基于支持向量回归的PET/CT图像衰减校正方法

目的在电子发射及计算机断层扫描系统(positron emission computed tomography/X-ray computed tomography,PET/CT)图像衰减校正的能量转换过程中,为了改进双线性转换法用线性关系来拟合非线性关系的不足,本文以支持向量回归为基础,提出了一种新的能量转换法即支持向量回归的PET/CT图像衰减校正方法来进行衰减校正,以寻找CT值和511 keV能量下线性衰减系数值之间的最佳转换关系。方法使用仿真软件GATE(Geant4 Application Tomographic Emission)模拟了11组不同材质的圆柱体体模。然后根据GATE仿真的不同材质圆柱体体模,求出其CT值和511 keV能量下线性衰减系数值并代入SVR模型中进行训练,建立CT值和511 keV能量下线性衰减系数值之间的SVR模型。最后与目前PET/CT衰减校正能量转换中常用的双线性能量转换法进行对比分析,并分别应用于GATE仿真的NCAT(NURBs Cardiac Torso)像素体模图像中,评估两种方法准确性的差异。结果支持向量回归的PET/CT图像衰减校正方法得到的511 keV能量下对应物质的线性衰减系数值的相对百分误差值较小(肺的相对百分误差值3.1%和肝脏的相对百分误差值1.08%),且经过支持向量回归法衰减校正的PET图像,其MSE评价值都是最小的(176.9230),其PSNR和AG的评价值都是最大的(31.8621和7.9083)。这说明经过支持向量回归法衰减校正的PET图像相比于双线性转换法衰减校正的PET图像,更接近于静态的图像。结论支持向量回归的PET/CT图像衰减校正方法在PET/CT图像的衰减校正应用中有更好的表现,可以更好地吻合CT值与511 keV能量下线性衰减系数之间的转换关系,从而提高了PET/CT图像的衰减校正效果,改善了PET/CT图像定量的准确性,便于医生做出更精确的临床诊断。     

Phased attenuation correction in respiration correlated computed tomography/positron emitted tomography

The motion of lung tumors with respiration causes difficulties in the imaging with computed tomography (CT) and positronemitted tomography (PET). Since an accurate knowledge of the position of the tumor and the surrounding tissues is needed for radiation treatment planning, it is important to improve CT/PET image acquisition. The purpose of this study was to evaluate the potential to improve image acquisition using phased attenuation correction in respiration correlated CT/PET, where data of both modalities were binned retrospectively. Respiration correlated scans were made on a Siemens Biograph Sensation 16 CT/PET scanner which was modified to make a low pitch CT scan and list mode PET scan possible. A lollipop phantom was used in the experiments. The sphere with a diameter of 3.1 cm was filled with approximately 20 MBq 18F-FDG. Three longitudinal movement amplitudes were tested: 2.5, 3.9, and 4.8 cm. After collection of the raw CT data, list mode PET data, and the respiratory signal CT/PET images were binned to ten phases with the help of in-house-built software. Each PET phase was corrected for attenuation with CT data of the corresponding phase. For comparison, the attenuation correction was also performed with nonrespiration correlated (non-RC) CT data. The volume and the amplitude of the movement were calculated for every phaseof both the CT and PET data (with phased attenuation correction). Maximum and average activity concentrations were compared between the phased and nonphased attenuation corrected PET. With a standard non-RC CT/PET scan, the volume was underestimated by as much as 46% in CT and the PET volume was overestimated to 370%. The volumes found with RC-CT/PET scanning had average deviations of 1.9% (+/- 4.8%) and 1.5% (+/- 3.4%) from the actual volume, for the CT and PET volumes, respectively. Evaluation of the maximum activity concentration showed a clear displacement in the images with non-RC attenuation correction, and activity values were on average14% (+/- 12%) lower than with phased attenuation correction. The standard deviation of the maximum activity values found in the different phases was a factor of 10 smaller when phased attenuation correction was applied. In this phantom study, we have shown that a combination of respiration correlated CT/PET scanning with application of phased attenuation correction can improve the imaging of moving objects and can lead to improved volume estimation and a more precise localization and quantification of the activity.     

Single and dual energy attenuation correction in PET/CT in the presence of iodine based contrast agents

In present positron emission tomography (PET)/computed tomography (CT) scanners, PET attenuation correction is performed by relying on the information given by a single CT scan. The scaling of the linear attenuation coefficients from CT x-ray energy to PET 511 keV gamma energy is prone to errors especially in the presence of CT contrast agents. Attenuation correction based upon two CT scans at different energies but performed at the same time and patient position should reduce such errors and therefore improve the accuracy of the reconstructed PET images at the cost of introduced additional noise. Such CT scans could be provided by future PET/CT scanners that have either dual source CT or energy sensitive CT. Three different dual energy scaling methods for attenuation correction are introduced and assessed by measurements with a modified NEMA 1994 phantom with different CT contrast agent concentrations. The scaling is achieved by differentiating between (1) Compton and photoelectric effect, (2) atomic number and density, or (3) water-bone and water-iodine scaling schemes. The scaling method (3) is called hybrid dual energy computed tomography attenuation correction (hybrid DECTAC). All three dual energy scaling methods lead to a reduction of contrast agent artifacts with respect to single energy scaling. The hybrid DECTAC method resulted in PET images with the weakest artifacts. Both, the hybrid DECTAC and Compton/photoelectric effect scaling resulted also in images with the lowest PET background variability. Atomic number/density scaling and Compton/photoelectric effect scaling had problems to correctly scale water, hybrid DECTAC scaling and single energy scaling to correctly scale Teflon. Atomic number/density scaling and hybrid DECTAC could be generalized to reduce these problems.     

A novel method for incorporating respiratory-matched attenuation correction in the motion correction of cardiac PET-CT studies

Mismatches between PET and CT datasets due to respiratory effects can lead to artefactual perfusion defects. To overcome this, we have proposed a method of aligning a single CT with each frame of a gated PET study in a semi-automatic manner, incorporating a statistical shape model of the diaphragm and a rigid registration of the heart. This ensures that the structures that could influence the appearance of the reconstructed cardiac activity are correctly matched between emission and transmission datasets. When tested on two patient studies, it was found in both cases that attenuation correction using the proposed technique resulted in PET images that were closer to the gold standard of attenuation correction with a gated CT, compared with scenarios where only heart matching was considered (and not the diaphragm) or where no transformation was performed (i.e. where a single CT frame was used to attenuation-correct all PET frames). These preliminary results suggest that diaphragm matching between PET and CT improves the quantitative accuracy of reconstructed PET images and that the proposed method of using a statistical shape model to describe the diaphragm shape and motion, in combination with a rigid registration to determine respiratory-induced heart motion, is a feasible method of achieving this.     

Physiological uptake in FDG PET simulating disease

Many potential pitfalls and artefacts have been described in PET imaging that uses F-18 fluorodeoxyglucose (FDG). Normal uptake of FDG occurs in many sites of the body and may cause confusion in interpretation particularly in oncology imaging. Clinical correlation, awareness of the areas of normal uptake of FDG in the body and knowledge of variation in uptake as well as benign processes that are FDG avid are necessary to avoid potential pitfalls in image interpretation. In this context, optimum preparation of patients for their scans can be instituted in an attempt to reduce the problem. Many of the problems and pitfalls associated with areas of normal uptake of FDG can be solved by using PET CT imaging. PET CT imaging has the ability to correctly attribute FDG activity to a structurally normal organ on CT. However, the development of combined PET CT scanners also comes with its own specific problems related to the combined PET CT technique. These include misregistration artefacts due to respiration and the presence of high density substances which may lead to artefactual overestimation of activity if CT data are used for attenuation correction.     

Automated cardiac motion compensation in PET/CT for accurate reconstruction of PET myocardial perfusion images

Error-free reconstruction of PET data with a registered CT attenuation map is essential for accurate quantification and interpretation of cardiac perfusion. Misalignment of the CT and PET data can produce an erroneous attenuation map that projects lung attenuation parameters onto the heart wall, thereby underestimating the attenuation and creating artifactual areas of hypoperfusion that can be misinterpreted as myocardial ischemia or infarction. The major causes of misregistration between CT and PET images are the respiratory motion, cardiac motion and gross physical motion of the patient. The misalignment artifact problem is overcome with automated cardiac registration software that minimizes the alignment error between the two modalities. Results show that the automated registration process works equally well for any respiratory phase in which the CT scan is acquired. Further evaluation of this procedure on 50 patients demonstrates that the automated registration software consistently aligns the two modalities, eliminating artifactual hypoperfusion in reconstructed PET images due to PET/CT misregistration. With this registration software, only one CT scan is required for PET/CT imaging, which reduces the radiation dose required for CT-based attenuation correction and improves the clinical workflow for PET/CT.     

基于互信息的多分辨率三维脑图像配准方法

在3D多模医学图像的配准方法中，最大互信息法精度高，鲁棒性强，使用范围广，本文将归一化互信息作为相似性测度，采用不同的采样范围和采样子集，使用Powell多参数优化法和Brent一维搜索算法对3DCT，MR和PET脑图像进行了刚体配准，为了加快配准速度，使用了多分辨的金字塔方法，对PET图像采用基于坐标的阈值选取方法对图像进行分割预算法，消除了大部分放射状背景伪影，美国万德贝尔大学对结果进行的评估证明配准精度可达亚体元级。     

Design of respiration averaged CT for attenuation correction of the PET data from PET/CT

Our previous patient studies have shown that the use of respiration averaged computed tomography (ACT) for attenuation correction of the positron emission tomography (PET) data from PET/CT reduces the potential misalignment in the thorax region by matching the temporal resolution of the CT to that of the PET. In the present work, we investigated other approaches of acquiring ACT in order to reduce the CT dose and to improve the ease of clinical implementation. Four-dimensional CT (4DCT) data sets for ten patients (17 lung/esophageal tumors) were acquired in the thoracic region immediately after the routine PET/CT scan. For each patient, multiple sets of ACTs were generated based on both phase image averaging (phase approach) and fixed cine duration image averaging (cine approach). In the phase approach, the ACTs were calculated from CT images corresponding to the significant phases of the respiratory cycle: ACT(050phs) from end-inspiration (0%) and end-expiration (50%), ACT(2070phs) from mid-inspiration (20%) and mid-expiration (70%), ACT(4phs) from 0%, 20%, 50% and 70%, and ACT(10phs) from all ten phases, which was the original approach. In the cine approach, which does not require 4DCT, the ACTs were calculated based on the cine images from cine durations of 1 to 6 s at 1 s increments. PET emission data for each patient were attenuation corrected with each of the above mentioned ACTs and the tumor maximum standard uptake value (SUVmax), average SUV (SUVavg), and tumor volume measurements were compared. Percent differences were calculated between PET data corrected with various ACTs and that corrected with ACT(10phs). In the phase approach, the ACT(10phs) can be approximated by the ACT(4phs) to within a mean percent difference of 2% in SUV and tumor volume measurements. In cine approach, ACT(10phs) can be approximated to within a mean percent difference of 3% by ACTs computed from cine durations > or =3 s. Acquiring CT images only at the four significant phases for the ACT can reduce radiation dose to 1/3 of the current 4DCT dose; however, the implementation of this approach requires additional hardware that is not standard equipment on PET/CT scanners. In the cine approach, we recommend a duration of 6 +/- 1 s in order to include variations of respiratory patterns in a larger population. This approach can be easily implemented because cine acquisition mode is available on all GE PET/CT scanners. The CT dose in the cine approach can be reduced to approximately 5 mGy by using the lowest mA setting (10 mA), while still maintaining good quality CT data for PET attenuation correction. In our scanning protocol, the ACT is only acquired if respiration-induced misregistration is observed (determined before the PET scan is completed), and therefore patients do not receive unnecessary CT radiation dose.     

Why is TOF PET reconstruction a more robust method in the presence of inconsistent data?

In order to obtain an accurate and quantitative positron emission tomography (PET) image, emission data need to be corrected for random coincidences, photon attenuation and Compton scattering of photons in the tissue, and detector efficiency response or normalization. The accuracy of these corrections strongly affects the quality of the PET image. There is evidence that time-of-flight (TOF) PET reconstruction is less sensitive than non-TOF reconstruction to inconsistencies between emission data and corrections. The purpose of this study is to analyze and discuss such experimental evidence. In this work, inconsistent correction data (inconsistent normalization, absence of scatter correction and mismatched attenuation correction) are introduced in experimental phantom data. Both TOF and non-TOF reconstructed images are analyzed to examine the effect of flawed data. The behavior of TOF reconstruction in respiratory artifacts, a very common example of inconsistency in the data, is studied in patient images. TOF reconstruction is less sensitive to mismatched attenuation correction, erroneous normalization and poorly estimated scatter correction. Such robustness depends strongly on the time resolution of the TOF PET scanner. In particular, the robustness of TOF in the presence of attenuation correction inconsistencies is discussed, using a simulation of a simple model of respiratory artifacts. We expect new generations of PET scanners, with improved time resolution, to be less and less sensitive to poor quality normalization, scatter and attenuation corrections. This not only reduces artifacts in the PET image, but also opens the way to less stringent requirements for the quality of the CT image (reducing either the equipment cost or the dose to the patient), and for the normalization protocols (simplifying or shortening the normalization procedures). Moreover, TOF reconstruction can be beneficial in multimodalities such as PET/MR, where a direct attenuation measurement is not available and attenuation correction can only be approximated.     

Phantom validation of coregistration of PET and CT for image-guided radiotherapy

Radiotherapy treatment planning integrating positron emission tomography (PET) and computerized tomography (CT) is rapidly gaining acceptance in the clinical setting. Although hybrid systems are available, often the planning CT is acquired on a dedicated system separate from the PET scanner. A limiting factor to using PET data becomes the accuracy of the CT/PET registration. In this work, we use phantom and patient validation to demonstrate a general method for assessing the accuracy of CT/PET image registration and apply it to two multi-modality image registration programs. An IAEA (International Atomic Energy Association) brain phantom and an anthropomorphic head phantom were used. Internal volumes and externally mounted fiducial markers were filled with CT contrast and 18F-fluorodeoxyglucose (FDG). CT, PET emission, and PET transmission images were acquired and registered using two different image registration algorithms. CT/PET Fusion (GE Medical Systems, Milwaukee, WI) is commercially available and uses a semi-automated initial step followed by manual adjustment. Automatic Mutual Information-based Registration (AMIR), developed at our institution, is fully automated and exhibits no variation between repeated registrations. Registration was performed using distinct phantom structures; assessment of accuracy was determined from registration of the calculated centroids of a set of fiducial markers. By comparing structure-based registration with fiducial-based registration, target registration error (TRE) was computed at each point in a three-dimensional (3D) grid that spans the image volume. Identical methods were also applied to patient data to assess CT/PET registration accuracy. Accuracy was calculated as the mean with standard deviation of the TRE for every point in the 3D grid. Overall TRE values for the IAEA brain phantom are: CT/PET Fusion = 1.71 +/- 0.62 mm, AMIR = 1.13 +/- 0.53 mm; overall TRE values for the anthropomorphic head phantom are: CT/PET Fusion = 1.66 +/- 0.53 mm, AMIR = 1.15 +/- 0.48 mm. Precision (repeatability by a single user) measured for CT/PET Fusion: IAEA phantom = 1.59 +/- 0.67 mm and anthropomorphic head phantom = 1.63 +/- 0.52 mm. (AMIR has exact precision and so no measurements are necessary.) One sample patient demonstrated the following accuracy results: CT/PET Fusion = 3.89 +/- 1.61 mm, AMIR = 2.86 +/- 0.60 mm. Semi-automatic and automatic image registration methods may be used to facilitate incorporation of PET data into radiotherapy treatment planning in relatively rigid anatomic sites, such as head and neck. The overall accuracies in phantom and patient images are < 2 mm and < 4 mm, respectively, using either registration algorithm. Registration accuracy may decrease, however, as distance from the initial registration points (CT/PET fusion) or center of the image (AMIR) increases. Additional information provided by PET may improve dose coverage to active tumor subregions and hence tumor control. This study shows that the accuracy obtained by image registration with these two methods is well suited for image-guided radiotherapy.     

A knowledge-based method for reducing attenuation artefacts caused by cardiac appliances in myocardial PET/CT

Attenuation artefacts due to implanted cardiac defibrillator leads have previously been shown to adversely impact cardiac PET/CT imaging. In this study, the severity of the problem is characterized, and an image-based method is described which reduces the resulting artefact in PET. Automatic implantable cardioverter defibrillator (AICD) leads cause a moving-metal artefact in the CT sections from which the PET attenuation correction factors (ACFs) are derived. Fluoroscopic cine images were measured to demonstrate that the defibrillator's highly attenuating distal shocking coil moves rhythmically across distances on the order of 1 cm. Rhythmic motion of this magnitude was created in a phantom with a moving defibrillator lead. A CT study of the phantom showed that the artefact contained regions of incorrect, very high CT values and adjacent regions of incorrect, very low CT values. The study also showed that motion made the artefact more severe. A knowledge-based metal artefact reduction method (MAR) is described that reduces the magnitude of the error in the CT images, without use of the corrupted sinograms. The method modifies the corrupted image through a sequence of artefact detection procedures, morphological operations, adjustments of CT values and three-dimensional filtering. The method treats bone the same as metal. The artefact reduction method is shown to run in a few seconds, and is validated by applying it to a series of phantom studies in which reconstructed PET tracer distribution values are wrong by as much as 60% in regions near the CT artefact when MAR is not applied, but the errors are reduced to about 10% of expected values when MAR is applied. MAR changes PET image values by a few per cent in regions not close to the artefact. The changes can be larger in the vicinity of bone. In patient studies, the PET reconstruction without MAR sometimes results in anomalously high values in the infero-septal wall. Clinical performance of MAR is assessed by two physicians' inspection of images generated in 30 patients with and without MAR. Noticeable image differences are judged in 14 of 28 (50%) observations with AICD leads, and significant clinical impact is judged in 2 of 28 (7%) of those observations. A polar map analysis shows significant differences in 10 of 14 (71%) studies with AICD leads, and 0 of 16 (0%) studies without AICD leads. These results show that the MAR method is successful in reducing the magnitude of the metal artefact without incorrectly altering cases without metal artefact. In spite of profound changes to the CT image from the moving metal, the PET ACF in that study was changed by no more than 20%.     

Digimouse: a 3D whole body mouse atlas from CT and cryosection data

We have constructed a three-dimensional (3D) whole body mouse atlas from coregistered x-ray CT and cryosection data of a normal nude male mouse. High quality PET, x-ray CT and cryosection images were acquired post mortem from a single mouse placed in a stereotactic frame with fiducial markers visible in all three modalities. The image data were coregistered to a common coordinate system using the fiducials and resampled to an isotropic 0.1 mm voxel size. Using interactive editing tools we segmented and labelled whole brain, cerebrum, cerebellum, olfactory bulbs, striatum, medulla, masseter muscles, eyes, lachrymal glands, heart, lungs, liver, stomach, spleen, pancreas, adrenal glands, kidneys, testes, bladder, skeleton and skin surface. The final atlas consists of the 3D volume, in which the voxels are labelled to define the anatomical structures listed above, with coregistered PET, x-ray CT and cryosection images. To illustrate use of the atlas we include simulations of 3D bioluminescence and PET image reconstruction. Optical scatter and absorption values are assigned to each organ to simulate realistic photon transport within the animal for bioluminescence imaging. Similarly, 511 keV photon attenuation values are assigned to each structure in the atlas to simulate realistic photon attenuation in PET. The Digimouse atlas and data are available at http://neuroimage.usc.edu/Digimouse.html.     

Evaluation of the combined effects of target size, respiratory motion and background activity on 3D and 4D PET/CT images

Gated (4D) PET/CT has the potential to greatly improve the accuracy of radiotherapy at treatment sites where internal organ motion is significant. However, the best methodology for applying 4D-PET/CT to target definition is not currently well established. With the goal of better understanding how to best apply 4D information to radiotherapy, initial studies were performed to investigate the effect of target size, respiratory motion and target-to-background activity concentration ratio (TBR) on 3D (ungated) and 4D PET images. Using a PET/CT scanner with 4D or gating capability, a full 3D-PET scan corrected with a 3D attenuation map from 3D-CT scan and a respiratory gated (4D) PET scan corrected with corresponding attenuation maps from 4D-CT were performed by imaging spherical targets (0.5-26.5 mL) filled with (18)F-FDG in a dynamic thorax phantom and NEMA IEC body phantom at different TBRs (infinite, 8 and 4). To simulate respiratory motion, the phantoms were driven sinusoidally in the superior-inferior direction with amplitudes of 0, 1 and 2 cm and a period of 4.5 s. Recovery coefficients were determined on PET images. In addition, gating methods using different numbers of gating bins (1-20 bins) were evaluated with image noise and temporal resolution. For evaluation, volume recovery coefficient, signal-to-noise ratio and contrast-to-noise ratio were calculated as a function of the number of gating bins. Moreover, the optimum thresholds which give accurate moving target volumes were obtained for 3D and 4D images. The partial volume effect and signal loss in the 3D-PET images due to the limited PET resolution and the respiratory motion, respectively were measured. The results show that signal loss depends on both the amplitude and pattern of respiratory motion. However, the 4D-PET successfully recovers most of the loss induced by the respiratory motion. The 5-bin gating method gives the best temporal resolution with acceptable image noise. The results based on the 4D scan protocols can be used to improve the accuracy of determining the gross tumor volume for tumors in the lung and abdomen.     

A preliminary study of neuroSPECT evaluation of patients with post-traumatic smell impairment

Background

Attenuation correction is generally used to PET images to achieve count rate values independent from tissue densities. The goal of this study was to provide a qualitative comparison of attenuation corrected PET images produced by a PET-CT device (CT, 120 kV, 40 mAs, FOV 600 mm) with and without segmentation of transmission data (ACseg⁺ and ACseg^-respectively). Methods: The reconstructed images were compared to attenuation corrected images obtained with a high-energy transmission source (Cs-137 – 662 keV). Thirty oncologic patients were studied using CT and ¹³⁷Cs for attenuation correction. All image data were acquired using the Gemini PET-CT scanner (Philips Medical Systems). It is an open PET-CT system that consists of the MX8000 multislice CT and the Allegro PET scanner arranged in a separable configuration. Images with ACseg⁺ and ACseg^- were analyzed simultaneously in coronal, sagittal and transaxial planes. Two nuclear medicine physicians reviewed the image sets. Results: The image quality in the area of metal implants was better with ACseg⁺ than ACseg^-, without metal induced artifacts generally observed in CT corrected images. Further the images with ACseg⁺ were qualitatively comparable to those obtained with ¹³⁷Cs attenuation correction. Conclusions: In case of metal implants, PET studies corrected by CT should preferably use the ACseg⁺ method to avoid the image artifacts.     

基于集成SVM的肺部肿瘤PET/CT三模态计算机辅助诊断方法

本研究提出基于集成SVM的肺部肿瘤PET/CT三模态计算机辅助诊断新方法.首先在临床采集肺部肿瘤患者PET、CT和PET/CT各2000例三模态图像数据上提取对同一病灶ROI区域;然后根据CT、PET和PET/CT的不同特点,从三模态图像的ROI区域中提取形状特征、灰度特征、Tamura纹理特征和GLCM特征等不同特征分别构成80、98、98维特征分量,并分别在不同特征空间里构造个体分类器,包括CT-SVM、PET-SVM、PET/CT-SVM;最后,基于相对多数投票原则,对CT-SVM、PET-SVM和PET/CT-SVM进行集成,识别对肺部肿瘤.实验结果表明,该方法能够有效提高肺部肿瘤的诊断正确率.     

PET/CT image registration: preliminary tests for its application to clinical dosimetry in radiotherapy

The quality of dosimetry in radiotherapy treatment requires the accurate delimitation of the gross tumor volume. This can be achieved by complementing the anatomical detail provided by CT images through fusion with other imaging modalities that provide additional metabolic and physiological information. Therefore, use of multiple imaging modalities for radiotherapy treatment planning requires an accurate image registration method. This work describes tests carried out on a Discovery LS positron emission/computed tomography (PET/CT) system by General Electric Medical Systems (GEMS), for its later use to obtain images to delimit the target in radiotherapy treatment. Several phantoms have been used to verify image correlation, in combination with fiducial markers, which were used as a system of external landmarks. We analyzed the geometrical accuracy of two different fusion methods with the images obtained with these phantoms. We first studied the fusion method used by the PET/CT system by GEMS (hardware fusion) on the basis that there is satisfactory coincidence between the reconstruction centers in CT and PET systems; and secondly the fiducial fusion, a registration method, by means of least-squares fitting algorithm of a landmark points system. The study concluded with the verification of the centroid position of some phantom components in both imaging modalities. Centroids were estimated through a calculation similar to center-of-mass, weighted by the value of the CT number and the uptake intensity in PET. The mean deviations found for the hardware fusion method were: deltax/ +/-sigma = 3.3 mm +/- 1.0 mm and /deltax/ +/-sigma = 3.6 mm +/- 1.0 mm. These values were substantially improved upon applying fiducial fusion based on external landmark points: /deltax/ +/-sigma = 0.7 mm +/- 0.8 mm and /deltax/ +/-sigma = 0.3 mm 1.7 mm. We also noted that differences found for each of the fusion methods were similar for both the axial and helical CT image acquisition protocols.     

Ultra-low dose CT attenuation correction for PET/CT

A challenge for positron emission tomography/computed tomography (PET/CT) quantitation is patient respiratory motion, which can cause an underestimation of lesion activity uptake and an overestimation of lesion volume. Several respiratory motion correction methods benefit from longer duration CT scans that are phase matched with PET scans. However, even with the currently available, lowest dose CT techniques, extended duration cine CT scans impart a substantially high radiation dose. This study evaluates methods designed to reduce CT radiation dose in PET/CT scanning. We investigated selected combinations of dose reduced acquisition and noise suppression methods that take advantage of the reduced requirement of CT for PET attenuation correction (AC). These include reducing CT tube current, optimizing CT tube voltage, adding filtration, CT sinogram smoothing and clipping. We explored the impact of these methods on PET quantitation via simulations on different digital phantoms. CT tube current can be reduced much lower for AC than that in low dose CT protocols. Spectra that are higher energy and narrower are generally more dose efficient with respect to PET image quality. Sinogram smoothing could be used to compensate for the increased noise and artifacts at radiation dose reduced CT images, which allows for a further reduction of CT dose with no penalty for PET image quantitation. When CT is not used for diagnostic and anatomical localization purposes, we showed that ultra-low dose CT for PET/CT is feasible. The significant dose reduction strategies proposed here could enable respiratory motion compensation methods that require extended duration CT scans and reduce radiation exposure in general for all PET/CT imaging.     

Attenuation correction of four dimensional (4D) PET using phase-correlated 4D-computed tomography

The image quality in a conventional positron emission tomography (PET)/computed tomography (CT) scanner is degraded by respiratory motion because of erroneous attenuation correction when three-dimensional image acquisition is used. To overcome this problem, time-resolved data acquisition (4D) is required. For this, a Siemens Biograph 16 PET/CT scanner has been modified and its normal capability has been extended to a true 4D-PET/4D-CT imaging device including phase-correlated attenuation correction. To verify the correct functionality of this device, experiments on a respiratory motion phantom that allowed movement in two dimensions have been performed. The measurements showed good spatial correlation as well as good time synchronization between the PET and CT data. Furthermore, the motion pattern of the phantom and the shape of the activity distribution have been examined, and the volume of the reconstructed PET images has been analyzed. The results demonstrate the feasibility of such a procedure, and we therefore recommend that 4D-PET data should be reconstructed using 4D-CT data, which can be acquired on the same machine.     

Accuracy of CT-based attenuation correction in PET/CT bone imaging

We evaluate the accuracy of scaling CT images for attenuation correction of PET data measured for bone. While the standard tri-linear approach has been well tested for soft tissues, the impact of CT-based attenuation correction on the accuracy of tracer uptake in bone has not been reported in detail. We measured the accuracy of attenuation coefficients of bovine femur segments and patient data using a tri-linear method applied to CT images obtained at different kVp settings. Attenuation values at 511 keV obtained with a (68)Ga/(68)Ge transmission scan were used as a reference standard. The impact of inaccurate attenuation images on PET standardized uptake values (SUVs) was then evaluated using simulated emission images and emission images from five patients with elevated levels of FDG uptake in bone at disease sites. The CT-based linear attenuation images of the bovine femur segments underestimated the true values by 2.9 ± 0.3% for cancellous bone regardless of kVp. For compact bone the underestimation ranged from 1.3% at 140 kVp to 14.1% at 80 kVp. In the patient scans at 140 kVp the underestimation was approximately 2% averaged over all bony regions. The sensitivity analysis indicated that errors in PET SUVs in bone are approximately proportional to errors in the estimated attenuation coefficients for the same regions. The variability in SUV bias also increased approximately linearly with the error in linear attenuation coefficients. These results suggest that bias in bone uptake SUVs of PET tracers ranges from 2.4% to 5.9% when using CT scans at 140 and 120 kVp for attenuation correction. Lower kVp scans have the potential for considerably more error in dense bone. This bias is present in any PET tracer with bone uptake but may be clinically insignificant for many imaging tasks. However, errors from CT-based attenuation correction methods should be carefully evaluated if quantitation of tracer uptake in bone is important.     

Suppression of high-density artefacts in x-ray CT images using temporal digital subtraction with application to cryotherapy

Image guidance in cryotherapy is usually performed using ultrasound. Although not currently in routine clinical use, x-ray CT imaging is an alternative means of guidance that can display the full 3D structure of the iceball, including frozen and unfrozen regions. However, the quality of x-ray CT images is compromised by the presence of high-density streak artefacts. To suppress these artefacts we applied temporal digital subtraction (TDS). This TDS method has the added advantage of improving the grey scale contrast between frozen and unfrozen tissue in the CT images. Two sets of CT images were taken of a phantom material, cryoprobes and a urethral warmer (UW) before and during the cryoprobe freeze cycle. The high density artefacts persisted in both image sets. TDS was performed on these two image sets using the corresponding mask image of unfrozen material and the same geometrical configuration of the cryoprobes and the UW. The resultant difference image had a significantly reduced artefact content. Thus TDS can be used to significantly suppress or eliminate high-density CT streak artefacts without reducing the metallic content of the cryoprobes. In vivo study needs to be conducted to establish the utility of this TDS procedure for CT assisted prostate or liver cryotherapy. Applying TDS in x-ray CT guided cryotherapy will facilitate estimation of the number and location of all frozen and unfrozen regions, potentially making cryotherapy safer and less operator dependent.