Shigeki Sugawara

Quantification of Cerebral Blood Flow and Oxygen Metabolism with 3-Dimensional PET and 15O: Validation by Comparison with 2-Dimensional PET

Quantitative PET with 15O provides absolute values for cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rate of oxygen (CMRO2), and oxygen extraction fraction (OEF), which are used for assessment of brain pathophysiology. Absolute quantification relies on physically accurate measurement, which, thus far, has been achieved by 2-dimensional PET (2D PET), the current gold standard for measurement of CBF and oxygen metabolism. We investigated whether quantitative 15O study with 3-dimensional PET (3D PET) shows the same degree of accuracy as 2D PET. Methods: 2D PET and 3D PET measurements were obtained on the same day on 8 healthy men (age, 21–24 y). 2D PET was performed using a PET scanner with bismuth germanate (BGO) detectors and a 150-mm axial field of view (FOV). For 3D PET, a 3D-only tomograph with gadolinium oxyorthosilicate (GSO) detectors and a 156-mm axial FOV was used. A hybrid scatter-correction method based on acquisition in the dual-energy window (hybrid dual-energy window [HDE] method) was applied in the 3D PET study. Each PET study included 3 sequential PET scans for C15O, 15O2, and \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{H}_{2}^{15}\mathrm{O}\) \end{document} (3-step method). The inhaled (or injected) dose for 3D PET was approximately one fourth of that for 2D PET. Results: In the 2D PET study, average gray matter values (mean ± SD) of CBF, CBV, CMRO2, and OEF were 53 ± 12 (mL/100 mL/min), 3.6 ± 0.3 (mL/100 mL), 3.5 ± 0.5 (mL/100 mL/min), and 0.35 ± 0.06, respectively. In the 3D PET study, scatter correction strongly affected the results. Without scatter correction, average values were 44 ± 6 (mL/100 mL/min), 5.2 ± 0.6 (mL/100 mL), 3.3 ± 0.4 (mL/100 mL/min), and 0.39 ± 0.05, respectively. With the exception of OEF, values differed between 2D PET and 3D PET. However, average gray matter values of scatter-corrected 3D PET were comparable to those of 2D PET: 55 ± 11 (mL/100 mL/min), 3.7 ± 0.5 (mL/100 mL), 3.8 ± 0.7 (mL/100 mL/min), and 0.36 ± 0.06, respectively. Even though the 2 PET scanners with different crystal materials, data acquisition systems, spatial resolution, and attenuation-correction methods were used, the agreement of the results between 2D PET and scatter-corrected 3D PET was excellent. Conclusion: Scatter coincidence is a problem in 3D PET for quantitative 15O study. The combination of both the present PET/CT device and the HDE scatter correction permits quantitative 3D PET with the same degree of accuracy as 2D PET and with a lower radiation dose. The present scanner is also applicable to conventional steady-state 15O gas inhalation if inhaled doses are adjusted appropriately.

18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries

PurposeThe purpose of this study was to depict 18F-fluoro-2-deoxy-D-glucose (FDG) accumulation in atherosclerotic lesions of the thoracic and carotid arteries on CT and MR images by means of automatic co-registration software.MethodsFifteen hospitalised men suffering cerebral infarction or severe carotid stenosis requiring surgical treatment participated in this study. Automatic co-registration of neck MR images and FDG-PET images and of contrast-enhanced CT images and FDG-PET images was achieved with co-registration software. We calculated the count ratio, which was standardised to the blood pool count of the superior vena cava, for three arteries that branch from the aorta, i.e. the brachial artery, the left common carotid artery and the subclavian artery (n=15), for atherosclerotic plaques in the thoracic aorta (n=10) and for internal carotid arteries with and without plaque (n=13).ResultsFDG accumulated to a significantly higher level in the brachial artery, left common carotid artery and left subclavian artery at their sites of origin than in the superior vena cava (p=0.000, p=0.000 and p=0.002, respectively). Chest CT showed no atherosclerotic plaque at these sites. Furthermore, the average count ratio of thoracic aortic atherosclerotic plaques was not higher than that of the superior vena cava. The maximum count ratio of carotid atherosclerotic plaques was significantly higher than that of the superior vena cava but was not significantly different from that of the carotid artery without plaque.ConclusionThe results of our study suggest that not all atherosclerotic plaques show high FDG accumulation. FDG-PET studies of plaques with the use of fused images can potentially provide detailed information about atherosclerosis.

Design and experimental validation of a quantitative myocardial /sup 201/Tl SPECT system

We have developed a quantitative SPECT system, and evaluated its potential for quantitative assessment of bio-physiological functions in the myocardium particularly with /sup 201/Tl. Our approach included development of a transmission system that provides accurate attenuation /spl mu/ maps, and implementation of ordered-subset EM reconstruction with transmission data based attenuation correction in addition to scatter correction using the transmission-dependent convolution subtraction (TDCS) technique. The transmission system was designed using Monte Carlo simulation to minimize the scatter in the transmission projection data while keeping loss of sensitivity minimal, and was attached to an opposing 2-head gamma camera fitted with parallel beam collimators. Observed /spl mu/ values agreed quantitatively well with the theoretical expected values in both phantoms and human thorax. Phantom experiments with /sup 201/Tl also demonstrated that, with both corrections for attenuation and scatter, observed images were directly proportional to the actual radioactivity distribution for various phantom geometries. Attenuation correction without scatter correction improved images in deep structure, but resulted in significant artifacts in the chest phantom in addition to dependency of observed radioactivity concentrations on the diameter of cylindrical phantoms. Absolute quantitation of bio-physiological functions, which is well established in PET, is shown to be feasible using SPECT, if both quantitative attenuation and scatter corrections are employed.

The effect of activity outside the field-of-view on image signal-to-noise ratio for 3D PET with 15O

Activity outside the field-of-view (FOV) degrades the count rate performance of 3D PET and consequently reduces signal-to-noise ratios (SNRs) of reconstructed images. The aim of this study was to evaluate a neck-shield installed in a 3D PET scanner for reducing the effect of the outside FOV activity. Specifically, we compared brain PET scans ((15)O(2) and H(2)(15)O) with and without the use of the neck-shield. Image SNRs were directly estimated by a sinogram bootstrap method. The bootstrap analysis showed that the use of the neck-shield improved the SNR by 8% and 19% for H(2)(15)O and (15)O(2), respectively. The SNR improvements were predominantly due to the reduction of the random count rates. Noise equivalent count rate (NECR) analysis provided SNR estimates that were very similar with the bootstrap-based results for H(2)(15)O, but not for (15)O(2). This discrepancy may be due to the fundamental difference between the two methods: the bootstrap method directly calculates the local SNR of reconstructed images, whereas the NECR calculation is based on the whole-gantry count rates, indicating a limitation of the conventional NECR-based method as a tool for assessing the image SNR. Although quantitative parameters, e.g. cerebral blood flow, did not differ when examined with and without the neck-shield, the use of the shield for brain (15)O study is recommended in terms of the image SNR.

Whole-brain perfusion measurement using 320-detector row computed tomography in patients with cerebrovascular steno-occlusive disease: comparison with 15O-positron emission tomography.

Objective: The 320-detector row computed tomography (CT) can provide whole-brain CT perfusion (CTP) maps with continuous angiographic images by performing a single dynamic scan. We investigated the reliability of CTP cerebral blood flow (CTP-CBF) with 320-detector row CT by comparing findings with 15O-positron emission tomography (PET-CBF). Methods: Whole-brain CTP and PET were performed in 10 patients with chronic unilateral steno-occlusive disease. We compared absolute and relative CBF values of bilateral middle cerebral artery territories between CTP and PET. Results: Although mean CTP-CBF values were approximately 30% lower than mean PET-CBF values, the mean ischemic-to-nonischemic CBF ratios of CTP and PET were almost identical (P = 0.804). Regression analysis showed a significant correlation between CTP-CBF and PET-CBF values for each patient (r = 0.52-0.85, P < 0.001). Conclusions: Whole-brain CTP using 320-detector row CT is useful for evaluating the degree of ischemia for the entire brain with chronic cerebrovascular disease.

Influence of arterial partial pressure of carbon dioxide on cerebral MRA in normal volunteers.

Objective Signal intensity of MR angiography (MRA) is influenced by the physiological factors of flowing blood in the vessels. We examined whether MRA can detect a cerebral hemodynamic change induced by reducing or elevating the arterial partial pressure of carbon dioxide (Paco2). Materials and Methods Cerebral MRA was performed in six normal volunteers, each having three measurements during hyperventilation, normal breathing, and 7% CO2 inhalation. The MRA data were obtained by a 0.5 T whole-body scanner and a time-of-flight technique of three-dimensional GE imaging. In addition to the visual inspection, the signal intensity and the lengths of the middle cerebral artery (MCA) and posterior cerebral artery (PCA) were estimated in relation to Paco2. Results The MRA appearances of major cerebral arteries were remarkably different depending on the breathing conditions. There was significant difference in the mean signal intensity (p < 0.01) and the mean length (p < 0.01) of the MCA and PCA between the hyperventilation and normal breathing trials. Conclusion The MRA signal was sensitive to the changes in Paco2 level of flowing blood. This phenomenon may result from changes in the velocity of blood flow in major cerebral arteries.