A novel objective method for discriminating pathological and physiological colorectal uptake in the lower abdominal region using whole-body dynamic 18F-FDG-PET.

OBJECTIVES: To investigate whether the center-of-mass shift distance (CMSD) analysis on whole-body dynamic positron emission tomography (WBD-PET) with continuous bed motion is an objective index for discriminating pathological and physiological uptake in the lower abdominal colon. METHODS: We retrospectively analyzed the CMSD in 39 patients who underwent delayed imaging to detect incidental focal uptake that was difficult to determine as pathological and physiological on a conventional early-PET (early) image reconstructed by 5-phase WBD-PET images. The CMSD between each phase of WBD-PET images and between conventional early and delayed (two-phase) PET images were classified into pathological and physiological uptake groups based on endoscopic histology or other imaging diagnostics. The diagnostic performance of CMSD analysis on WBD-PET images was evaluated by receiver operator characteristic (ROC) analysis and compared to that of two-phase PET images. RESULTS: A total of 66 incidental focal uptake detected early image were classified into 19 and 47 pathological and physiological uptake groups, respectively. The CMSD on WBD-PET and two-phase PET images in the pathological uptake group was significantly lower than that in the physiological uptake group (p < 0.01), respectively. The sensitivity, specificity, and accuracy in CMSD analysis on WBD-PET images at the optimal cutoff of 5.2 mm estimated by the Youden index were 94.7%, 89.4%, and 89.4%, respectively, which were not significantly different (p = 0.74) from those of two-phase PET images. CONCLUSIONS: The CMSD analysis on WBD-PET was useful in discriminating pathological and physiological colorectal uptake in the lower abdominal region, and its diagnostic performance was comparable to that of two-phase PET images. We suggested that CMSD analysis on WBD-PET images would be a novel objective method to omit unnecessary additional delayed imaging.

Specific Binding Ratio Estimation of [123I]-FP-CIT SPECT Using Frontal Projection Image and Machine Learning.

This study aimed to develop a new convolutional neural network (CNN) method for estimating the specific binding ratio (SBR) from only frontal projection images in single-photon emission-computed tomography using [123I]ioflupane. We created five datasets to train two CNNs, LeNet and AlexNet: (1) 128FOV used a 0° projection image without preprocessing, (2) 40FOV used 0° projection images cropped to 40 × 40 pixels centered on the striatum, (3) 40FOV training data doubled by data augmentation (40FOV_DA, left-right reversal only), (4) 40FOVhalf, and (5) 40FOV_DAhalf, split into left and right (20 × 40) images of 40FOV and 40FOV_DA to separately evaluate the left and right SBR. The accuracy of the SBR estimation was assessed using the mean absolute error, root mean squared error, correlation coefficient, and slope. The 128FOV dataset had significantly larger absolute errors compared to all other datasets (p < 0. 05). The best correlation coefficient between the SBRs using SPECT images and those estimated from frontal projection images alone was 0.87. Clinical use of the new CNN method in this study was feasible for estimating the SBR with a small error rate using only the frontal projection images collected in a short time.

Acquisition count dependence of the specific binding ratio in 123I-FP-CIT SPECT.

OBJECTIVE: In the [123I]FP-CIT single-photon emission computed tomography (SPECT) examination, the specific binding ratio (SBR), calculated from the ratio of the striatal specific to extra-striatal background non-specific binding in the brain, is now commonly used as a quantitative index of parkinsonian syndrome. The purpose of this study was to examine the influence of count reduction on the SBR and to clarify the reliability of SBR values in patients with shorter scan times. METHODS: A striatum phantom was used in a phantom study, with the radioactivity concentration adjusted so that the right striatum:left striatum:brain parenchyma ratio was 8:4:1. Changes in SBR values and image quality, expressed as the % coefficient of variation (%CV) and normalized mean squared error (NMSE), with decreasing acquisition counts were evaluated. In the clinical study, 106 patients (73.1 ± 9.6 years) with suspected parkinsonian syndrome underwent [123I]FP-CIT SPECT, and SBR values from normal 30 min acquisitions (fullSBR) and half-count acquisitions (halfSBR) were compared. SBR values were calculated using the Tossici-Bolt (SBRTB) and a fully automatic count-based (SBRcb) methods. RESULTS: In the phantom study, image quality decreased with a reduction of acquisition counts. The %CV and NMSE decreased by up to 52.5% and 81.5%, respectively. SBR values decreased slightly as acquisition counts decreased. In the clinical study, the mean values of halfSBR were lower than those of fullSBR, and they were significantly different except for SBRTB without attenuation correction. halfSBR and fullSBR values correlated well, with halfSBR values 1-8% lower than fullSBR. The accuracy of diagnosis did not decrease even after acquisition counts were reduced by half. CONCLUSION: This study demonstrated that SBR values decrease as a function of reduced acquisition counts. Since halfSBR and fullSBR showed excellent correlation, it is suggested that fullSBR can be estimated from halfSBR using a calibration formula when scan times are reduced.

[Simplification of Activity Measurement during Quantitative Value Estimation in Bone SPECT].

PURPOSE: To calculate the quantitative values in bone single-photon emission computed tomography, it is necessary to measure the amount of syringe radiation before and after the administration of a radiopharmaceutical. We proposed a method to omit the measurement of radioactivity. In this study, we clarified the effects of adopting this method and calculated its influence on quantitative values in a clinical setting. METHODS: We derived a relational expression of the administration time and dose of radioactivity from the measured value and the administration time of the syringe dose before and after the administration in each patient. Next, we determined the differences for radioactivity calculated from this relational expression (estimated dose) and actual administered radioactivity (actual dose). Furthermore, we calculated the differences in the quantitative values of a normal region (the fourth lumbar vertebra) on adopting these data. RESULTS: No significant differences between the estimated dose and actual dose were noted. Additionally, no significant differences in the quantitative values were observed. CONCLUSION: Our findings suggest that adoption of the estimated dose does not affect the quantitative value. When the estimated dose is adopted, it can be administered with an accuracy of 0.80%. Thus, it is possible to omit the actual measurement of radioactivity by using our proposed method.

Standardization of the specific binding ratio in [123I]FP-CIT SPECT: study by striatum phantom.

OBJECTIVE: The quantitative values of the specific binding ratio (SBR) in [I]FP-CIT have been reported to change because of differences in apparatus, collection conditions, and image reconstruction. The aim of this study was to clarify the distribution of calculated SBR values by performing [I]FP-CIT single-photon emission computed tomography in a multicenter collaborative study using a phantom. A simple correction method was also devised that enables direct comparison of the SBR value calculated at one facility with those calculated at other facilities. MATERIALS AND METHODS: Data were acquired at 14 facilities using the phantom adjusted to right striatum : left striatum : cerebral parenchyma (back ground)=8 : 4 : 1, and the SBR values were calculated.We devised a method to correct the SBR using the results of experiments with a known ratio phantom. RESULTS: The SBR values considerably differed between facilities. The average SBR with a theoretical value of 7 and with a theoretical value of 3 in all facilities was 6.48±0.89 and 2.58±0.51, respectively. The range of SBRs with a theoretical value of 7 and a theoretical value of 3 was 3.18 and 1.59, respectively. We devised a simple method for calibrating the SBR value at the clinical examination of each facility to a directly comparable value. CONCLUSION: Direct comparison of the SBR with those of other facilities and sharing other facilities normal values is clinically difficult. We devised countermeasures that do not affect the diagnosis and developed a simple tool to calculate the standardized SBR.

Influence of myocardial count on phase dyssynchrony analysis of gated myocardial perfusion single-photon emission computed tomography.

OBJECTIVES: Drugs and acquisition times for gated myocardial perfusion single-photon emission computed tomography scintigraphy vary depending on the facility. Even if the same examination is performed in the same facility, the acquisition count differs for each examination because factors such as the patient's age, stress protocol of the patient, the biological half-life of the stress agent, and the patient's response are different. We aimed to evaluate the differences in acquisition counts on the effect of left ventricular function and phase analysis indices. MATERIALS AND METHODS: A gated myocardial perfusion phantom was used. The acquisition times acquired were varied (nine steps from 3 to 51 s per view). The myocardial average count per pixel of the left anterior oblique (LAO) of 45° of projection data were 9.4, 17.8, 28.7, 47.1, 67.1, 97.7, 122.7, 174.4, and 254.0 counts per view. We used the count value of LAO of 45° of projection data to find the lowest count that the left ventricular function and phase analysis indices can accurately calculate. The left ventricular function indices evaluated were the left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV). The bandwidth, phase SD, and entropy were evaluated as phase analysis indices. RESULTS: Functional analysis: LVEF and EDV showed constant values even when the collection count changed (%coefficient of variation (CV) of LVEF=2.1%, %CV of EDV=3.9%). The ESV value was large when the lowest count was obtained (9.4 counts per pixel per view), which caused %CV of ESV to be greater than that of LVEF and EDV (%CV of EDV=7.8%). Phase analysis indices: The difference between the highest and lowest values was that the bandwidth was 100.0%, phase SD was 62.0%, and entropy was 58.3%. Phase analysis indices declined as a function of increasing acquisition time. CONCLUSION: To accurately calculate left ventricular function, the myocardial counts of LAO of 45° of projection data should be at least 17.8 average counts per pixel per view. To accurately calculate the phase analysis index, the myocardial counts of LAO of 45° of projection data should be at least 67.1 average counts per pixel per view.

[Development of simple processing for deleting undershooting artifact using the FBP method ─evaluation of simulation data─].

The undershooting artifact occurs using the filtered back projection (FBP) method. This artifact is influenced by a ramp filter. Thereby, the fall of the target accumulation and a deficit arise and it becomes a clinical problem. We developed a new image reconstruction method based on the FBP method to delete the undershooting artifact of FBP. The image quality of the FBP method is equivalent to that obtained by an evaluation using a digital phantom. The two segmentation and ordinary FBP methods were evaluated in terms of hot contrast, cold contrast, coefficient of variation (%CV), and root mean square uncertainty (%RSMU). The two segmentation FBP method showed equivalent values of hot contrast, % CV, and% RSMU compared with those of the ordinary FBP method. With a threshold level value, cold contrast sharply changed. However, when the threshold level of the two segmentation FBP method was set as the proper value, 90% contrast was obtained. It is necessary to set a threshold level as a proper value using the two segmentation FBP methods. I thought that it can delete an artifact in a simple way, without impairing the image quality. However, it is an examination of only a digital phantom this time. Before using it clinically, one has to use and verify a real phantom.

[Uncertainty of cross calibration-applied beam quality conversion factor for the Japan Society of Medical Physics 12].

The uncertainty of the beam quality conversion factor (k(Q,Q0)) of standard dosimetry of absorbed dose to water in external beam radiotherapy 12 (JSMP12) is determined by combining the uncertainty of each beam quality conversion factor calculated for each type of ionization chamber. However, there is no guarantee that ionization chambers of the same type have the same structure and thickness, so there may be individual variations. We evaluated the uncertainty of k(Q,Q0) for JSMP12 using an ionization chamber dosimeter and linear accelerator without a specific device or technique in consideration of the individual variation of ionization chambers and in clinical radiation field. The cross calibration formula was modified and the beam quality conversion factor for the experimental values [(k(Q,Q0))field] determined using the modified formula. It's uncertainty was calculated to be 1.9%. The differences between (k(Q,Q0))field of experimental values and k(Q,Q0) for Japan Society of Medical Physics 12 (JSMP12) were 0.73% and 0.88% for 6- and 10-MV photon beams, respectively, remaining within ± 1.9%. This showed k(Q,Q0) for JSMP12 to be consistent with (k(Q,Q0))field of experimental values within the estimated uncertainty range. Although inter-individual differences may be generated, even when the same type of ionized chamber is used, k(Q,Q0) for JSMP12 appears to be consistent within the estimated uncertainty range of (k(Q,Q0)field.

[Comparison of the absorbed dose at calibration depth of photon beams using the Japan Society of Medical Physics 12 beam quality conversion factor in the presence or absence of a waterproofing sleeve].

In standard external beam radiotherapy dosimetry, which is based on absorbed dose by water, the absorbed dose at any calibration depth is calculated using the same beam quality conversion factor, regardless of the presence or absence of a waterproofing sleeve. In this study, we evaluated whether there were differences between absorbed doses at calibration depths calculated using a beam quality conversion factor including a wall correction factor that corresponds to a waterproofing sleeve thickness of 0.3 mm, and without a waterproofing sleeve. The Japan Society of Medical Physics (JSMP) has reported that the uncertainty of the results using a beam quality conversion factor that included a wall correction factor corresponding to a waterproofing sleeve thickness of 0.3 mm, regardless of the presence or absence of the sleeve, was 0.2%. This uncertainty proved to be in agreement with the reported range.

[A comparison of absorbed doses to water in photon beams in Japan Society of Medical Physics 01 and 12].

A comparison of absorbed doses to water at a calibration depth determined by Japan Society of Medical Physics (JSMP) 12 and 01 was conducted, using a farmer type ionization chamber. The absorbed dose to water calibration factor (ND,W,Q0) and beam quality conversion factor (kQ,Q0) for JSMP 12 were smaller than the absorbed dose to water calibration factor and beam quality conversion factor for JSMP 01. Differences in absorbed doses at a calibration depth were -0.78% for 6 MV photon beam and -0.94% for 10 MV photon beam. In the present experiment, absorbed doses at a calibration depth were measured, using a farmer type ionization chamber. Further experiments at a larger number of facilities should be conducted to reveal the status of measurement of absorbed doses at a calibration depth using JSMP 12.

[Usefulness of top-hat transform processing in whole body bone scintigraphy].

To assess the usefulness of top-hat transform processing in whole body bone scintigraphy, five radiological technicians interpreted both original and top-hat processed images to determine the improvement of lesion detectability and interpretation time. For the evaluation of detectability, receiver operating characteristic (ROC) analysis was performed. The area under the curve (AUC) calculated from the ROC curve was improved in all observers (from 0.786 to 0.864 in average), although no significant difference was observed. However, the interpretation time was improved significantly (from 24.5 to 16.2 s in average). Top-hat transform processing in whole body bone scintigraphy is thought to be useful for the improvement of lesion detectability and interpretation time.

[A simple method for generating temporal subtraction image in bone SPECT-initial evaluation in pelvic region-].

We proposed and optimized a simple method of temporal subtraction image between successive bone single photon emission computed tomography (SPECT) images for supporting interpretation of temporal changes, and we evaluated its clinical utility. This method consisted of image registration, count normalization, and image subtraction. For image registration, we used a BEAT-Tl software. For count normalization, a pixel value of the normal accumulation part in a SPECT image was used as a reference region. We evaluated accuracy of image registration and optimized the normalization procedure. The accuracy of image registration ranged within 1 pixel in all directions (x, y, x-axis, and rotation). As the reference region, the second lumbar vertebra showed the best results in terms of the normalization procedure. Our method simply allowed the production of a temporal subtraction image. Because the software used in this method can be used free, this method would be available in every institution.

[Dynamic contrast-enhanced T(1) measuring MRI using variable flip angle SPGR].

We modified the multi-phase spoiled gradient recalled echo (SPGR) pulse sequence using the double-echo MR technique for estimation of T(1) during the first pass of contrast agent, and examined its precision. In the first half of the pulse sequence, the flip angle was varied systematically to calculate static T(1) values. It was necessary to choose optimal flip angles to minimize the calculation error of static T(1) values. In the latter half of this sequence, changes in absolute T(1) were calculated using differences in signal intensities before and after the injection of contrast agent. The optimal flip angle was 20 degrees for precise conversion to T(1) values under the short TR (33.3 ms) condition. Double echo MR data were used to minimize the T(2)* effect. The present method appears to be useful for quantitative estimation of dynamic contrast-enhanced MRI.