Xuping Zhu

MRI-Based Nonrigid Motion Correction in Simultaneous PET/MRI

Respiratory and cardiac motion is the most serious limitation to whole-body PET, resulting in spatial resolution close to 1 cm. Furthermore, motion-induced inconsistencies in the attenuation measurements often lead to significant artifacts in the reconstructed images. Gating can remove motion artifacts at the cost of increased noise. This paper presents an approach to respiratory motion correction using simultaneous PET/MRI to demonstrate initial results in phantoms, rabbits, and nonhuman primates and discusses the prospects for clinical application. Methods: Studies with a deformable phantom, a free-breathing primate, and rabbits implanted with radioactive beads were performed with simultaneous PET/MRI. Motion fields were estimated from concurrently acquired tagged MR images using 2 B-spline nonrigid image registration methods and incorporated into a PET list-mode ordered-subsets expectation maximization algorithm. Using the measured motion fields to transform both the emission data and the attenuation data, we could use all the coincidence data to reconstruct any phase of the respiratory cycle. We compared the resulting SNR and the channelized Hotelling observer (CHO) detection signal-to-noise ratio (SNR) in the motion-corrected reconstruction with the results obtained from standard gating and uncorrected studies. Results: Motion correction virtually eliminated motion blur without reducing SNR, yielding images with SNR comparable to those obtained by gating with 5–8 times longer acquisitions in all studies. The CHO study in dynamic phantoms demonstrated a significant improvement (166%–276%) in lesion detection SNR with MRI-based motion correction as compared with gating (P < 0.001). This improvement was 43%–92% for large motion compared with lesion detection without motion correction (P < 0.001). CHO SNR in the rabbit studies confirmed these results. Conclusion: Tagged MRI motion correction in simultaneous PET/MRI significantly improves lesion detection compared with respiratory gating and no motion correction while reducing radiation dose. In vivo primate and rabbit studies confirmed the improvement in PET image quality and provide the rationale for evaluation in simultaneous whole-body PET/MRI clinical studies.

Nonrigid PET motion compensation in the lower abdomen using simultaneous tagged‐MRI and PET imaging

PURPOSE We propose a novel approach for PET respiratory motion correction using tagged-MRI and simultaneous PET-MRI acquisitions. METHODS We use a tagged-MRI acquisition followed by motion tracking in the phase domain to estimate the nonrigid deformation of biological tissues during breathing. In order to accurately estimate motion even in the presence of noise and susceptibility artifacts, we regularize the traditional HARP tracking strategy using a quadratic roughness penalty on neighboring displacement vectors (R-HARP). We then incorporate the motion fields estimated with R-HARP in the system matrix of an MLEM PET reconstruction algorithm formulated both for sinogram and list-mode data representations. This approach allows reconstruction of all detected coincidences in a single image while modeling the effect of motion both in the emission and the attenuation maps. At present, tagged-MRI does not allow estimation of motion in the lungs and our approach is therefore limited to motion correction in soft tissues. Since it is difficult to assess the accuracy of motion correction approaches in vivo, we evaluated the proposed approach in numerical simulations of simultaneous PET-MRI acquisitions using the NCAT phantom. We also assessed its practical feasibility in PET-MRI acquisitions of a small deformable phantom that mimics the complex deformation pattern of a lung that we imaged on a combined PET-MRI brain scanner. RESULTS Simulations showed that the R-HARP tracking strategy accurately estimated realistic respiratory motion fields for different levels of noise in the tagged-MRI simulation. In simulations of tumors exhibiting increased uptake, contrast estimation was 20% more accurate with motion correction than without. Signal-to-noise ratio (SNR) was more than 100% greater when performing motion-corrected reconstruction which included all counts, compared to when reconstructing only coincidences detected in the first of eight gated frames. These results were confirmed in our proof-of-principle PET-MRI acquisitions, indicating that our motion correction strategy is accurate, practically feasible, and is therefore ready to be tested in vivo. CONCLUSIONS This work shows that PET motion correction using motion fields measured with tagged-MRI in simultaneous PET-MRI acquisitions can be made practical for clinical application and that doing so has the potential to remove motion blur in whole-body PET studies of the torso.

Monitoring proton radiation therapy with in-room PET imaging

We used a mobile positron emission tomography (PET) scanner positioned within the proton therapy treatment room to study the feasibility of proton range verification with an in-room, stand-alone PET system, and compared with off-line equivalent studies. Two subjects with adenoid cystic carcinoma were enrolled into a pilot study in which in-room PET scans were acquired in list-mode after a routine fractionated treatment session. The list-mode PET data were reconstructed with different time schemes to generate in-room short, in-room long and off-line equivalent (by skipping coincidences from the first 15 min during the list-mode reconstruction) PET images for comparison in activity distribution patterns. A phantom study was followed to evaluate the accuracy of range verification for different reconstruction time schemes quantitatively. The in-room PET has a higher sensitivity compared to the off-line modality so that the PET acquisition time can be greatly reduced from 30 to <5 min. Features in deep-site, soft-tissue regions were better retained with in-room short PET acquisitions because of the collection of (15)O component and lower biological washout. For soft tissue-equivalent material, the distal fall-off edge of an in-room short acquisition is deeper compared to an off-line equivalent scan, indicating a better coverage of the high-dose end of the beam. In-room PET is a promising low cost, high sensitivity modality for the in vivo verification of proton therapy. Better accuracy in Monte Carlo predictions, especially for biological decay modeling, is necessary.

Modeling and simulation of positron range effects for high resolution PET imaging

Employing a diffusion approximation for monoenergetic positrons and well-known theoretical and empirical relations we model positron range distributions and show them to be in close agreement with Monte Carlo simulation results produced using EGSnrc. We calculate the range-blurring effect on system resolution for 21 positron emitters of biomedical interest. The line-spread function for a tomograph with intrinsic spatial resolution of 1.5 mm FWHM is blurred to 1.7 mm FWHM for the low end-point energy emitters F-18 or Cu-64 and to about 4.3 mm FWHM for the high end-point energy emitters Rb-82 and I-120. Annihilation distributions exhibit a biphasic nature-very sharply peaked with long-range, low-intensity tails. The sharp peaks preserve high spatial frequencies while the tails, responsible for the predominant blurring effects, asymptotically approach exponential terms. By suitable manipulation of the model equations we derive the exponential constant-an apparent mass absorption coefficient-and find it to be in close agreement with a classical estimate. This long-range character introduces a blur component that can be removed during iterative reconstruction. Our model, while not entirely explicit, is conveniently formulated for application in linear algorithms such as Fourier transformation and re-projection during iterative reconstruction. The model thus facilitates range-blurring corrections, which are essential for high-resolution PET, particularly with high-energy emitters.

The reliability of proton-nuclear interaction cross-section data to predict proton-induced PET images in proton therapy.

In vivo PET range verification relies on the comparison of measured and simulated activity distributions. The accuracy of the simulated distribution depends on the accuracy of the Monte Carlo code, which is in turn dependent on the accuracy of the available cross-section data for β(+) isotope production. We have explored different cross-section data available in the literature for the main reaction channels ((16)O(p,pn)(15)O, (12)C(p,pn)(11)C and (16)O(p,3p3n)(11)C) contributing to the production of β(+) isotopes by proton beams in patients. Available experimental and theoretical values were implemented in the simulation and compared with measured PET images obtained with a high-resolution PET scanner. Each reaction channel was studied independently. A phantom with three different materials was built, two of them with high carbon or oxygen concentration and a third one with average soft tissue composition. Monoenergetic and SOBP field irradiations of the phantom were accomplished and measured PET images were compared with simulation results. Different cross-section values for the tissue-equivalent material lead to range differences below 1 mm when a 5 min scan time was employed and close to 5 mm differences for a 30 min scan time with 15 min delay between irradiation and scan (a typical off-line protocol). The results presented here emphasize the need of more accurate measurement of the cross-section values of the reaction channels contributing to the production of PET isotopes by proton beams before this in vivo range verification method can achieve mm accuracy.

Proton therapy verification with PET imaging.

Proton therapy is very sensitive to uncertainties introduced during treatment planning and dose delivery. PET imaging of proton induced positron emitter distributions is the only practical approach for in vivo, in situ verification of proton therapy. This article reviews the current status of proton therapy verification with PET imaging. The different data detecting systems (in-beam, in-room and off-line PET), calculation methods for the prediction of proton induced PET activity distributions, and approaches for data evaluation are discussed.

Solid-tumor radionuclide therapy dosimetry: new paradigms in view of tumor microenvironment and angiogenesis.

PURPOSE The objective of this study is to evaluate requirements for radionuclide-based solid tumor therapy by assessing the radial dose distribution of beta-particle-emitting and alpha-particle-emitting molecules localized either solely within endothelial cells of tumor vasculature or diffusing from the vasculature throughout the adjacent viable tumor cells. METHODS Tumor blood vessels were modeled as a group of microcylindrical layers comprising endothelial cells (one-cell thick, 10μm diameter), viable tumor cells (25-cell thick, 250μm radius), and necrotic tumor region (>250μm from any blood vessel). Sources of radioactivity were assumed to distribute uniformly in either endothelial cells or in concentric cylindrical 10μm shells within the viable tumor-cell region. The EGSnrc Monte Carlo simulation code system was used for beta particle dosimetry and a dose-point kernel method for alpha particle dosimetry. The radioactive decays required to deposit cytocidal doses (≥100Gy) in the vascular endothelial cells (endothelial cell mean dose) or, alternatively, at the tumor edge [tumor-edge mean dose (TEMD)] of adjacent viable tumor cells were then determined for six beta (P32, P33, C67u, Y90, I131, and R188e) and two alpha (A211t and B213i) particle emitters. RESULTS Contrary to previous modeling in targeted radionuclide therapy dosimetry of solid tumors, the present work restricts the region of tumor viability to 250μm around tumor blood vessels for consistency with biological observations. For delivering ≥100Gy at the viable tumor edge (TEMD) rather than throughout a solid tumor, energetic beta emitters Y90, P32, and R188e can be effective even when the radionuclide is confined to the blood vessel (i.e., no diffusion into the tumor). Furthermore, the increase in tumor-edge dose consequent to beta emitter diffusion is dependent on the energy of the emitted beta particles, being much greater for lower-energy emitters I131, C67u, and P33 relative to higher-energy emitters Y90, P32, and R188e. Compared to alpha particle emitters, a ∼150-400 times higher number of beta-particle-emitting radioactive atoms is required to deposit the same dose in tumor neovasculature. However, for the alpha particle emitters A211t and B213i to be effective in irradiating viable tumor-cell regions in addition to the vasculature, the carrier molecules must diffuse substantially from the vasculature into the viable tumor. CONCLUSION The presented data enable comparison of radionuclides used for antiangiogenic therapy on the basis of their radioactive decay properties, tumor neovasculature geometry, and tumor-cell viability. For alpha particle emitters or low-energy beta particle emitters, the targeting carrier molecule should be chosen to permit the radiopharmaceutical to diffuse from the endothelial wall of the blood vessel, while for long-range energetic beta particle emitters that target neovasculature, a radiopharmaceutical that binds to newly formed endothelial cells and does not diffuse is preferable. The work is a first approximation to modeling of tumor neovasculature that ignores factors such as pharmacokinetics and targeting capability of carrier molecules. The calculations quantify the interplay between irradiation of neovasculature, the surrounding viable tumor cells, and the physical properties of commonly used radionuclides and can be used to assist estimation of radioactivity to be administered for neovasculature-targeted tumor therapy.

Quantitative simultaneous 99mTc∕123I cardiac SPECT using MC-JOSEM

Simultaneous rest 99mTc-Sestamibi/ 123I-BMIPP cardiac SPECT imaging has the potential to replace current clinical 99mTc-Sestamibi rest/stress imaging and therefore has great potential in the case of patients with chest pain presenting to the emergency department. Separation of images of these two radionuclides is difficult, however, because their emission energies are close. The authors previously developed a fast Monte Carlo (MC)-based joint ordered-subset expectation maximization (JOSEM) iterative reconstruction algorithm (MC-JOSEM), which simultaneously compensates for scatter and cross talk as well as detector response within the reconstruction algorithm. In this work, the authors evaluated the performance of MC-JOSEM in a realistic population of 99mTc/123I studies using cardiac phantom data on a Siemens e.cam system using a standard cardiac protocol. The authors also compared the performance of MC-JOSEM for estimation tasks to that of two other methods: standard OSEM using photopeak energy windows without scatter correction (NSC-OSEM) and standard OSEM using a Compton-scatter energy window for scatter correction (SC-OSEM). For each radionuclide the authors separately acquired high-count projections of radioactivity in the myocardium wall, liver, and soft tissue background compartments of a water-filled torso phantom, and they generated synthetic projections of various dual-radionuclide activity distributions. Images of different combinations of myocardium wall/background activity concentration ratios for each radionuclide were reconstructed by NSC-OSEM, SC-OSEM, and MC-JOSEM. For activity estimation in the myocardium wall, MC-JOSEM always produced the best relative bias and relative standard deviation compared with NSC-OSEM and SC-OSEM for all the activity combinations. On average, the relative biases after 100 iterations were 8.1% for 99mTc and 3.7% for 123I with MC-JOSEM, 39.4% for 99mTc and 23.7% for 123I with NSC-OSEM, and 20.9% for 99mTc with SC-OSEM. The relative standard deviations after 30 iterations were 0.7% for 99mTc and 1.0% for 123I with MC-JOSEM, as compared to 1.1% for 99mTc and 1.2% for 123I with NSC-OSEM and 1.3% for 99mTc with SC-OSEM. Finally, the authors compared the relative standard deviation after 30 iterations with the minimum theoretical variance on activity estimation, the Cramer-Rao lower bound (CRB), and with the biased CRB. The measured precision was larger than the biased bound values by factors of 2-4, suggesting that further improvement could be made to the method.

Improved MAGIC gel for higher sensitivity and elemental tissue equivalent 3D dosimetry.

PURPOSE Polymer-based gel dosimeter (MAGIC type) is a preferable phantom material for PET range verification of proton beam therapy. However, improvement in elemental tissue equivalency (specifically O/C ratio) is very desirable to ensure realistic time-activity measurements. METHODS Glucose and urea was added to the original MAGIC formulation to adjust the O/C ratio. The dose responses of the new formulations were tested with MRI transverse relaxation rate (R2) measurements. RESULTS The new ingredients improved not only the elemental composition but also the sensitivity of the MAGIC gel. The O/C ratios of our new gels agree with that of soft tissue within 1%. The slopes of dose response curves were 1.6-2.7 times larger with glucose. The melting point also increased by 5 degrees C. Further addition of urea resulted in a similar slope but with an increased intercept and a decreased melting point. CONCLUSIONS Our improved MAGIC gel formulations have higher sensitivity and better elemental tissue equivalency for 3D dosimetry applications involving nuclear reactions.

Behavioral Profiling of Human Transitional Cell Carcinoma Ex vivo

Outcome studies of many types of cancer have revealed that tumors of indistinguishable histologic appearance may differ significantly in aggressiveness and in their response to therapy. A strategy that would enable early identification of patients at high risk for disease progression and allow screening of multiple therapeutic agents simultaneously for efficacy would improve clinical management. We have developed an orthotopic organ culture model of bladder cancer in which quantum dot-based fluorescent imaging approaches are used to obtain quantitative measurements of tumor cell behavior. Human transitional cell carcinoma (TCC) cells are labeled with quantum dot nanoparticles, and the cells instilled into the rat bladder in vivo, after which the bladder is excised and cultured ex vivo. Cell implantation, proliferation, and invasion into the organ wall are monitored using epifluorescence imaging and two-photon laser scanning confocal microscopy. Using this approach, we were able to assign distinct phenotypes to two metastatic bladder cancer cell lines based on different patterns of invasiveness into the bladder wall. We also showed that established tumor cell masses regressed following intravesical administration of the chemotherapeutic drug thiotepa. Collectively, these findings suggest that this assay system, which we have named EViTAS (for ex vivo tumor assay system), can recapitulate salient aspects of tumor growth in the host and is amenable to behavioral profiling of human cancer.