[High resolution reconstruction of PET images using the iterative OSEM algorithm]. / Auflösungsverbesserende Rekonstruktion von PET-Bildern mit dem iterativen OSEM-Algorithmus.

AIM: Improvement of the spatial resolution in positron emission tomography (PET) by incorporation of the image-forming characteristics of the scanner into the process of iterative image reconstruction. METHODS: All measurements were performed at the whole-body PET system ECAT EXACT HR(+) in 3D mode. The acquired 3D sinograms were sorted into 2D sinograms by means of the Fourier rebinning (FORE) algorithm, which allows the usage of 2D algorithms for image reconstruction. The scanner characteristics were described by a spatially variant line-spread function (LSF), which was determined from activated copper-64 line sources. This information was used to model the physical degradation processes in PET measurements during the course of 2D image reconstruction with the iterative OSEM algorithm. To assess the performance of the high-resolution OSEM algorithm, phantom measurements performed at a cylinder phantom, the hotspot Jaszczack phantom, and the 3D Hoffmann brain phantom as well as different patient examinations were analyzed. RESULTS: Scanner characteristics could be described by a Gaussian-shaped LSF with a full-width at half-maximum increasing from 4.8 mm at the center to 5.5 mm at a radial distance of 10.5 cm. Incorporation of the LSF into the iteration formula resulted in a markedly improved resolution of 3.0 and 3.5 mm, respectively. The evaluation of phantom and patient studies showed that the high-resolution OSEM algorithm not only lead to a better contrast resolution in the reconstructed activity distributions but also to an improved accuracy in the quantification of activity concentrations in small structures without leading to an amplification of image noise or even the occurrence of image artifacts. CONCLUSION: The spatial and contrast resolution of PET scans can markedly be improved by the presented image restauration algorithm, which is of special interest for the examination of both patients with brain disorders and small animals.

Performance of a whole-body PET scanner using curve-plate NaI(Tl) detectors.

UNLABELLED: A whole-body PET scanner, without interplane septa, has been designed to achieve high performance in clinical applications. The C-PET scanner, an advancement of the PENN PET scanners, is unique in the use of 6 curved NaI(Tl) detectors (2.54 cm thick). The scanner has a ring diameter of 90 cm, a patient port diameter of 56 cm, and an axial field of view of 25.6 cm. A (137)Cs point source is used for transmission scans. METHODS: Following the protocols of the International Electrotechnical Commission ([IEC] 61675-1) and the National Electrical Manufacturers Association ([NEMA] NU-2-1994 and an updated version, NU2-2001), point and line sources, as well as uniform cylinders, were used to determine the performance characteristics of the C-PET scanner. An image-quality phantom and patient data were used to evaluate image quality under clinical scanning conditions. Data were rebinned with Fourier rebinning into 2-dimensional (slice-oriented) datasets and reconstructed with an iterative reconstruction algorithm. RESULTS: The spatial resolution for a point source in the transaxial direction was 4.6 mm (full width at half maximum) at the center, and the axial resolution was 5.7 mm. For the NU2-1994 analysis, the sensitivity was 12.7 cps/Bq/mL (444 kcps/microCi/mL), the scatter fraction was 25%, and the peak noise equivalent count rate (NEC) for a uniform cylinder (diameter = 20 cm, length = 19 cm) was 49 kcps at an activity concentration of 11.2 kBq/mL. For the IEC protocol, the peak NEC was 41 kcps at 12.3 kBq/mL, and for the NU2-2001 protocol, the peak NEC was 14 kcps at 3.8 kBq/mL. The NU2-2001 NEC value differed significantly because of differences in the data analysis and the use of a 70-cm-long phantom. CONCLUSION: Compared with previous PENN PET scanners, the C-PET, with its curved detectors and improvements in pulse shaping, integration dead time, and triggering, has an improved count-rate capability and spatial resolution. With the refinements in the singles transmission technique and iterative reconstruction, image quality is improved and scan time is shortened. With single-event transmission scans interleaved between sequential emission scans, a whole-body study can be completed in <1 h. Overall, C-PET is a cost-effective PET scanner that performs well in a broad variety of clinical applications.

Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders?

BACKGROUND: The association of hyperglycaemia with reduced fluorodeoxyglucose (FDG) uptake by tumour cells is well established. Therefore, it is standard practice that all patients must fast for at least several hours prior to FDG positron emission tomography (PET) imaging. However, the effect of hyperglycaemia on FDG uptake by inflammatory and infectious lesions is unknown. The aim of this study was to investigate this important issue. METHODS: For in vitro studies human mononuclear cells were isolated from 12 normal volunteers and FDG uptake was determined in medium containing differing concentrations of glucose. FDG uptake by human mesothelioma cells was also measured for comparison. For studies involving patients, 416 FDG PET scans of patients with confirmed malignancy (n=321) or benign lesions (n=95) were reviewed retrospectively. The relationship between serum glucose level and FDG uptake by the lesions was assessed utilizing the standardized uptake value (SUV) technique. RESULTS: In the in vitro studies, while FDG uptake by mesothelioma cells decreased as glucose concentration increased, there was no differential uptake of FDG uptake by mononuclear cells at glucose concentrations less than 250 mg x dl(-1). In clinical patients, FDG uptake by malignant lesions was slightly, but negatively affected by serum glucose level (r= -0.21, P<0.01) (glucose range 49-187 mg x dl(-1)). In contrast, FDG uptake by inflammatory lesions was positively associated with serum glucose level (r=0.43, P<0.01) (glucose range 54-215 mg x dl(-1)). DISCUSSION AND CONCLUSION: While the degree of FDG uptake is primarily influenced by the nature of the underlying lesion, serum glucose concentration appears to have a small effect on FDG uptake, which differs between malignant disorders and inflammatory processes. Our data suggest that below a certain level, elevated glucose concentration might not have a negative effect on FDG uptake in inflammatory cells, contrary to that observed in malignant disorders.

F-18 FDG uptake in a patient with psoriatic arthritis: imaging correlation with patient symptoms.

The authors describe a patient with psoriatic arthritis in whom an increased level of F-18 fluorodeoxyglucose (F-18 FDG) uptake was seen in the joints of the hands. The areas of increased activity correlated well with the regions of symptoms reported by the patient. This case illustrates the potential use of F-18 FDG positron emission tomography to quantitatively assess the degree of arthritis activity.

Osseous stress reaction in a rower diagnosed with positron emission tomography (PET): a case report.

Back injury is one of the most frequently encountered injuries in the collegiate rower. The differential diagnosis of back pain in the competitive rower includes muscle strain, ligament/tendon injury, stress reaction, stress fracture, and a tear in the annulus fibrosis. Endurance sports, such as rowing, have an increased frequency of stress injury The diagnosis of stress reaction cannot be made with plain radiographs. Many studies have firmly established the efficacy of single photon emission computed tomography (SPECT) bone scans and magnetic resonance imaging in establishing the diagnosis of a stress reaction We present a case of a collegiate rower with mid back pain secondary to a stress reaction of the endplates of the costotransverse articulation at the T8 level diagnosed by a positive positron emission tomogram study in the setting of a negative SPECT scan.

Energy-based scatter correction for 3-D PET scanners using NaI(T1) detectors.

Earlier investigations with BGO positron emission tomography (PET) scanners showed that the scatter correction technique based on multiple acquisitions with different energy windows are problematic to implement because of the poor energy resolution of BGO (22%), particularly for whole-body studies. We believe that these methods are likely to work better with NaI(TI) because of the better energy resolution achievable with NaI(TI) detectors (10%). Therefore, we investigate two different choices for the energy window, a low-energy window (LEW) on the Compton spectrum at 400-450 keV, and a high-energy window (HEW) within the photopeak (lower threshold above 511 keV). The results obtained for our three-dimensional (3-D) (septa-less) whole-body scanners [axial field of view (FOV) of 12.8 cm and 25.6 cm] as well as for our 3-D brain scanner (axial FOV of 25.6 cm) show an accurate prediction of the scatter distribution for the estimation of trues method (ETM) using a HEW, leading to a significant reduction of the scatter contamination. The dual-energy window (DEW) technique using a LEW is shown to be intrinsically wrong; in particular, it fails for line source and bar phantom measurements. However, the method is able to produce good results for homogeneous activity distributions. Both methods are easy to implement, are fast, have a low noise propagation, and will be applicable to other PET scanners with good energy resolution and stability, such as hybrid NaI(TI) PET/SPECT dual-head cameras and future PET cameras with GSO or LSO scintillators.

[Reduction of radiation exposure in PET examinations by data acquisition in the 3D mode]. / Reduktion der Strahlenexposition bei PET-Untersuchungen durch Datenakquisition im 3D-Modus.

AIM: Modern volume PET systems offer the possibility to measure without the shadowing effect of interplane septa (2D mode) and thus to detect coincident events between detectors on distant rings (3D mode). It was the aim of the present paper to characterize the count rate behaviour of a latest-generation whole-body PET system in the 2D and 3D mode as well as to discuss the consequences for the radiation hygiene of PET examinations with 2-[F-18]-fluoro-2-deoxyglucose (18-F-FDG). METHODS: All experiments were performed with the PET system ECAT EXACT HR+. For 2D data acquisition, a collimator of thin tungsten septa was positioned in the field-of-view. The count rate behaviour of the scanner was evaluated in the 2D and 3D mode over a wide range of F-18 activity concentrations following the NEMA protocol. Moreover, PET images of the EEC whole-body phantom with different inserts were acquired in the 2D and 3D mode over a period of 15 min each. For the 3D measurement, the activity concentrations of the F-18 solution were only half of those used for the 2D measurement. RESULTS: For the circular NEMA phantom (phi = 19.4 cm, length = 19.0 cm), we observed an increase of the system sensitivity in the 3D mode by a factor of about 5 with respect to the 2D mode (27.7 vs. 5.7 cps/Bq/ml). The evaluation of the activity distributions of the EEC phantom reconstructed from the 3D data set revealed a superior image quality compared to the corresponding 2D images despite the fact that the activity concentrations were only half as high. CONCLUSIONS: By using the 3D data acquisition mode, it is possible to markedly reduce the amount of activity to be applied to the patient and nevertheless to improve image quality. In our experience, it is sufficient to administer an activity of 150-200 MBq for whole-body examinations with F-18-FDG, which results in an effective equivalent dose of 3 or 4 mSv, respectively.

[Experimental determination of the lower energy discriminator level of positron emission tomographs]. / Experimentelle Bestimmung der unteren Energieschwelle eines Positronen-Emissions-Tomographen.

AIM: Using the continuous energy spectra of Compton scattered photons we measured the lower energy discriminator level of a positron emission tomograph (PET). METHODS: In PET scans, coincident photons with an energy between the lower and upper level of the energy discriminator (LLD/ULD) are acquired. Usually, the energy response of a detector is determined by measurements using various radiation sources with different energies. But this method is limited to the availability of the sources with the desired energies. The procedure described in this paper uses the energy spectrum from Compton scattered photons, providing a continuous energy spectrum for the direct measurement of the energy response of the detectors. For our measurements we used an activated Cu-64 point source (phi = 1 mm) which was positioned in an aluminium sphere (phi = 2 cm). RESULTS: The measured LLD values for a whole-body PET-scanner ECAT EXACT HR+ (CTI/Siemens) were systematically lower than the nominal values (327 keV instead of 350 keV) and confirm the results of C. Watson, recently found for line sources. CONCLUSION: This leads to an increased number of detected low energy photons (mainly scattered photons) and has to be taken into account within the scatter correction.

Investigation of scattered radiation in 3D whole-body positron emission tomography using Monte Carlo simulations.

The correction of scattered radiation is one of the most challenging tasks in 3D positron emission tomography (PET) and knowledge about the amount of scatter and its distribution is a prerequisite for performing an accurate correction. One concern in 3D PET in contrast to 2D PET is the scatter contribution from activity outside the field-of-view (FOV) and multiple scatter. Using Monte Carlo simulations, we examined the scatter distribution for various phantoms. The simulations were performed for a whole-body PET system (ECAT EXACT HR+, Siemens/CTI) with an axial FOV of 15.5 cm and a ring diameter of 82.7 cm. With (without) interplane septa, up to one (two) out of three detected events are scattered (for a centred point source in a water-filled cylinder that nearly fills out the patient port), whereby the relative scatter fraction varies significantly with the axial position. Our results show that for an accurate scatter correction, activity as well as scattering media outside the FOV have to be taken into account. Furthermore it could be shown that there is a considerable amount of multiple scatter which has a different spatial distribution from single scatter. This means that multiple scatter cannot be corrected by simply rescaling the single scatter component.

[Investigation of the signal-to-noise ratio on a state-of-the-art PET system: measurements with the EEC whole-body phantom]. / Untersuchung des Signal-zu-Rausch-Verhältnisses an einem modernen PET-System: Messungen am EEC-Ganzkörperphantom.

AIM: The spatial resolution of PET scanners can be improved by using smaller detector elements. This approach, however, results in poorer counting statistics of the reconstructed images. Therefore, the aim of this study was to investigate the influence of different acquisition parameters on the signal-to-noise ratio (SNR) and thus to optimize PET image quality. METHODS: The experiments were performed with the latest-generation whole-body PET system (ECAT Exact HR+, Siemens/CTI) using the standard 2D and 3D data acquisition parameters recommended by the manufacturer. The EEC whole-body phantom with different inserts was used to simulate patient examinations of the thorax. Emission and transmission scans were acquired with varying numbers of events and at different settings of the lower level energy discriminator. The influence of the number of counts on the SNR was parameterized using a simple model function. RESULTS: For count rates frequently encountered in clinical PET studies, the emission scan has a stronger influence on the SNR in the reconstructed image than the transmission scan. The SNR can be improved by using a higher setting of the lower energy level provided that the total number of counts is kept constant. Based on the established model function, the relative duration of the emission scan with respect to the total acquisition time was optimized, yielding a value of about 75% for both the 2D and 3D mode. CONCLUSION: The presented phenomenological approach can readily be employed to optimize the SNR and thus the quality of PET images acquired at different scanners or with different examination protocols.

[Optimization of PET image quality by means of 3D data acquisition and iterative image reconstruction]. / Optimierung der Bildqualität von PET-Aufnahmen durch 3D-Datenakquisition und iterative Bildrekonstruction.

PURPOSE: In the recent past, several algorithms have been developed in order to transform 3D sinograms acquired at volume PET systems into 2D data sets. These methods offer the possibility to combine the high sensitivity of the 3D measurement with the advantages of iterative 2D image reconstruction. The purpose of our study was the assessment of this approach by using phantom measurements and patient examinations. METHODS: The experiments were performed at the latest-generation whole-body PET system ECAT EXACT HR+. For 2D data acquisition, a collimator of thin tungsten septa was positioned in the field-of-view. Prior to image reconstruction, the measured 3D data were sorted into 2D sinograms by suing the Fourier rebinning (FORE) algorithm developed by M. Defrise. The standard filtered backprojection (FBP) method and an optimized ML/EM algorithm with overrelaxation for accelerated convergence were employed for image reconstruction. The spatial resolution of both methods as well as the convergence and noise properties of the ML/EM algorithm were studied in phantom measurements. Furthermore, patient data were acquired in the 2D mode as well as in the 3D mode and reconstructed with both techniques. RESULTS: At the same spatial resolution, the ML/EM-reconstructed images showed fewer and less prominent artefacts than the FBP-reconstructed images. The resulting improved detail conspicuously was achieved for the data acquired in the 2D mode as well as in the 3D mode. The best image quality was obtained by iterative 2D reconstruction of 3D data sets which were previously rebinned into 2D sinograms with help of the FORE algorithm. The phantom measurements revealed that 50 iteration steps with the optimized ML/EM algorithm were sufficient to keep the relative quantitation error below 5%. CONCLUSION: Our measurements show that the image quality in 3D PET can be improved by using iterative reconstruction techniques. The concept of 3D data acquisition and combining the FORE algorithm with 2D ML/EM reconstruction can readily be employed in clinical practice since the computation time is not considerably longer than that in iterative reconstruction of true 2D data.

Performance evaluation of a whole-body PET scanner using the NEMA protocol. National Electrical Manufacturers Association.

UNLABELLED: This study evaluates the performance of the newly developed high-resolution whole-body PET scanner ECAT EXACT HR+. METHODS: The scanner consists of four rings of 72 bismuth germanate block detectors each, covering an axial field of view of 15.5 cm with a patient port of 56.2 cm. A single block detector is divided into an 8 x 8 matrix, giving a total of 32 rings with 576 detectors each. The dimensions of a single detector element are 4.39 x 4.05 x 30 mm3. The scanner is equipped with extendable tungsten septa for two-dimensional two-dimensional measurements, as well as with three 68Ge line sources for transmission scans and daily quality control. The spatial resolution, scatter fraction, count rate, sensitivity, uniformity and accuracy of the implemented correction algorithms were evaluated after the National Electrical Manufacturers Association protocol using the standard acquisition parameters. RESULTS: The transaxial resolution in the two-dimensional mode is 4.3 mm (4.4 mm) in the center and increases to 4.7 mm (4.8 mm) tangential and to 8.3 mm (8.0 mm) radial at a distance of r = 20 cm from the center. The axial slice width measured in the two-dimensional mode varies between 4.2 and 6.6 mm FWHM over the transaxial field of view. In the three-dimensional mode the average axial resolution varies between 4.1 mm FWHM in the center and 7.8 mm at r = 20 cm. The scatter fraction is 17.1% (32.5%) for a lower energy discriminator level of 350 keV. The maximum true event count rate of 263 (345) kcps was measured at an activity concentration of 142 (26.9) kBq/ml. The total system sensitivity for true events is 5.7 (27.7) cps/Bq/ml. From the uniformity measurements, we obtained a volume variance of 3.9% (5.0%) and a system variance of 1.6% (1.7%). The implemented three-dimensional scatter correction algorithm reveals very favorable properties, whereas the three-dimensional attenuation correction yields slightly inaccurate results in low- and high-density regions. CONCLUSION: The ECAT EXACT HR+ has an excellent, nearly isotropic spatial resolution, which is advantageous for brain and small animal studies. While the relatively low slice sensitivity may hamper the capability for performing fast dynamic two-dimensional studies, the scanner offers a sufficient sensitivity and count rate capacity for fully three-dimensional whole-body imaging.

Monte Carlo-based analysis of PET scatter components.

UNLABELLED: This study quantifies the different scatter components in PET and examines how the different components degrade reconstructed PET images. METHODS: We simulated the measurement of various phantoms using Monte Carlo (MC) calculations and compared the MC-generated projections and images with the corresponding experimental data. The coincidences were subdivided in four classes: primaries, object scatter (scattered in the object only), gantry scatter (scattered in the scanner only) and mixed scatter (scattered both in the object and the scanner). RESULTS: In the projections of the line sources, the gantry scatter was closely located around the source position, whereas the object scatter was smeared over the whole field of view and could be parameterized well by a monoexponential function. The mixed scatter had nearly the same distribution as the object scatter, but with a smaller amplitude. The calculations and experimental data were in excellent agreement; i.e., led to the same parameterization of the scatter distribution functions and to a similar localization of the scatter components in the reconstructed images. CONCLUSION: The spatial distribution of the scatter components justifies the widely-used assumption that it is sufficient to restrict experimental scatter correction techniques to the object scatter. Furthermore, it is possible to derive the parameters for the scatter kernels, which are needed for the convolution-subtraction algorithm, by MC simulations.