cm AFOV were considered, including designs with only axial gaps (AGs), only transverse gaps (TGs), and a mixture of AGs and TGs (MG), with retained detector fractions (DFs) ranging from 71% to 40%. Human data from the PPEx were used to emulate sparse designs by discarding lines of response as a proxy for missing detectors. We embedded lesion events in the resultant list data with varying uptakes in the lung and liver before reconstruction. A generalized scan statistics methodology was used to measure lesion detectability and quantification as a function of lesion uptake and scan duration. Results: Relative to a fully populated system, an AG design with 71% performs well but is susceptible to image artifacts as the DF decreases to 58%. A TG design performs well with a DF of 58% but requires twice the scan time to achieve similar lesion detectability and is susceptible to transverse field-of-view truncation below 60 cm as the DF is further decreased. An MG design with a DF of 58% requires 3 times the scan time to achieve similar lesion detectability, and with no evidence of artifacts even as the DF is decreased to 40%. Conclusion: Sparse designs with artifact-free images can provide comparable lesion quantification and detectability to the fully populated PPEx after compensating for the reduced sensitivity with increased scan time. Because an AG design is more susceptible to image artifacts with a lower DF, a system with only AGs is not an optimal choice for dramatic cost reduction. A TG design provides a higher relative sensitivity than AG or MG designs for a given DF, leading to a shorter scan time to achieve comparable lesion detectability. However, the increased truncation of the transverse field of view with decreasing DF limits this design choice. An MG design allows for the greatest cost reduction (lowest DF) if the scan duration is increased to compensate for the higher loss in sensitivity. Sparse designs of PET with a long AFOV provide a technologic solution for introducing such systems at reduced cost into routine clinical use.

Total-Body PET/CT: Challenges and Opportunities

Long-axial field-of-view (LAFOV) systems have changed the field of molecular imaging. Since their introduction, many PET centers have installed these next-generation digital systems to provide more detailed imaging and acquire PET images in a single bed position. Indeed, vertex to thigh imaging for oncological indications can be obtained in most of the population with the currently available LAFOV systems. Moreover, Total Body (TB) PET, a subtype of LAFOV, enables imaging the entire patient-from vertex through the toes-with one bed-position for most of the population. This review aims to identify possible challenges and opportunities for PET-centers working with TB and LAFOV systems. Emphasis is placed on the strength and weaknesses in clinical routine of currently available and upcoming TB and LAFOV PET systems.

Total Body PET/CT: Clinical Value and Future Aspects of Quantification in Static and Dynamic Imaging

Total body (TB) Positron Emission Tomography (PET) / Computed Tomography (CT) scanners have revolutionized nuclear medicine by enabling whole-body imaging in a single bed position.1 This review assesses the physical and clinical value of TB-PET/CT, with a focus on the advancements in both static and dynamic imaging, as well as the evolving quantification techniques. The significantly enhanced sensitivity of TB scanners can reduce radiation exposure and scan time, offering improved patient comfort and making it particularly useful for pediatric imaging and various other scenarios. Shorter scan times also decrease motion artifacts, leading to higher-quality images and better diagnostic accuracy. Dynamic PET imaging with TB scanners extends these advantages by capturing temporal changes in tracer uptake over time, providing real-time insights into both structural and functional assessment, and promoting the ability to monitor disease progression and treatment response. We also present CT-free attenuation correction methods that utilize the increased sensitivity of TB-PET as a potential improvement for dynamic TB-PET protocols. In static imaging, emerging quantification techniques such as dual-tracer PET using TB scanners allow imaging of two biological pathways, simultaneously, for a more comprehensive assessment of disease. In addition, positronium imaging, a novel technique utilizing positronium lifetime measurements, is introduced as a promising aspect for providing structural information alongside functional quantification. Finally, the potential of expanding clinical applications with the increased sensitivity of TB-PET/CT scanners is discussed.

Performance Characteristics of a New Generation 148-cm Axial Field-of-View uMI Panorama GS PET/CT System with Extended NEMA NU 2-2018 and EARL Standards

The uMI Panorama GS PET/CT system is a new long-axial-field-of-view scanner featuring high sensitivity, time-of-flight (TOF) resolution, spatial resolution, and count rate performance. The aim of this study is to assess the PET system on the basis of the National Electrical Manufacturers Association (NEMA) NU 2-2018 and European Association of Nuclear Medicine Research Limited (EARL) standards. Methods: Spatial resolution, count rate performance, sensitivity, accuracy, image quality, TOF resolution, and coregistration accuracy were evaluated following the NEMA NU 2-2018 standard. Additional experiments included energy resolution, 200-cm-long line sources for sensitivity, a 175-cm-long scatter phantom for count rate and TOF resolution, as well as the compliance with the EARL guideline. Moreover, an 18F-FDG PET patient study was reconstructed with various frame durations. Results: The PET system achieved sub-3-mm transaxial and axial spatial resolutions at a 1-cm radial offset. The sensitivities with the 70-cm-long and 200-cm-long line sources were observed to be 176.3 and 90.8 kcps/MBq, respectively, at the center of the field of view. The noise-equivalent count rates (NECRs) of the 70-cm-long and 175-cm-long scatter phantoms were measured to be 3.35 Mcps at 57.57 kBq/mL and 2.24 Mcps at 33.27 kBq/mL, respectively. The TOF resolutions for both phantoms were approximately 189 ps at 5.3 kBq/mL and lower than 200 ps below the NECR peaks. The absolute count rate errors of all 34 acquisitions were less than 3% below the NECR peak for the 70-cm-long scatter phantom. With the standard NEMA image quality phantom experiment, the contrast recovery coefficient varied from 68.17% to 94.20% and the background variabilities were all below 2%. The maximum PET/CT coregistration error was 1.33 mm. Regarding EARL compliance, the gaussian filter of 5-mm full width at half maximum could produce acceptable images. The patient data demonstrate visually satisfactory image quality with short frames (less than 1 min). Conclusion: The uMI Panorama GS exhibits spatial resolution and TOF resolution similar to those of the uMI Panorama system (35-cm axial field of view), despite the extended axial field of view. The 148-cm axial coverage, sub-200-ps TOF resolution, high sensitivity, and count rate performances are expected to yield superior image quality and offer new opportunities for various clinical applications.

Positronium image of the human brain in vivo

Positronium is abundantly produced within the molecular voids of a patient's body during positron emission tomography (PET). Its properties dynamically respond to the submolecular architecture of the tissue and the partial pressure of oxygen. Current PET systems record only two annihilation photons and cannot provide information about the positronium lifetime. This study presents the in vivo images of positronium lifetime in a human, for a patient with a glioblastoma brain tumor, by using the dedicated Jagiellonian PET system enabling simultaneous detection of annihilation photons and prompt gamma emitted by a radionuclide. The prompt gamma provides information on the time of positronium formation. The photons from positronium annihilation are used to reconstruct the place and time of its decay. In the presented case study, the determined positron and positronium lifetimes in glioblastoma cells are shorter than those in salivary glands and those in healthy brain tissues, indicating that positronium imaging could be used to diagnose disease in vivo.

Transformer-CNN hybrid network for improving PET time of flight prediction

Objective.In positron emission tomography (PET) reconstruction, the integration of time-of-flight (TOF) information, known as TOF-PET, has been a major research focus. Compared to traditional reconstruction methods, the introduction of TOF enhances the signal-to-noise ratio of images. Precision in TOF is measured by full width at half maximum (FWHM) and the offset from ground truth, referred to as coincidence time resolution (CTR) and bias.Approach.This study proposes a network combining transformer and convolutional neural network (CNN) to utilize TOF information from detector waveforms, using event waveform pairs as inputs. This approach integrates the global self-attention mechanism of Transformer, which focuses on temporal relationships, with the local receptive field of CNN. The combination of global and local information allows the network to assign greater weight to the rising edges of waveforms, thereby extracting valuable temporal information for precise TOF predictions. Experiments were conducted using lutetium yttrium oxyorthosilicate (LYSO) scintillators and silicon photomultiplier (SiPM) detectors. The network was trained and tested using the waveform datasets after cropping.Main results.Compared to the constant fraction discriminator (CFD), CNN, CNN with attention, long short-term memory (LSTM) and Transformer, our network achieved an average CTR of 189 ps, reducing it by 82 ps (more than 30%), 13 ps (6.4%), 12 ps (6.0%), 16 ps (7.8%) and 9 ps (4.6%), respectively. Additionally, a reduction of 10.3, 8.7, 6.7 and 4 ps in average bias was achieved compared to CNN, CNN with attention, LSTM and Transformer.Significance.This work demonstrates the potential of applying the Transformer for PET TOF estimation using real experimental data. Through the integration of both CNN and Transformer with local and global attention, it achieves optimal performance, thereby presenting a novel direction for future research in this field.

Performance and application of the total-body PET/CT scanner: a literature review

BACKGROUND

The total-body positron emission tomography/computed tomography (PET/CT) system, with a long axial field of view, represents the state-of-the-art PET imaging technique. Recently, the total-body PET/CT system has been commercially available. The total-body PET/CT system enables high-resolution whole-body imaging, even under extreme conditions such as ultra-low dose, extremely fast imaging speed, delayed imaging more than 10 h after tracer injection, and total-body dynamic scan. The total-body PET/CT system provides a real-time picture of the tracers of all organs across the body, which not only helps to explain normal human physiological process, but also facilitates the comprehensive assessment of systemic diseases. In addition, the total-body PET/CT system may play critical roles in other medical fields, including cancer imaging, drug development and immunology.

MAIN BODY

Therefore, it is of significance to summarize the existing studies of the total-body PET/CT systems and point out its future direction. This review collected research literatures from the PubMed database since the advent of commercially available total-body PET/CT systems to the present, and was divided into the following sections: Firstly, a brief introduction to the total-body PET/CT system was presented, followed by a summary of the literature on the performance evaluation of the total-body PET/CT. Then, the research and clinical applications of the total-body PET/CT were discussed. Fourthly, deep learning studies based on total-body PET imaging was reviewed. At last, the shortcomings of existing research and future directions for the total-body PET/CT were discussed.

CONCLUSION

Due to its technical advantages, the total-body PET/CT system is bound to play a greater role in clinical practice in the future.

Phantom study for 90Y liver radioembolization dosimetry with a long axial field-of-view PET/CT

PURPOSE

The physical properties of yttrium-90 (90Y) allow for imaging with positron emission tomography/computed tomography (PET/CT). The increased sensitivity of long axial field-of-view (LAFOV) PET/CT scanners possibly allows to overcome the small branching ratio for positron production from 90Y decays and to improve for the post-treatment dosimetry of 90Y of selective internal radiation therapy.

METHODS

For the challenging case of an image quality body phantom, we compare a full Monte Carlo (MC) dose calculation with the results from the two commercial software packages Simplicit90Y and Hermes. The voxel dosimetry module of Hermes relies on the 90Y images taken with a LAFOV PET/CT, while the MC and Simplicit90Y dose calculations are image independent.

RESULTS

The resulting doses from the MC calculation and Simplicit90Y agree well within the error margins. The image-based dose calculation with Hermes, however, consistently underestimates the dose. This is due to the mismatch of the activity distribution in the PET images and the size of the volume of interest. We found that only for the smallest phantom sphere there is a statistically significant dependence of the Hermes dose on the image reconstruction parameters and scan time.

CONCLUSION

Our study shows that Simplicit90Y's local deposition model can provide a reliable dose estimate. On the other hand, the image based dose calculation suffers from the suboptimal reconstruction of the 90Y distribution in small structures.

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.

Quantitation of dynamic total-body PET imaging: recent developments and future perspectives

BACKGROUND

Positron emission tomography (PET) scanning is an important diagnostic imaging technique used in disease diagnosis, therapy planning, treatment monitoring, and medical research. The standardized uptake value (SUV) obtained at a single time frame has been widely employed in clinical practice. Well beyond this simple static measure, more detailed metabolic information can be recovered from dynamic PET scans, followed by the recovery of arterial input function and application of appropriate tracer kinetic models. Many efforts have been devoted to the development of quantitative techniques over the last couple of decades.

CHALLENGES

The advent of new-generation total-body PET scanners characterized by ultra-high sensitivity and long axial field of view, i.e., uEXPLORER (United Imaging Healthcare), PennPET Explorer (University of Pennsylvania), and Biograph Vision Quadra (Siemens Healthineers), further stimulates valuable inspiration to derive kinetics for multiple organs simultaneously. But some emerging issues also need to be addressed, e.g., the large-scale data size and organ-specific physiology. The direct implementation of classical methods for total-body PET imaging without proper validation may lead to less accurate results.

CONCLUSIONS

In this contribution, the published dynamic total-body PET datasets are outlined, and several challenges/opportunities for quantitation of such types of studies are presented. An overview of the basic equation, calculation of input function (based on blood sampling, image, population or mathematical model), and kinetic analysis encompassing parametric (compartmental model, graphical plot and spectral analysis) and non-parametric (B-spline and piece-wise basis elements) approaches is provided. The discussion mainly focuses on the feasibilities, recent developments, and future perspectives of these methodologies for a diverse-tissue environment.

Walk-through flat panel total-body PET: a patient-centered design for high throughput imaging at lower cost using DOI-capable high-resolution monolithic detectors

PURPOSE

Long axial field-of-view (LAFOV) systems have a much higher sensitivity than standard axial field-of-view (SAFOV) PET systems for imaging the torso or full body, which allows faster and/or lower dose imaging. Despite its very high sensitivity, current total-body PET (TB-PET) throughput is limited by patient handling (positioning on the bed) and often a shortage of available personnel. This factor, combined with high system costs, makes it hard to justify the implementation of these systems for many academic and nearly all routine nuclear medicine departments. We, therefore, propose a novel, cost-effective, dual flat panel TB-PET system for patients in upright standing positions to avoid the time-consuming positioning on a PET-CT table; the walk-through (WT) TB-PET. We describe a patient-centered, flat panel PET design that offers very efficient patient throughput and uses monolithic detectors (with BGO or LYSO) with depth-of-interaction (DOI) capabilities and high intrinsic spatial resolution. We compare system sensitivity, component costs, and patient throughput of the proposed WT-TB-PET to a SAFOV (= 26 cm) and a LAFOV (= 106 cm) LSO PET systems.

METHODS

Patient width, height (= top head to start of thighs) and depth (= distance from the bed to front of patient) were derived from 40 randomly selected PET-CT scans to define the design dimensions of the WT-TB-PET. We compare this new PET system to the commercially available Siemens Biograph Vision 600 (SAFOV) and Siemens Quadra (LAFOV) PET-CT in terms of component costs, system sensitivity, and patient throughput. System cost comparison was based on estimating the cost of the two main components in the PET system (Silicon Photomultipliers (SiPMs) and scintillators). Sensitivity values were determined using Gate Monte Carlo simulations. Patient throughput times (including CT and scout scan, patient positioning on bed and transfer) were recorded for 1 day on a Siemens Vision 600 PET. These timing values were then used to estimate the expected patient throughput (assuming an equal patient radiotracer injected activity to patients and considering differences in system sensitivity and time-of-flight information) for WT-TB-PET, SAFOV and LAFOV PET.

RESULTS

The WT-TB-PET is composed of two flat panels; each is 70 cm wide and 106 cm high, with a 50-cm gap between both panels. These design dimensions were justified by the patient sizes measured from the 40 random PET-CT scans. Each panel consists of 14 × 20 monolithic BGO detector blocks that are 50 × 50 × 16 mm in size and are coupled to a readout with 6 × 6 mm SiPMs arrays. For the WT-TB-PET, the detector surface is reduced by a factor of 1.9 and the scintillator volume by a factor of 2.2 compared to LAFOV PET systems, while demonstrating comparable sensitivity and much better uniform spatial resolution (< 2 mm in all directions over the FOV). The estimated component cost for the WT-TB-PET is 3.3 × lower than that of a 106 cm LAFOV system and only 20% higher than the PET component costs of a SAFOV. The estimated maximum number of patients scanned on a standard 8-h working day increases from 28 (for SAFOV) to 53-60 (for LAFOV in limited/full acceptance) to 87 (for the WT-TB-PET). By scanning faster (more patients), the amount of ordered activity per patient can be reduced drastically: the WT-TB-PET requires 66% less ordered activity per patient than a SAFOV.

CONCLUSIONS

We propose a monolithic BGO or LYSO-based WT-TB-PET system with DOI measurements that departs from the classical patient positioning on a table and allows patients to stand upright between two flat panels. The WT-TB-PET system provides a solution to achieve a much lower cost TB-PET approaching the cost of a SAFOV system. High patient throughput is increased by fast patient positioning between two vertical flat panel detectors of high sensitivity. High spatial resolution (< 2 mm) uniform over the FOV is obtained by using DOI-capable monolithic scintillators.