Clinical evaluation of data-driven respiratory gating for PET/CT in an oncological cohort of 149 patients: impact on image quality and patient management

Objectives: To evaluate the impact of fully automatic motion correction by data-driven respiratory gating (DDG) on positron emission tomography (PET) image quality, lesion detection and patient management. Materials and Methods: A total of 149 patients undergoing PET/CT for cancer (re-)staging were retrospectively included. Patients underwent a PET/CT on a digital detector scanner and for every patient a PET data set where DDG was enabled (PETDDG) and as well as where DDG was not enabled (PETnonDDG) was reconstructed. All PET data sets were evaluated by two readers which rated the general image quality, motion effects and organ contours. Further, both readers reviewed all scans on a case-by-case basis and evaluated the impact of PETDDG on additional apparent lesion, change of report, and change of management. Results: In 85% (n = 126) of the patients, at least one bed position was acquired using DDG, resulting in mean scan time increase of 4:37 min per patient in the whole study cohort (n = 149). General image quality was not rated differently for PETnonDDG and PETDDG images (p = 1.000) while motion effects (i.e. indicating general blurring) was rated significantly lower in PETDDG images and organ contours, including liver and spleen, were rated significantly sharper using PETDDG as compared to PETnonDDG (all p < 0.001). In 27% of patients, PETDDG resulted in a change of the report and in a total of 12 cases (8%), PETDDG resulted in a change of further clinical management. Conclusion: Deviceless DDG provided reliable fully automatic motion correction in clinical routine and increased lesion detectability and changed management in a considerable number of patients. Advances in knowledge: DDG enables PET/CT with respiratory gating to be used routinely in clinical practice without external gating equipment needed.

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The impact of data-driven respiratory gating in clinical F-18 FDG PET/CT: comparison of free breathing and deep-expiration breath-hold CT protocol

Annals of Nuclear Medicine ◽

10.1007/s12149-020-01574-4 ◽

2021 ◽

Vol 35 (3) ◽

pp. 328-337

Author(s):

Seo Young Kang ◽

Byung Seok Moon ◽

Hye Ok Kim ◽

Hai-Jeon Yoon ◽

Bom Sahn Kim

Keyword(s):

Fdg Pet ◽

Respiratory Gating ◽

Free Breathing ◽

Data Driven ◽

Breath Hold ◽

Pet Ct ◽

Ct Protocol ◽

Fdg Pet Ct ◽

The Impact

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Data-driven gated PET/CT: implications for lesion segmentation and quantitation

EJNMMI Physics ◽

10.1186/s40658-021-00411-5 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

M. Allan Thomas ◽

Tinsu Pan

Keyword(s):

Motion Correction ◽

Data Driven ◽

Lesion Volume ◽

Lesion Segmentation ◽

Body Contour ◽

Pet Ct ◽

Pet Quantitation ◽

Cine Ct ◽

Ct Data ◽

The Impact

Abstract Background Data-driven gating (DDG) can improve PET quantitation and alleviate many issues with patient motion. However, misregistration between DDG-PET and CT may occur due to the distinct temporal resolutions of PET and CT and can be mitigated by DDG-CT. Here, the effects of misregistration and respiratory motion on PET quantitation and lesion segmentation were assessed with a new DDG-PET/CT method. Methods A low-dose cine-CT was acquired in misregistered regions to enable both average CT (ACT) and DDG-CT. The following were compared: (1) baseline PET/CT, (2) PET/ACT (attenuation correction, AC = ACT), (3) DDG-PET (AC = helical CT), and (4) DDG-PET/CT (AC = DDG-CT). For DDG-PET, end-expiration (EE) data were derived from 50% of the total PET data at 30% from end-inspiration. For DDG-CT, EE phase CT data were extracted from cine-CT data by lung Hounsfield unit (HU) value and body contour. A total of 91 lesions from 16 consecutive patients were assessed for changes in standard uptake value (SUV), lesion glycolysis (LG), lesion volume, centroid-to-centroid distance (CCD), and DICE coefficients. Results Relative to baseline PET/CT, median changes in SUVmax ± σ for all 91 lesions were 20 ± 43%, 26 ± 23%, and 66 ± 66%, respectively, for PET/ACT, DDG-PET, and DDG-PET/CT. Median changes in lesion volume were 0 ± 58%, − 36 ± 26%, and − 26 ± 40%. LG for individual lesions increased for PET/ACT and decreased for DDG-PET, but was not different for DDG-PET/CT. Changes in mean HU from baseline PET/CT were dramatic for most lesions in both PET/ACT and DDG-PET/CT, especially for lesions with mean HU < 0 at baseline. CCD and DICE were both affected more by motion correction with DDG-PET than improved registration with ACT or DDG-CT. Conclusion As misregistration becomes more prominent, the impact of motion correction with DDG-PET is diminished. The potential benefits of DDG-PET toward accurate lesion segmentation and quantitation could only be fully realized when combined with DDG-CT. These results impress upon the necessity of ensuring both misregistration and motion correction are accounted for together to optimize the clinical utility of PET/CT.

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Impact of PET data driven respiratory motion correction and BSREM reconstruction of 68Ga-DOTATATE PET/CT for differentiating neuroendocrine tumors (NET) and intrapancreatic accessory spleens (IPAS)

Scientific Reports ◽

10.1038/s41598-020-80855-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Virginia Liberini ◽

Fotis Kotasidis ◽

Valerie Treyer ◽

Michael Messerli ◽

Erika Orita ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Motion Correction ◽

Accessory Spleen ◽

Pancreatic Neuroendocrine Tumor ◽

Reconstruction Algorithm ◽

Data Driven ◽

Operating Characteristics ◽

Quantitative Pet ◽

Pet Ct ◽

Accessory Spleens

AbstractTo evaluate whether quantitative PET parameters of motion-corrected 68Ga-DOTATATE PET/CT can differentiate between intrapancreatic accessory spleens (IPAS) and pancreatic neuroendocrine tumor (pNET). A total of 498 consecutive patients with neuroendocrine tumors (NET) who underwent 68Ga-DOTATATE PET/CT between March 2017 and July 2019 were retrospectively analyzed. Subjects with accessory spleens (n = 43, thereof 7 IPAS) and pNET (n = 9) were included, resulting in a total of 45 scans. PET images were reconstructed using ordered-subsets expectation maximization (OSEM) and a fully convergent iterative image reconstruction algorithm with β-values of 1000 (BSREM1000). A data-driven gating (DDG) technique (MOTIONFREE, GE Healthcare) was applied to extract respiratory triggers and use them for PET motion correction within both reconstructions. PET parameters among different samples were compared using non-parametric tests. Receiver operating characteristics (ROC) analyzed the ability of PET parameters to differentiate IPAS and pNETs. SUVmax was able to distinguish pNET from accessory spleens and IPAs in BSREM1000 reconstructions (p < 0.05). This result was more reliable using DDG-based motion correction (p < 0.003) and was achieved in both OSEM and BSREM1000 reconstructions. For differentiating accessory spleens and pNETs with specificity 100%, the ROC analysis yielded an AUC of 0.742 (sensitivity 56%)/0.765 (sensitivity 56%)/0.846 (sensitivity 62%)/0.840 (sensitivity 63%) for SUVmax 36.7/41.9/36.9/41.7 in OSEM/BSREM1000/OSEM + DDG/BSREM1000 + DDG, respectively. BSREM1000 + DDG can accurately differentiate pNET from accessory spleen. Both BSREM1000 and DDG lead to a significant SUV increase compared to OSEM and non-motion-corrected data.

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Evaluation of a Novel Elastic Respiratory Motion Correction Algorithm on Quantification and Image Quality in Abdominothoracic PET/CT

Journal of Nuclear Medicine ◽

10.2967/jnumed.118.213884 ◽

2018 ◽

Vol 60 (2) ◽

pp. 279-284 ◽

Cited By ~ 3

Author(s):

Joseph G. Meier ◽

Carol C. Wu ◽

Sonia L. Betancourt Cuellar ◽

Mylene T. Truong ◽

Jeremy J. Erasmus ◽

...

Keyword(s):

Image Quality ◽

Motion Correction ◽

Respiratory Motion ◽

Correction Algorithm ◽

Respiratory Motion Correction ◽

Pet Ct

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Respiratory Gating and the Performance of PET/CT in Pulmonary Lesions

Current Radiopharmaceuticals ◽

10.2174/1874471013666200317144629 ◽

2020 ◽

Vol 13 (3) ◽

pp. 218-227

Author(s):

Cinzia Crivellaro ◽

Luca Guerra

Keyword(s):

Lung Cancer ◽

New Technologies ◽

Respiratory Gating ◽

Motion Artifacts ◽

Radiotherapy Planning ◽

Acquisition Time ◽

Lung Lesions ◽

Gated Pet ◽

Pet Ct ◽

The Impact

Background: Motion artifacts related to the patient’s breathing can be the cause of underestimation of the lesion uptake and can lead to missing of small lung lesions. The respiratory gating (RG) technology has demonstrated a significant increase in image quality. Objective: The aim of this paper was to evaluate the advantages of RG technique on PET/CT performance in lung lesions. The impact of 4D-PET/CT on diagnosis (metabolic characterization), staging and re-staging lung cancer was also assessed, including its application for radiotherapy planning. Finally, new technologies for respiratory motion management were also discussed. Methods: A comprehensive electronic search of the literature was performed by using Medline database (PubMed) searching “PET/CT”, “gated” and “lung”. Original articles, review articles, and editorials published in the last 10 years were selected, included and critically reviewed in order to select relevant articles. Results: Many papers compared Standardized Uptake Value (SUV) in gated and ungated PET studies showing an increase in SUV of gated images, particularly for the small lesions located in medium and lower lung. In addition, other features as Metabolic Tumor Volume (MTV), Total Lesion Glycolysis (TLG) and textural-features presented differences when obtained from gated and ungated PET acquisitions. Besides the increase in quantification, gating techniques can determine an increase in the diagnostic accuracy of PET/CT. Gated PET/CT was evaluated for lung cancer staging, therapy response assessment and for radiation therapy planning. Conclusion: New technologies able to track the motion of organs lesion directly from raw PET data, can reduce or definitively solve problems (i.e.: extended acquisition time, radiation exposure) currently limiting the use of gated PET/CT in clinical routine.

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Impact of total variation regularized expectation maximization reconstruction on the image quality of 68Ga-PSMA PET: a phantom and patient study

British Journal of Radiology ◽

10.1259/bjr.20201356 ◽

2021 ◽

pp. 20201356

Author(s):

Feng-Jiao Yang ◽

Shu-Yue Ai ◽

Runze Wu ◽

Yang Lv ◽

Hui-Fang Xie ◽

...

Keyword(s):

Prostate Cancer ◽

Image Quality ◽

Total Variation ◽

Expectation Maximization ◽

Image Noise ◽

Psma Pet ◽

Pet Ct ◽

Digital Pet ◽

The Impact

Objectives: To investigate the impact of total variation regularized expectation maximization (TVREM) reconstruction on the image quality of 68Ga-PSMA-11 PET/CT using phantom and patient data. Methods: Images of a phantom with small hot sphere inserts and 20 prostate cancer patients were acquired with a digital PET/CT using list-mode and reconstructed with ordered subset expectation maximization (OSEM) and TVREM with seven penalisation factors between 0.01 and 0.42 for 2 and 3 minutes-per-bed (m/b) acquisition. The contrast recovery (CR) and background variability (BV) of the phantom, image noise of the liver, and SUVmax of the lesions were measured. Qualitative image quality was scored by two radiologists using a 5-point scale (1-poor, 5-excellent). Results: The performance of CR, BV, and image noise, and the gain of SUVmax was higher for TVREM 2 m/b groups with the penalization of 0.07 to 0.28 compared to OSEM 3 m/b group (all p < 0.05). The image noise of OSEM 3 m/b group was equivalent to TVREM 2 and 3 m/b groups with a penalization of 0.14 and 0.07, while lesions’ SUVmax increased 15 and 20%. The highest qualitative score was attained at the penalization of 0.21 (3.30 ± 0.66) for TVREM 2 m/b groups and the penalization 0.14 (3.80 ± 0.41) for 3 m/b group that equal to or greater than OSEM 3 m/b group (2.90 ± 0.45, p = 0.2 and p < 0.001). Conclusions: TVREM improves lesion contrast and reduces image noise, which allows shorter acquisition with preserved image quality for PSMA PET/CT. Advances in knowledge: TVREM reconstruction with optimized penalization factors can generate higher quality PSMA-PET images for prostate cancer diagnosis.

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Different preprocessing strategies lead to different conclusions: A [11C]DASB-PET reproducibility study

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x19880450 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1902-1911

Author(s):

Martin Nørgaard ◽

Melanie Ganz ◽

Claus Svarer ◽

Vibe G Frokjaer ◽

Douglas N Greve ◽

...

Keyword(s):

Motion Correction ◽

Positive Association ◽

Sequential Data ◽

Double Blind ◽

Data Set ◽

Reproducibility Study ◽

Positron Emission ◽

The Impact ◽

Data Analytic

Positron emission tomography (PET) neuroimaging provides unique possibilities to study biological processes in vivo under basal and interventional conditions. For quantification of PET data, researchers commonly apply different arrays of sequential data analytic methods (“preprocessing pipeline”), but it is often unknown how the choice of preprocessing affects the final outcome. Here, we use an available data set from a double-blind, randomized, placebo-controlled [11C]DASB-PET study as a case to evaluate how the choice of preprocessing affects the outcome of the study. We tested the impact of 384 commonly used preprocessing strategies on a previously reported positive association between the change from baseline in neocortical serotonin transporter binding determined with [11C]DASB-PET, and change in depressive symptoms, following a pharmacological sex hormone manipulation intervention in 30 women. The two preprocessing steps that were most critical for the outcome were motion correction and kinetic modeling of the dynamic PET data. We found that 36% of the applied preprocessing strategies replicated the originally reported finding ( p < 0.05). For preprocessing strategies with motion correction, the replication percentage was 72%, whereas it was 0% for strategies without motion correction. In conclusion, the choice of preprocessing strategy can have a major impact on a study outcome.

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