EJNMMI Physics最新文献

Purpose: To develop a deep learning (DL) model for generating automated regions of interest (ROIs) on ^99mTc-diethylenetriamine pentaacetic acid (DTPA) renal scans for glomerular filtration rate (GFR) measurement.

Methods: Manually-drawn ROIs retrieved from a Picture Archiving and Communications System were used as ground-truth (GT) labels. A two-dimensional U-Net convolutional neural network architecture with multichannel input was trained to generate DL ROIs. The agreement between GFR values from GT and DL ROIs was evaluated using Lin's concordance correlation coefficient (CCC) and slope coefficients for linear regression analyses. Bias and 95% limits of agreement (LOA) were assessed using Bland-Altman plots.

Results: A total of 24,364 scans (12,822 patients) were included. Excellent concordance between GT and DL GFR was found for left (CCC 0.982, 95% confidence interval [CI] 0.981-0.982; slope 1.004, 95% CI 1.003-1.004), right (CCC 0.969, 95% CI 0.968-0.969; slope 0.954, 95% CI 0.953-0.955) and both kidneys (CCC 0.978, 95% CI 0.978-0.979; slope 0.979, 95% CI 0.978-0.979). Bland-Altman analysis revealed minimal bias between GT and DL GFR, with mean differences of - 0.2 (95% LOA - 4.4-4.0), 1.4 (95% LOA - 3.5-6.3) and 1.2 (95% LOA - 6.5-8.8) mL/min/1.73 m² for left, right and both kidneys, respectively. Notably, 19,960 scans (81.9%) showed an absolute difference in GFR of less than 5 mL/min/1.73 m².

Conclusion: Our DL model exhibited excellent performance in the generation of ROIs on ^99mTc-DTPA renal scans. This automated approach could potentially reduce manual effort and enhance the precision of GFR measurement in clinical practice.

Background: Internal dosimetry in individual patients is essential for safe and effective radioligand therapy. Multiple time point imaging for accurate dosimetry is time consuming and hence can be demanding for nuclear medicine departments as well as patients. The objectives of this study were (1) to assess absorbed doses to organs at risk and tumor lesions for [¹⁷⁷Lu]Lu-PSMA-I&T using whole body SPECT imaging and (2) to investigate possible simplified dosimetry protocols.

Methods: This study included 16 patients each treated with 4 cycles of [¹⁷⁷Lu]Lu-PSMA-I&T. They underwent quantitative whole body SPECT/CT imaging (3 bed positions) at four time points (TP) comprising 2 h, 24 h, 48 h and 72-168 h post-injection (p.i.). Full 3D dosimetry (reference method) was performed for all patients and dose cycles for organs at risk (kidneys, parotid glands and submandibular glands) and up to ten tumor lesions per patient (resulting in 90 lesions overall). The simplified dosimetry methods (SM) included (1) generating time activity curves for subsequent cycles using a single TP of imaging applying the kinetics of dose cycle 1, and for organs at risk also (2) simple extrapolation from dose cycle 1 and (3) from both, dose cycle 1 and 2.

Results: Normalized absorbed doses were 0.71 ± 0.32 mGy/MBq, 0.28 ± 0.12 mGy/MBq and 0.22 ± 0.08 mGy/MBq for kidneys, parotid glands and submandibular glands, respectively. Tumor doses decreased from 3.86 ± 3.38 mGy/MBq in dose cycle 1 to 2.01 ± 2.65 mGy/MBq in dose cycle 4. Compared to the full dosimetry approach the SM 1 using single TP imaging at 48 h p.i. resulted in the most accurate and precise results for the organs at risk in terms of absorbed doses per cycle and total cumulated dose. For tumor lesions better results were achieved using the fourth TP (≥ 72 h p.i.).

Conclusion: Simplification of safety dosimetry protocols is possible for [¹⁷⁷Lu]Lu-PSMA-I&T therapy. If tumor dosimetry is of interest a later imaging TP (≥ 72 h p.i.) should be used/added to account for the slower kinetics of tumors compared to organs at risk.

Background: Several research groups have explored the potential of scandium radionuclides for theragnostic applications due to their longer half-lives and equal or similar coordination chemistry between their diagnostic and therapeutic counterparts, as well as lutetium-177 and terbium-161, respectively. Unlike the gallium-68/lutetium-177 pair, which may show different in-vivo uptake patterns, the use of scandium radioisotopes promises consistent behaviour between diagnostic and therapeutic radiopeptides. An advantage of scandium's longer half-life over gallium-68 is the ability to study radiopeptide uptake over extended periods and its suitability for centralized production and distribution. However, concerns arise from scandium-44's decay characteristics and scandium-43's high production costs. This study aimed to evaluate the dosimetric implications of using scandium radioisotopes with somatostatin analogues against gallium-68 for PET imaging of neuroendocrine tumours.

Methods: Absorbed dose per injected activity (AD/IA) from the generated time-integrated activity curve (TIAC) were estimated using the radiopeptides [^43/44/44mSc]Sc- and [⁶⁸Ga]Ga-DOTATATE. The kidneys, liver, spleen, and red bone marrow (RBM) were selected for dose estimation studies. The EGSnrc and MCNP6.1 Monte Carlo (MC) codes were used with female (AF) and male (AM) ICRP phantoms. The results were compared to Olinda/EXM software, and the effective dose concentrations assessed, varying composition between the scandium radioisotopes.

Results: Our findings showed good agreement between the MC codes, with - 3 ± 8% mean difference. Kidneys, liver, and spleen showed differences between the MC codes (min and max) in a range of - 4% to 8%. This was observed for both phantoms for all radiopeptides used in the study. Compared to Olinda/EXM the largest observed difference was for the RBM, of 21% for the AF and 16% for the AM for scandium- and gallium-based radiopeptides. Despite the differences, our findings showed a higher absorbed dose on [^43/44Sc]Sc-DOTATATE compared to its ⁶⁸Ga-based counterpart.

Conclusion: This study found that [^43/44Sc]Sc-DOTATATE delivers a higher absorbed dose to organs at risk compared to [⁶⁸Ga]Ga-DOTATATE, assuming equal distribution. This is due to the longer half-life of scandium radioisotopes compared to gallium-68. However, calculated doses are within acceptable ranges, making scandium radioisotopes a feasible replacement for gallium-68 in PET imaging, potentially offering enhanced diagnostic potential with later timepoint imaging.

Background: The aim was to investigate the noise and bias properties of quantitative ¹⁷⁷Lu-SPECT with respect to the number of projection angles, and the number of subsets and iterations in the OS-EM reconstruction, for different total acquisition times.

Methods: Experimental SPECT acquisition of six spheres in a NEMA body phantom filled with ¹⁷⁷Lu was performed, using medium-energy collimators and 120 projections with 180 s per projection. Bootstrapping was applied to generate data sets representing acquisitions with 20 to 120 projections for 10 min, 20 min, and 40 min, with 32 noise realizations per setting. Monte Carlo simulations were performed of ¹⁷⁷Lu-DOTA-TATE in an anthropomorphic computer phantom with three tumours (2.8 mL to 40.0 mL). Projections representing 24 h and 168 h post administration were simulated, each with 32 noise realizations. Images were reconstructed using OS-EM with compensation for attenuation, scatter, and distance-dependent resolution. The number of subsets and iterations were varied within a constrained range of the product number of iterations $\times$ number of projections $\le 2400$ . Volumes-of-interest were defined following the physical size of the spheres and tumours, the mean activity-concentrations estimated, and the absolute mean relative error and coefficient of variation (CV) over noise realizations calculated. Pareto fronts were established by analysis of CV versus mean relative error.

Results: Points at the Pareto fronts with low CV and high mean error resulted from using a low number of subsets, whilst points at the Pareto fronts associated with high CV but low mean error resulted from reconstructions with a high number of subsets. The number of projection angles had limited impact.

Conclusions: For accurate estimation of the ¹⁷⁷Lu activity-concentration from SPECT images, the number of projection angles has limited importance, whilst the total acquisition time and the number of subsets and iterations are parameters of importance.

Purpose: ¹²³I-Ioflupane SPECT is an effective tool for the diagnosis and progression assessment of Parkinson's disease (PD). Radiomics and deep learning (DL) can be used to track and analyze the underlying image texture and features to predict the Hoehn-Yahr stages (HYS) of PD. In this study, we aim to predict HYS at year 0 and year 4 after the first diagnosis with combined imaging, radiomics and DL-based features using ¹²³I-Ioflupane SPECT images at year 0.

Methods: In this study, 161 subjects from the Parkinson's Progressive Marker Initiative database underwent baseline 3T MRI and ¹²³I-Ioflupane SPECT, with HYS assessment at years 0 and 4 after first diagnosis. Conventional imaging features (IF) and radiomic features (RaF) for striatum uptakes were extracted from SPECT images using MRI- and SPECT-based (SPECT-V and SPECT-T) segmentations respectively. A 2D DenseNet was used to predict HYS of PD, and simultaneously generate deep features (DF). The random forest algorithm was applied to develop models based on DF, RaF, IF and combined features to predict HYS (stage 0, 1 and 2) at year 0 and (stage 0, 1 and ≥ 2) at year 4, respectively. Model predictive accuracy and receiver operating characteristic (ROC) analysis were assessed for various prediction models.

Results: For the diagnostic accuracy at year 0, DL (0.696) outperformed most models, except DF + IF in SPECT-V (0.704), significantly superior based on paired t-test. For year 4, accuracy of DF + RaF model in MRI-based method is the highest (0.835), significantly better than DF + IF, IF + RaF, RaF and IF models. And DL (0.820) surpassed models in both SPECT-based methods. The area under the ROC curve (AUC) highlighted DF + RaF model (0.854) in MRI-based method at year 0 and DF + RaF model (0.869) in SPECT-T method at year 4, outperforming DL models, respectively. And then, there was no significant differences between SPECT-based and MRI-based segmentation methods except for the imaging feature models.

Conclusion: The combination of radiomic and deep features enhances the prediction accuracy of PD HYS compared to only radiomics or DL. This suggests the potential for further advancements in predictive model performance for PD HYS at year 0 and year 4 after first diagnosis using ¹²³I-Ioflupane SPECT images at year 0, thereby facilitating early diagnosis and treatment for PD patients. No significant difference was observed in radiomics results obtained between MRI- and SPECT-based striatum segmentations for radiomic and deep features.

Background: Good timing resolution in medical imaging applications such as TOF-CT or TOF-PET can boost image quality or patient comfort significantly by reducing the influence of background noise. However, the timing resolution of state-of-the-art detectors in CT and PET are limited by their light emission process. Core-valence cross-luminescence is an alternative, but well-known compounds (e.g. BaF₂) pose several problems for medical imaging applications, such as their emission wavelength in the deep UV. CsZnCl-based materials show promise to solve this issue, as they provide fast decay times of 1-2 ns and an emission wavelength around 300 nm.

Results: In this work, we investigated two CsZnCl-compounds: Cs₂ZnCl₄ and Cs₃ZnCl₅. We validated the previously published decay times on a time-correlated single-photon counting setup with 1.786 ± 0.016 ns for Cs₂ZnCl₄ and 1.034 ± 0.013 ns for Cs₃ZnCl₅. The setup's high resolution enabled the discovery of an additional prompt emission component with a significant abundance of 98 ± 18 (Cs₂ZnCl₄) and 86 ± 14 (Cs₃ZnCl₅) photons/MeV energy deposit. In a PET coincidence experiment, we measured the best coincidence time resolution (CTR) of 62 ps (FWHM) for Cs₂ZnCL₄ coupled to FBK VUV SiPMs with silicon oil. To assess the CTR for lower energies, we filtered the energy along the Compton continuum and found a deteriorated CTR that seems to be mainly influenced by photon statistics. Furthermore, this study gave us a rough estimate of e.g. 150 ps (FWHM) CTR at 100 keV energy for Cs₂ZnCL₄. From measurements with high activity of 14 MBq to check for pile-up effects we assume that Cs₂ZnCl₄ is better suited for high-rate time-of-flight applications than lutetium-based oxides. Simulations demonstrated that the stopping power of Cs₂ZnCl₄ is lower than for LSO:Ce,Ca, meaning that a high amount of material would be needed for TOF-PET applications. However, the stopping power seems acceptable for applications in TOF-CT.

Conclusions: The fast decay time, state-of-the-art CTR in benchtop experiments and high-rate suitability make CsZnCl materials a promising candidate for time-of-flight experiments. We consider especially TOF-CT a suitable application due to its relatively low X-ray energies (~ 100 keV) and the thusly acceptable stopping power of Cs₂ZnCl₄. Currently, further exploration of the prompt emission and its creation mechanism is planned, as well as investigating the light transport of Cs₂ZnCl₄ in longer crystals.

Background: Portable gamma cameras are being developed for nuclear medicine procedures such as thyroid scintigraphy. This article introduces Seracam® - a new technology that combines small field of view gamma imaging with optical imaging - and reports its performance and suitability for small organ imaging.

Methods: The count rate capability, uniformity, spatial resolution, and sensitivity for ^99mTc are reported for four integrated pinhole collimators of nominal sizes of 1 mm, 2 mm, 3 mm and 5 mm. Characterisation methodology is based on NEMA guidelines, with some adjustments necessitated by camera design. Two diagnostic scenarios - thyroid scintigraphy and gastric emptying - are simulated using clinically relevant activities and geometries to investigate application-specific performance. A qualitative assessment of the potential benefits and disadvantages of Seracam is also provided.

Results: Seracam's performance across the measured characteristics is appropriate for small field of view applications in nuclear medicine. At an imaging distance of 50 mm, corresponding to a field of view of 77.6 mm × 77.6 mm, spatial resolution ranged from 4.6 mm to 26 mm and sensitivity from 3.6 cps/MBq to 52.2 cps/MBq, depending on the collimator chosen. Results from the clinical simulations were particularly promising despite the challenging scenarios investigated. The optimal collimator choice was strongly application dependent, with gastric emptying relying on the higher sensitivity of the 5 mm pinhole whereas thyroid imaging benefitted from the enhanced spatial resolution of the 1 mm pinhole. Signal to noise ratio in images was improved by pixel binning. Seracam has lower measured sensitivity when compared to a traditional large field of view gamma camera, for the simulated applications this is balanced by advantages such as high spatial resolution, portability, ease of use and real time gamma-optical image fusion and display.

Conclusion: The results show that Seracam has appropriate performance for small organ ^99mTc imaging. The results also show that the performance of small field of view systems must be considered holistically and in clinically appropriate scenarios.

Purpose: This study proposes a practical method for evaluating 2D spatial resolution with scatter on a CZT planar detector gamma camera, which is simpler and faster than the NEMA method. It is used to characterize the influence of distance on spatial resolution FWHM on a CZT camera equipped with a WEHR collimator.

Methods: The practical method uses linear sources tilted with respect to the detector axes. The spatial resolution full width at half maximum (FWHM) with four tilt angles was compared to the FWHM evaluated using the NEMA NU1-2018 method. Spatial resolution FWHM was also assessed with tilted sources acquired at distances of 0 to 20 cm using a single angle, with and without the post-processing image enhancement proposed by the manufacturer.

Results: Estimated spatial resolution FWHM with tilted sources was close to the spatial resolution FWHM estimated at 7.63 mm by the NEMA method, with deviations ranging from - 5.62 to 4.59% at 10 cm depending on the angle considered. The study of spatial resolution FWHM dependence on distance indicates that, for distances less than 3 cm, the FWHM no longer decreases with distance. The manufacturer's post-processing reduces the FWHM by an average of 15%.

Conclusion: The practical method is quicker to implement and gives comparable results to the NEMA reference method for spatial resolution FWHM. Evaluation of spatial resolution with linear sources at short distances from the collimator is limited by the collimator effect and signal digitization. The tilted source method can be used to measure spatial resolution quickly and easily under clinical conditions for CZT planar cameras.

Background: Several factors may decrease the accuracy of quantitative PET myocardial perfusion imaging (MPI). It is therefore essential to ensure that myocardial blood flow (MBF) values are reproducible and accurate, and to design systematic protocols to achieve this. Until now, no systematic phantom protocols have been available to assess the technical factors affecting measurement accuracy and reproducibility in MPI.

Materials and methods: We implemented a standard measurement protocol, which applies a flow phantom in order to compare image-derived flow values with respect to a ground truth flow value with [¹⁵O]H₂O MPI performed on both a Discovery MI (DMI-20, GE Healthcare) and a Biograph Vision 600 (Vision-600, Siemens Healthineers) system. Both systems have automatic [¹⁵O]H₂O radio water generators (Hidex Oy) individually installed, allowing us to also study the differences occurring due to two different bolus delivery systems. To investigate the technical factors contributing to the modelled flow values, we extracted the [¹⁵O]H₂O bolus profiles, the flow values from the kinetic modeling (Qin and Qout), and finally calculated their differences between test-retest measurements on both systems.

Results: The measurements performed on the DMI-20 system produced Qin and Qout values corresponging to each other as well as to the reference flow value across all test-retest measurements. The repeatability differences on DMI-20 were 2.1% ± 2.6% and 3.3% ± 4.1% for Qin and Qout, respectively. On Vision-600 they were 10% ± 8.4% and 11% ± 10% for Qin and Qout, respectively. The measurements performed on the Vision-600 system showed more variation between Qin and Qout values across test-retest measurements and exceeded 15% difference in 7/24 of the measurements.

Conclusions: A preliminary protocol for measuring the accuracy and reproducibility of flow values in [¹⁵O]H₂O MPI between digital PET/CT systems was assessed. The test-retest reproducibility falls below 15% in majority of the measurements conducted between two individual injector systems and two digital PET/CT systems. This study highlights the importance of implementing a standardized bolus injection and delivery protocol and importance of assessing technical factors affecting flow value reproducibility, which should be carefully investigated in a multi-center setting.