Jörg van den Hoff

Suitability of bilateral filtering for edge-preserving noise reduction in PET

BackgroundTo achieve an acceptable signal-to-noise ratio (SNR) in PET images, smoothing filters (SF) are usually employed during or after image reconstruction preventing utilisation of the full intrinsic resolution of the respective scanner. Quite generally Gaussian-shaped moving average filters (MAF) are used for this purpose. A potential alternative to MAF is the group of so-called bilateral filters (BF) which provide a combination of noise reduction and edge preservation thus minimising resolution deterioration of the images. We have investigated the performance of this filter type with respect to improvement of SNR, influence on spatial resolution and for derivation of SUVmax values in target structures of varying size.MethodsData of ten patients with head and neck cancer were evaluated. The patients had been investigated by routine whole body scans (ECAT EXACT HR+, Siemens, Erlangen). Tomographic images were reconstructed (OSEM 6i/16s) using a Gaussian filter (full width half maximum (FWHM): Γ0 = 4 mm). Image data were then post-processed with a Gaussian MAF (FWHM: ΓM = 7 mm) and a Gaussian BF (spatial domain: ΓS = 9 mm, intensity domain: ΓI = 2.5 SUV), respectively. Images were assessed regarding SNR as well as spatial resolution. Thirty-four lesions (volumes of about 1-100 mL) were analysed with respect to their SUVmax values in the original as well as in the MAF and BF filtered images.ResultsWith the chosen filter parameters both filters improved SNR approximately by a factor of two in comparison to the original data. Spatial resolution was significantly better in the BF-filtered images in comparison to MAF (MAF: 9.5 mm, BF: 6.8 mm). In MAF-filtered data, the SUVmax was lower by 24.1 ± 9.9% compared to the original data and showed a strong size dependency. In the BF-filtered data, the SUVmax was lower by 4.6 ± 3.7% and no size effects were observed.ConclusionBilateral filtering allows to increase the SNR of PET image data while preserving spatial resolution and preventing smoothing-induced underestimation of SUVmax values in small lesions. Bilateral filtering seems a promising and superior alternative to standard smoothing filters.

Development of 18 F-labeled radiotracers for neuroreceptor imaging with positron emission tomography

Positron emission tomography (PET) is an in vivo molecular imaging tool which is widely used in nuclear medicine for early diagnosis and treatment follow-up of many brain diseases. PET uses biomolecules as probes which are labeled with radionuclides of short half-lives, synthesized prior to the imaging studies. These probes are called radiotracers. Fluorine-18 is a radionuclide routinely used in the radiolabeling of neuroreceptor ligands for PET because of its favorable half-life of 109.8 min. The delivery of such radiotracers into the brain provides images of transport, metabolic, and neurotransmission processes on the molecular level. After a short introduction into the principles of PET, this review mainly focuses on the strategy of radiotracer development bridging from basic science to biomedical application. Successful radiotracer design as described here provides molecular probes which not only are useful for imaging of human brain diseases, but also allow molecular neuroreceptor imaging studies in various small-animal models of disease, including genetically-engineered animals. Furthermore, they provide a powerful tool for in vivo pharmacology during the process of pre-clinical drug development to identify new drug targets, to investigate pathophysiology, to discover potential drug candidates, and to evaluate the pharmacokinetics and pharmacodynamics of drugs in vivo.

Cerebral blood flow quantification in the rat: a direct comparison of arterial spin labeling MRI with radioactive microsphere PET.

BackgroundArterial spin labeling magnetic resonance imaging (ASL-MRI) has been recognised as a valuable method for non-invasive assessment of cerebral blood flow but validation studies regarding quantification accuracy by comparison against an accepted gold standard are scarce, especially in small animals. We have conducted the present study with the aim of comparing ASL flow-sensitive alternating inversion recovery (FAIR)-derived unidirectional water uptake (K1) and 68Ga/64Cu microsphere (MS)-derived blood flow (f) in the rat brain.MethodsIn 15 animals, K1and f were determined successively in dedicated small animal positron emission tomography and MR scanners. The Renkin-Crone model modified by a scaling factor was used for the quantification of f and K1.ResultsBelow about 1 mL/min/mL, we obtain an approximately linear relationship between f and K1. At higher flow values, the limited permeability of water at the blood brain barrier becomes apparent. Within the accessed dynamic flow range (0.2 to 1.9 mL/min/mL), the data are adequately described by the Renkin-Crone model yielding a permeability surface area product of (1.53±0.46) mL/min/mL.ConclusionThe ASL-FAIR technique is suitable for absolute blood flow quantification in the rat brain when using a one-compartment model including a suitable extraction correction for data evaluation.Trial registration24-9168.21-4/2004-1 (registered in Freistadt Sachsen, Landesdirektion Dresden)

Test-retest variability of lesion SUV and lesion SUR in 18F-FDG PET: an analysis of data from two prospective multicenter trials

Quantitative assessment of radio- and chemotherapy response with 18F-FDG whole-body PET has attracted increasing interest in recent years. In most published work, SUV has been used for this purpose. In the context of therapy response assessment, the reliability of lesion SUVs, notably their test–retest stability, thus becomes crucial. However, a recent study demonstrated substantial test–retest variability (TRV) in SUVs. The purpose of the present study was to investigate whether the tumor-to-blood SUV ratio (SUR) can improve TRV in tracer uptake. Methods: 73 patients with advanced non–small cell lung cancer from the prospective multicenter trials ACRIN 6678 (n = 34) and MK-0646-008 (n = 39) were included in this study. All patients underwent two 18F-FDG PET/CT investigations on two different days (time difference, 3.6 ± 2.1 d; range, 1–7 d) before therapy. For each patient, up to 7 tumor lesions were evaluated. For each lesion, SUVmax and SUVpeak were determined. Blood SUV was determined as the mean value of a 3-dimensional aortic region of interest that was delineated on the attenuation CT image and transferred to the PET image. SURs were computed as the ratio of tumor SUV to blood SUV and were uptake time–corrected to 75 min after injection. TRV was quantified as 1.96 multiplied by the root-mean-square deviation of the fractional paired differences in SUV and SUR. The combined effect of blood normalization and uptake time correction was inspected by considering RTRV (TRVSUR/TRVSUV), a ratio reflecting the reduction in the TRV in SUR relative to SUV. RTRV was correlated with the group-averaged-value difference (δ) in CFmean (δCFmean) of the quantity δCF = |CF – 1|, where CF is the numeric factor that converts individual ratios of paired SUVs into corresponding SURs. This correlation analysis was performed by successively increasing a threshold value δCFmin and computing δCFmean and RTRV for the remaining subgroup of patients/lesions with δCF ≥ δCFmin. Results: The group-averaged TRVSUV and TRVSUR were 32.1 and 29.0, respectively, which correspond to a reduction of variability in SUR by an RTRV factor of 0.9 in comparison to SUV. This rather marginal improvement can be understood to be a consequence of the atypically low intrasubject variability in blood SUV and uptake time and the accordingly small δCF values in the investigated prospective study groups. In fact, subgroup analysis with increasing δCFmin thresholds revealed a pronounced negative correlation (Spearman ρ = −0.99, P < 0.001) between RTRV and δCFmean, where RTRV ≈ 0.4 in the δCFmin = 20% subgroup, corresponding to a more than 2-fold reduction of TRVSUR compared with TRVSUV. Conclusion: Variability in blood SUV and uptake time has been identified as a causal factor in the TRV in lesion SUV. Therefore, TRV in lesion uptake measurements can be reduced by replacing SUV with SUR as the uptake measure. The improvement becomes substantial for the level of variability in blood SUV and uptake time typically observed in the clinical context.

FDG PET/MR in initial staging of sarcoma: Initial experience and comparison with conventional imaging

OBJECTIVEnTo assess the feasibility of positron emission tomography/magnetic resonance imaging (PET/MR) with 18F-fluordeoxyglucose (FDG) for initial staging of sarcoma.nnnMATERIALS AND METHODSnTwenty-nine patients with sarcoma were included in this study. Weighted kappa (κ) was used to assess the agreement between PET/MR and conventional imaging (CT and MR). The accuracy of PET/MR and conventional imaging for distant metastases was compared using receiver operating characteristic (ROC) analysis.nnnRESULTSnT and M stage were identical for PET/MR and conventional modalities in all patients (κ=1). N stage was identical for 28/29 patients (κ=0.65).nnnCONCLUSIONSnFDG PET/MR shows excellent agreement with the currently preferred imaging methods (CT and MR) in initial staging of sarcoma.

Improved anatomic visualization of a glomus caroticum tumour within the carotic bifurcation with combined 68Ga-DOTATATE PET/MRI

A 12-year-old girl from a family with hereditary paraganglioma was referred for somatostatin receptor PET. A glomus caroticum tumour of the left side had been resected 1 year before, and now a paraganglioma of the right side was suspected. In the current investigation with 136 MBq Ga-DOTATATE and PET/CT, a focal uptake in the right neck was seen, highly suspicious of one further glomus tumour (a red arrow) contralateral to the previously resected tumour. No further foci were detected in the trunk. The girl was transferred to a combined PET/MRI scanner (Ingenuity PET-MR, TOF-PET, 3 TMRI; Philips). Positioned in a head coil (NV-16 head coil), first an attenuation MR scan was performed. From 2 h after injection, a PET scan of the head and neck area was acquired, and afterwards a diagnosticMRI scan was performed including nonenhanced time-of-flight MR angiography. The glomus tumour can be seen in close proximity to the bifurcation of the carotid artery (b–e). Glomus tumours can be imaged by somatostatin receptor ligands (preferably PET ligands such as Ga-DOTATOC/Ga-DOTATATE or SPECT ligands such as Inoctreotide) [2], F-DOPA PET [1] or I-MIBG. The combination of PET (or SPECT) and a morphological imaging method such as CT brings the advantage of exact anatomic localization which is necessary if a resection of the tumour is considered. With the advent of the newly introduced PET/MRI scanner, the combination of superb soft-tissue contrast of MRI and a specific PET tracer forms a highly sophisticated imaging tool for this indication. To

Functional monoamine oxidase B gene intron 13 polymorphism predicts putaminal dopamine turnover in de novo Parkinson's disease: Gene Polymorphisms and Dopamine Turnover

Objective: The objective of this study was to evaluate the effects of common functional polymorphisms in genes involved in dopamine metabolism on striatal dopamine turnover in de novo Parkinsons disease (PD).

Monitoring scanner calibration using the image-derived arterial blood SUV in whole-body FDG-PET

BackgroundThe current de facto standard for quantification of tumor metabolism in oncological whole-body PET is the standardized uptake value (SUV) approach. SUV determination requires accurate scanner calibration. Residual inaccuracies of the calibration lead to biased SUV values. Especially, this can adversely affect multicenter trials where it is difficult to ensure reliable cross-calibration across participating sites. The goal of the present work was the evaluation of a new method for monitoring scanner calibration utilizing the image-derived arterial blood SUV (BSUV) averaged over a sufficiently large number of whole-body FDG-PET investigations.Data of 681 patients from three sites which underwent routine 18F-FDG PET/CT or PET/MR were retrospectively analyzed. BSUV was determined in the descending aorta using a three-dimensional ROI concentric to the aorta’s centerline. The ROI was delineated in the CT or MRI images and transferred to the PET images. A minimum ROI volume of 5 mL and a concentric safety margin to the aortic wall was observed. Mean BSUV, standard deviation (SD), and standard error of the mean (SE) were computed for three groups of patients at each site, investigated 2 years apart, respectively, with group sizes between 53 and 100 patients. Differences of mean BSUV between the individual groups and sites were determined.ResultsSD (SE) of BSUV in the different groups ranged from 14.3 to 20.7% (1.7 to 2.8%). Differences of mean BSUV between intra-site groups were small (1.1–6.3%). Only one out of nine of these differences reached statistical significance. Inter-site differences were distinctly larger (12.6–25.1%) and highly significant (P<0.001).ConclusionsImage-based determination of the group-averaged blood SUV in modestly large groups of whole-body FDG-PET investigations is a viable approach for ensuring consistent scanner calibration over time and across different sites. We propose this approach as a quality control and cross-calibration tool augmenting established phantom-based procedures.