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Quantitative PET and SPECT
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Quantitative PET and SPECT

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 32478

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Lioe-Fee de Geus-Oei

E-Mail Website
Guest Editor
Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
Interests: nuclear medicine; biomedical imaging; cancer pathogenesis and therapy
Special Issues, Collections and Topics in MDPI journals
Dr. Floris H. P. van Velden

E-Mail Website
Guest Editor
Department of Radiology, Section of Medical Technology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
Interests: PET quantification; absolute SPECT quantification; radiomics; image reconstruction

Special Issue Information

Dear colleagues,

Since the introduction of personalized medicine, the primary focus of imaging has moved from detection and diagnosis to tissue characterization, determination of prognosis, prediction of treatment efficacy, and measurement of treatment response. Precision (personalized) imaging heavily relies on the use of hybrid technologies and quantitative imaging biomarkers. The growing number of promising theranostics request accurate quantification for pre- and post-treatment dosimetry. Furthermore, quantification is required in the pharmacokinetic analysis of new tracers and drugs and in the assessment of drug resistance. PET is by nature a quantitative imaging tool, relating the time–activity concentration in tissues and the basic functional parameters governing the biological processes being studied. Recent innovations in SPECT reconstruction techniques have allowed SPECT to move from relative/semi-quantitative measures to absolute quantification. The strength of PET and SPECT is that they permit whole-body molecular imaging in a noninvasive way, evaluating multiple disease sites. Furthermore, serial scanning can be performed, allowing the measurement of functional changes over time during therapeutic interventions. Images can no longer be treated strictly as pictures but instead must use innovative approaches based on numerical analysis. Medical images contain much more information hidden in the millions of voxels that cannot be assessed by the human eye. Recent developments in computer science have introduced computational methods that can capture this concealed information, which is studied in the field of radiomics. Radiomics have the potential to improve knowledge of tumor biology and, combined with clinical data and other biomarkers, guide clinical management decisions, thereby contributing to precision medicine. This Special Issue highlights the hot topics on quantitative PET and SPECT and discusses the developments in the field of radiomics, the rise of artificial intelligence techniques, harmonization strategies, and the problems that have to be solved to be able to move toward validated and clinically accepted quantitative imaging biomarkers.

Prof. Dr. Lioe-Fee de Geus-Oei
Dr. Floris H. P. van Velden
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Quantitative PET
  • Quantitative SPECT
  • Dosimetry
  • Radiomics
  • Artificial intelligence
  • Deep learning
  • Imaging biomarkers
  • Tumor segmentation
  • PET pharmacokinetic modelling
  • Harmonization
  • Clinical validation of novel imaging tracers

Published Papers (16 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 196 KiB  
Editorial
Editorial on Special Issue “Quantitative PET and SPECT”
by Floris H. P. van Velden and Lioe-Fee de Geus-Oei
Diagnostics 2022, 12(8), 1989; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081989 - 16 Aug 2022
Viewed by 1160
Abstract
Since the introduction of personalized (or precision) medicine, where individually tailored treatments are designed to deliver the right treatment to the right patient at the right time, the primary focus of imaging has moved from detection and diagnosis to tissue characterization, determination of [...] Read more.
Since the introduction of personalized (or precision) medicine, where individually tailored treatments are designed to deliver the right treatment to the right patient at the right time, the primary focus of imaging has moved from detection and diagnosis to tissue characterization, determination of prognosis, prediction of treatment efficacy, and measurement of treatment response [...] Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)

Research

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15 pages, 2045 KiB  
Article
Image Quantification for TSPO PET with a Novel Image-Derived Input Function Method
by Yu-Hua Dean Fang, Jonathan E. McConathy, Talene A. Yacoubian, Yue Zhang, Richard E. Kennedy and David G. Standaert
Diagnostics 2022, 12(5), 1161; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051161 - 07 May 2022
Cited by 7 | Viewed by 1743
Abstract
There is a growing interest in using 18F-DPA-714 PET to study neuroinflammation and microglial activation through imaging the 18-kDa translocator protein (TSPO). Although quantification of 18F-DPA-714 binding can be achieved through kinetic modeling analysis with an arterial input function (AIF) measured [...] Read more.
There is a growing interest in using 18F-DPA-714 PET to study neuroinflammation and microglial activation through imaging the 18-kDa translocator protein (TSPO). Although quantification of 18F-DPA-714 binding can be achieved through kinetic modeling analysis with an arterial input function (AIF) measured with blood sampling procedures, the invasiveness of such procedures has been an obstacle for wide application. To address these challenges, we developed an image-derived input function (IDIF) that noninvasively estimates the arterial input function from the images acquired for 18F-DPA-714 quantification. Methods: The method entails three fully automatic steps to extract the IDIF, including a segmentation of voxels with highest likelihood of being the arterial blood over the carotid artery, a model-based matrix factorization to extract the arterial blood signal, and a scaling optimization procedure to scale the extracted arterial blood signal into the activity concentration unit. Two cohorts of human subjects were used to evaluate the extracted IDIF. In the first cohort of five subjects, arterial blood sampling was performed, and the calculated IDIF was validated against the measured AIF through the comparison of distribution volumes from AIF (VT,AIF) and IDIF (VT,IDIF). In the second cohort, PET studies from twenty-eight healthy controls without arterial blood sampling were used to compare VT,IDIF with VT,REF measured using a reference region-based analysis to evaluate whether it can distinguish high-affinity (HAB) and mixed-affinity (MAB) binders. Results: In the arterial blood-sampling cohort, VT derived from IDIF was found to be an accurate surrogate of the VT from AIF. The bias of VT, IDIF was −5.8 ± 7.8% when compared to VT,AIF, and the linear mixed effect model showed a high correlation between VT,AIF and VT, IDIF (p < 0.001). In the nonblood-sampling cohort, VT, IDIF showed a significance difference between the HAB and MAB healthy controls. VT, IDIF and standard uptake values (SUV) showed superior results in distinguishing HAB from MAB subjects than VT,REF. Conclusions: A novel IDIF method for 18F-DPA-714 PET quantification was developed and evaluated in this study. This IDIF provides a noninvasive alternative measurement of VT to quantify the TSPO binding of 18F-DPA-714 in the human brain through dynamic PET scans. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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12 pages, 1386 KiB  
Article
The Use of 18F-FDG PET/CT Metabolic Parameters in Predicting Overall Survival in Patients Undergoing Restaging for Malignant Melanoma
by Khanyisile N. Hlongwa, Kgomotso M. G. Mokoala, Zvifadzo Matsena-Zingoni, Mariza Vorster and Mike M. Sathekge
Diagnostics 2022, 12(3), 595; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12030595 - 25 Feb 2022
Cited by 4 | Viewed by 1557
Abstract
Malignant melanoma is one of the more aggressive cancers in the skin, with an increasing incidence every year. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. Positron emission tomography (PET) with 2-[18 [...] Read more.
Malignant melanoma is one of the more aggressive cancers in the skin, with an increasing incidence every year. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) has been used extensively over the past two decades in staging and assessing responses to therapy in patients with melanoma. Metabolic PET parameters have been demonstrated to be independent prognostic factors for progression-free survival (PFS) and overall survival (OS) in different malignancies, melanoma included. In our study, we evaluated the metabolic parameters of 18F-FDG PET/CT (flourodeoxyglucose positron emission tomography/computed tomography) in predicting the overall survival in patients with malignant melanoma who presented for restaging. Metabolic PET parameters (maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) of the primary tumor, as well as whole-body MTV and TLG of the metastatic disease, were measured. Survival curves for OS were constructed and mortality rates were determined using the different PET variables. Forty-nine patients who presented for a PET/CT restaging in melanoma were included in this study. We found that non-survivors had significantly higher median MTV (11.86 cm3 vs. 5.68 cm3; p-value = 0.022), TLG (3125 vs. 14; p-value = 0.0357), whole-body MTV (53.9 cm3 vs. 14.4 cm3; p-value = 0.0076) and whole-body TLG (963.4 vs. 114.6; p-value = 0.0056). This demonstrated that high MTV and TLG values of the primary tumor and whole-body TLG as quantified by 18F-FDG PET/CT were prognostic factors for overall survival. The findings may potentially guide clinicians in decision making and identifying patients with a poorer prognosis. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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10 pages, 2321 KiB  
Article
Effects of Respiratory Motion on Y-90 PET Dosimetry for SIRT
by Matthew D. Walker, Jonathan I. Gear, Allison J. Craig and Daniel R. McGowan
Diagnostics 2022, 12(1), 194; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12010194 - 14 Jan 2022
Cited by 2 | Viewed by 1498
Abstract
Respiratory motion degrades the quantification accuracy of PET imaging by blurring the radioactivity distribution. In the case of post-SIRT PET-CT verification imaging, respiratory motion can lead to inaccuracies in dosimetric measures. Using an anthropomorphic phantom filled with 90Y at a range of [...] Read more.
Respiratory motion degrades the quantification accuracy of PET imaging by blurring the radioactivity distribution. In the case of post-SIRT PET-CT verification imaging, respiratory motion can lead to inaccuracies in dosimetric measures. Using an anthropomorphic phantom filled with 90Y at a range of clinically relevant activities, together with a respiratory motion platform performing realistic motions (10–15 mm amplitude), we assessed the impact of respiratory motion on PET-derived post-SIRT dosimetry. Two PET scanners at two sites were included in the assessment. The phantom experiments showed that device-driven quiescent period respiratory motion correction improved the accuracy of the quantification with statistically significant increases in both the mean contrast recovery (+5%, p = 0.003) and the threshold activities corresponding to the dose to 80% of the volume of interest (+6%, p < 0.001). Although quiescent period gating also reduces the number of counts and hence increases the noise in the PET image, its use is encouraged where accurate quantification of the above metrics is desired. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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9 pages, 2550 KiB  
Communication
Cerebral [18F]-FDOPA Uptake in Autism Spectrum Disorder and Its Association with Autistic Traits
by Rik Schalbroeck, Lioe-Fee de Geus-Oei, Jean-Paul Selten, Maqsood Yaqub, Anouk Schrantee, Therese van Amelsvoort, Jan Booij and Floris H. P. van Velden
Diagnostics 2021, 11(12), 2404; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122404 - 20 Dec 2021
Cited by 5 | Viewed by 2318
Abstract
Dopaminergic signaling is believed to be related to autistic traits. We conducted an exploratory 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine positron emission tomography/computed tomography ([18F]-FDOPA PET/CT) study, to examine cerebral [18F]-FDOPA influx constant (kicer min−1), reflecting predominantly [...] Read more.
Dopaminergic signaling is believed to be related to autistic traits. We conducted an exploratory 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine positron emission tomography/computed tomography ([18F]-FDOPA PET/CT) study, to examine cerebral [18F]-FDOPA influx constant (kicer min−1), reflecting predominantly striatal dopamine synthesis capacity and a mixed monoaminergic innervation in extrastriatal neurons, in 44 adults diagnosed with autism spectrum disorder (ASD) and 22 controls, aged 18 to 30 years. Autistic traits were assessed with the Autism Spectrum Quotient (AQ). Region-of-interest and voxel-based analyses showed no statistically significant differences in kicer between autistic adults and controls. In autistic adults, striatal kicer was significantly, negatively associated with AQ attention to detail subscale scores, although Bayesian analyses did not support this finding. In conclusion, among autistic adults, specific autistic traits can be associated with reduced striatal dopamine synthesis capacity. However, replication of this finding is necessary. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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11 pages, 3931 KiB  
Article
Compensating Positron Range Effects of Ga-68 in Preclinical PET Imaging by Using Convolutional Neural Network: A Monte Carlo Simulation Study
by Ching-Ching Yang
Diagnostics 2021, 11(12), 2275; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122275 - 04 Dec 2021
Cited by 3 | Viewed by 2184
Abstract
This study aimed to investigate the feasibility of positron range correction based on three different convolutional neural network (CNN) models in preclinical PET imaging of Ga-68. The first model (CNN1) was originally designed for super-resolution recovery, while the second model (CNN2) and the [...] Read more.
This study aimed to investigate the feasibility of positron range correction based on three different convolutional neural network (CNN) models in preclinical PET imaging of Ga-68. The first model (CNN1) was originally designed for super-resolution recovery, while the second model (CNN2) and the third model (CNN3) were originally designed for pseudo CT synthesis from MRI. A preclinical PET scanner and 30 phantom configurations were modeled in Monte Carlo simulations, where each phantom configuration was simulated twice, once for Ga-68 (CNN input images) and once for back-to-back 511-keV gamma rays (CNN output images) with a 20 min emission scan duration. The Euclidean distance was used as the loss function to minimize the difference between CNN input and output images. According to our results, CNN3 outperformed CNN1 and CNN2 qualitatively and quantitatively. With regard to qualitative observation, it was found that boundaries in Ga-68 images became sharper after correction. As for quantitative analysis, the recovery coefficient (RC) and spill-over ratio (SOR) were increased after correction, while no substantial increase in coefficient of variation of RC (CVRC) or coefficient of variation of SOR (CVSOR) was observed. Overall, CNN3 should be a good candidate architecture for positron range correction in Ga-68 preclinical PET imaging. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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12 pages, 2474 KiB  
Article
Prognostic Value of Quantitative [18F]FDG-PET Features in Patients with Metastases from Soft Tissue Sarcoma
by Gijsbert M. Kalisvaart, Willem Grootjans, Judith V. M. G. Bovée, Hans Gelderblom, Jos A. van der Hage, Michiel A. J. van de Sande, Floris H. P. van Velden, Johan L. Bloem and Lioe-Fee de Geus-Oei
Diagnostics 2021, 11(12), 2271; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122271 - 04 Dec 2021
Cited by 3 | Viewed by 1795
Abstract
Background: Prognostic biomarkers are pivotal for adequate treatment decision making. The objective of this study was to determine the added prognostic value of quantitative [18F]FDG-PET features in patients with metastases from soft tissue sarcoma (STS). Methods: Patients with metastases from STS, [...] Read more.
Background: Prognostic biomarkers are pivotal for adequate treatment decision making. The objective of this study was to determine the added prognostic value of quantitative [18F]FDG-PET features in patients with metastases from soft tissue sarcoma (STS). Methods: Patients with metastases from STS, detected by (re)staging [18F]FDG-PET/CT at Leiden University Medical Centre, were retrospectively included. Clinical and histopathological patient characteristics and [18F]FDG-PET features (SUVmax, SUVpeak, SUVmean, total lesion glycolysis, and metabolic tumor volume) were analyzed as prognostic factors for overall survival using a Cox proportional hazards model and Kaplan–Meier methods. Results: A total of 31 patients were included. SUVmax and SUVpeak were significantly predictive for overall survival (OS) in a univariate analysis (p = 0.004 and p = 0.006, respectively). Hazard ratios (HRs) were 1.16 per unit increase for SUVmax and 1.20 per unit for SUVpeak. SUVmax and SUVpeak remained significant predictors for overall survival after correction for the two strongest predictive clinical characteristics (number of lesions and performance status) in a multivariate analysis (p = 0.02 for both). Median SUVmax and SUVpeak were 5.7 and 4.9 g/mL, respectively. The estimated mean overall survival in patients with SUVmax > 5.7 g/mL was 14 months; otherwise, it was 39 months (p < 0.001). For patients with SUVpeak > 4.9 g/mL, the estimated mean overall survival was 18 months; otherwise, it was 33 months (p = 0.04). Conclusions: In this study, SUVmax and SUVpeak were independent prognostic factors for overall survival in patients with metastases from STS. These results warrant further investigation of metabolic imaging with [18F]FDG-PET/CT in patients with metastatic STS. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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13 pages, 2170 KiB  
Article
Diagnostic Performance of [18F]FDG PET in Staging Grade 1–2, Estrogen Receptor Positive Breast Cancer
by Ramsha Iqbal, Lemonitsa H. Mammatas, Tuba Aras, Wouter V. Vogel, Tim van de Brug, Daniela E. Oprea-Lager, Henk M. W. Verheul, Otto S. Hoekstra, Ronald Boellaard and Catharina W. Menke-van der Houven van Oordt
Diagnostics 2021, 11(11), 1954; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11111954 - 21 Oct 2021
Cited by 11 | Viewed by 1610
Abstract
Positron emission tomography using [18F]fluorodeoxyglucose (FDG PET) potentially underperforms for staging of patients with grade 1–2 estrogen receptor positive (ER+) breast cancer. The aim of this study was to retrospectively investigate the diagnostic accuracy of FDG PET in this patient population. [...] Read more.
Positron emission tomography using [18F]fluorodeoxyglucose (FDG PET) potentially underperforms for staging of patients with grade 1–2 estrogen receptor positive (ER+) breast cancer. The aim of this study was to retrospectively investigate the diagnostic accuracy of FDG PET in this patient population. Suspect tumor lesions detected on conventional imaging and FDG PET were confirmed with pathology or follow up. PET-positive lesions were (semi)quantified with standardized uptake values (SUV) and these were correlated with various pathological features, including the histological subtype. Pre-operative imaging detected 155 pathologically verified lesions (in 74 patients). A total of 115/155 (74.2%) lesions identified on FDG PET were classified as true positive, i.e., malignant (in 67 patients) and 17/155 (10.8%) lesions as false positive, i.e., benign (in 9 patients); 7/155 (4.5%) as false negative (in 7 patients) and 16/155 (10.3%) as true negative (in 14 patients). FDG PET incorrectly staged 16/70 (22.9%) patients. The FDG uptake correlated with histological subtype, showing higher uptake in ductal carcinoma, compared to lobular carcinoma (p < 0.05). Conclusion: Within this study, FDG PET inadequately staged 22.9% of grade 1–2, ER + BC cases. Incorrect staging can lead to inappropriate treatment choices, potentially affecting survival and quality of life. Prospective studies investigating novel radiotracers are urgently needed. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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13 pages, 868 KiB  
Article
The Influence of the Exclusion of Central Necrosis on [18F]FDG PET Radiomic Analysis
by Wyanne A. Noortman, Dennis Vriens, Charlotte D. Y. Mooij, Cornelis H. Slump, Erik H. Aarntzen, Anouk van Berkel, Henri J. L. M. Timmers, Johan Bussink, Tineke W. H. Meijer, Lioe-Fee de Geus-Oei and Floris H. P. van Velden
Diagnostics 2021, 11(7), 1296; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11071296 - 19 Jul 2021
Cited by 6 | Viewed by 2247
Abstract
Background: Central necrosis can be detected on [18F]FDG PET/CT as a region with little to no tracer uptake. Currently, there is no consensus regarding the inclusion of regions of central necrosis during volume of interest (VOI) delineation for radiomic analysis. The [...] Read more.
Background: Central necrosis can be detected on [18F]FDG PET/CT as a region with little to no tracer uptake. Currently, there is no consensus regarding the inclusion of regions of central necrosis during volume of interest (VOI) delineation for radiomic analysis. The aim of this study was to assess how central necrosis affects radiomic analysis in PET. Methods: Forty-three patients, either with non-small cell lung carcinomas (NSCLC, n = 12) or with pheochromocytomas or paragangliomas (PPGL, n = 31), were included retrospectively. VOIs were delineated with and without central necrosis. From all VOIs, 105 radiomic features were extracted. Differences in radiomic features between delineation methods were assessed using a paired t-test with Benjamini–Hochberg multiple testing correction. In the PPGL cohort, performances of the radiomic models to predict the noradrenergic biochemical profile were assessed by comparing the areas under the receiver operating characteristic curve (AUC) for both delineation methods. Results: At least 65% of the features showed significant differences between VOIvital-tumour and VOIgross-tumour (65%, 79% and 82% for the NSCLC, PPGL and combined cohort, respectively). The AUCs of the radiomic models were not significantly different between delineation methods. Conclusion: In both tumour types, almost two-third of the features were affected, demonstrating that the impact of whether or not to include central necrosis in the VOI on the radiomic feature values is significant. Nevertheless, predictive performances of both delineation methods were comparable. We recommend that radiomic studies should report whether or not central necrosis was included during delineation. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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11 pages, 1185 KiB  
Article
Evaluation of Quantitative Ga-68 PSMA PET/CT Repeatability of Recurrent Prostate Cancer Lesions Using Both OSEM and Bayesian Penalized Likelihood Reconstruction Algorithms
by Mark J. Roef, Sjoerd Rijnsdorp, Christel Brouwer, Dirk N. Wyndaele and Albert J. Arends
Diagnostics 2021, 11(6), 1100; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061100 - 16 Jun 2021
Cited by 7 | Viewed by 1464
Abstract
Rationale: To formally determine the repeatability of Ga-68 PSMA lesion uptake in both relapsing and metastatic tumor. In addition, it was hypothesized that the BPL algorithm Q. Clear has the ability to lower SUV signal variability in the small lesions typically encountered in [...] Read more.
Rationale: To formally determine the repeatability of Ga-68 PSMA lesion uptake in both relapsing and metastatic tumor. In addition, it was hypothesized that the BPL algorithm Q. Clear has the ability to lower SUV signal variability in the small lesions typically encountered in Ga-68 PSMA PET imaging of prostate cancer. Methods: Patients with biochemical recurrence of prostate cancer were prospectively enrolled in this single center pilot test-retest study and underwent two Ga-68 PSMA PET/CT scans within 7.9 days on average. Lesions were classified as suspected local recurrence, lymph node metastases or bone metastases. Two datasets were generated: one standard PSF + OSEM and one with PSF + BPL reconstruction algorithm. For tumor lesions, SUVmax was determined. Repeatability was formally assessed using Bland–Altman analysis for both BPL and standard reconstruction. Results: A total number of 65 PSMA-positive tumor lesions were found in 23 patients (range 1 to 12 lesions a patient). Overall repeatability in the 65 lesions was −1.5% ± 22.7% (SD) on standard reconstructions and −2.1% ± 29.1% (SD) on BPL reconstructions. Ga-68 PSMA SUVmax had upper and lower limits of agreement of +42.9% and −45.9% for standard reconstructions and +55.0% and −59.1% for BPL reconstructions, respectively (NS). Tumor SUVmax repeatability was dependent on lesion area, with smaller lesions exhibiting poorer repeatability on both standard and BPL reconstructions (F-test, p < 0.0001). Conclusion: A minimum response of 50% seems appropriate in this clinical situation. This is more than the recommended 30% for other radiotracers and clinical situations (PERCIST response criteria). BPL does not seem to lower signal variability in these cases. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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17 pages, 2305 KiB  
Article
Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis
by Yu-Hung Chen, Sung-Chao Chu, Ling-Yi Wang, Tso-Fu Wang, Kun-Han Lue, Chih-Bin Lin, Bee-Song Chang, Dai-Wei Liu, Shu-Hsin Liu and Sheng-Chieh Chan
Diagnostics 2021, 11(6), 1065; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11061065 - 09 Jun 2021
Cited by 5 | Viewed by 2182
Abstract
We investigated whether the combination of primary tumor and nodal 18F-FDG PET parameters predict survival outcomes in patients with nodal metastatic non-small cell lung cancer (NSCLC) without distant metastasis. We retrospectively extracted pre-treatment 18F-FDG PET parameters from 89 nodal-positive NSCLC patients [...] Read more.
We investigated whether the combination of primary tumor and nodal 18F-FDG PET parameters predict survival outcomes in patients with nodal metastatic non-small cell lung cancer (NSCLC) without distant metastasis. We retrospectively extracted pre-treatment 18F-FDG PET parameters from 89 nodal-positive NSCLC patients (stage IIB–IIIC). The Cox proportional hazard model was used to identify independent prognosticators of overall survival (OS) and progression-free survival (PFS). We devised survival stratification models based on the independent prognosticators and compared the model to the American Joint Committee on Cancer (AJCC) staging system using Harrell’s concordance index (c-index). Our results demonstrated that total TLG (the combination of primary tumor and nodal total lesion glycolysis) and age were independent risk factors for unfavorable OS (p < 0.001 and p = 0.001) and PFS (both p < 0.001), while the Eastern Cooperative Oncology Group scale independently predicted poor OS (p = 0.022). Our models based on the independent prognosticators outperformed the AJCC staging system (c-index = 0.732 versus 0.544 for OS and c-index = 0.672 versus 0.521 for PFS, both p < 0.001). Our results indicate that incorporating total TLG with clinical factors may refine risk stratification in nodal metastatic NSCLC patients and may facilitate tailored therapeutic strategies in this patient group. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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14 pages, 1070 KiB  
Article
Impact of the Noise Penalty Factor on Quantification in Bayesian Penalized Likelihood (Q.Clear) Reconstructions of 68Ga-PSMA PET/CT Scans
by Sjoerd Rijnsdorp, Mark J. Roef and Albert J. Arends
Diagnostics 2021, 11(5), 847; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11050847 - 08 May 2021
Cited by 11 | Viewed by 2070 | Correction
Abstract
Functional imaging with 68Ga prostate-specific membrane antigen (PSMA) and positron emission tomography (PET) can fulfill an important role in treatment selection and adjustment in prostate cancer. This article focusses on quantitative assessment of 68Ga-PSMA-PET. The effect of various parameters on standardized [...] Read more.
Functional imaging with 68Ga prostate-specific membrane antigen (PSMA) and positron emission tomography (PET) can fulfill an important role in treatment selection and adjustment in prostate cancer. This article focusses on quantitative assessment of 68Ga-PSMA-PET. The effect of various parameters on standardized uptake values (SUVs) is explored, and an optimal Bayesian penalized likelihood (BPL) reconstruction is suggested. PET acquisitions of two phantoms consisting of a background compartment and spheres with diameter 4 mm to 37 mm, both filled with solutions of 68Ga in water, were performed with a GE Discovery 710 PET/CT scanner. Recovery coefficients (RCs) in multiple reconstructions with varying noise penalty factors and acquisition times were determined and analyzed. Apparent recovery coefficients of spheres with a diameter smaller than 17 mm were significantly lower than those of spheres with a diameter of 17 mm and bigger (p < 0.001) for a tumor-to-background (T/B) ratio of 10:1 and a scan time of 10 min per bed position. With a T/B ratio of 10:1, the four largest spheres exhibit significantly higher RCs than those with a T/B ratio of 20:1 (p < 0.0001). For spheres with a diameter of 8 mm and less, alignment with the voxel grid potentially affects the RC. Evaluation of PET/CT scans using (semi-)quantitative measures such as SUVs should be performed with great caution, as SUVs are influenced by scanning and reconstruction parameters. Based on the evaluation of multiple reconstructions with different β of phantom scans, an intermediate β (600) is suggested as the optimal value for the reconstruction of clinical 68Ga-PSMA PET/CT scans, considering that both detectability and reproducibility are relevant. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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Review

Jump to: Editorial, Research, Other

25 pages, 1376 KiB  
Review
Influences on PET Quantification and Interpretation
by Julian M. M. Rogasch, Frank Hofheinz, Lutz van Heek, Conrad-Amadeus Voltin, Ronald Boellaard and Carsten Kobe
Diagnostics 2022, 12(2), 451; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020451 - 10 Feb 2022
Cited by 10 | Viewed by 3238
Abstract
Various factors have been identified that influence quantitative accuracy and image interpretation in positron emission tomography (PET). Through the continuous introduction of new PET technology—both imaging hardware and reconstruction software—into clinical care, we now find ourselves in a transition period in which traditional [...] Read more.
Various factors have been identified that influence quantitative accuracy and image interpretation in positron emission tomography (PET). Through the continuous introduction of new PET technology—both imaging hardware and reconstruction software—into clinical care, we now find ourselves in a transition period in which traditional and new technologies coexist. The effects on the clinical value of PET imaging and its interpretation in routine clinical practice require careful reevaluation. In this review, we provide a comprehensive summary of important factors influencing quantification and interpretation with a focus on recent developments in PET technology. Finally, we discuss the relationship between quantitative accuracy and subjective image interpretation. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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15 pages, 2898 KiB  
Review
Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise
by Stijn De Schepper, Gopinath Gnanasegaran, John C. Dickson and Tim Van den Wyngaert
Diagnostics 2021, 11(12), 2333; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11122333 - 11 Dec 2021
Cited by 6 | Viewed by 2622
Abstract
The application of absolute quantification in SPECT/CT has seen increased interest in the context of radionuclide therapies where patient-specific dosimetry is a requirement within the European Union (EU) legislation. However, the translation of this technique to diagnostic nuclear medicine outside this setting is [...] Read more.
The application of absolute quantification in SPECT/CT has seen increased interest in the context of radionuclide therapies where patient-specific dosimetry is a requirement within the European Union (EU) legislation. However, the translation of this technique to diagnostic nuclear medicine outside this setting is rather slow. Clinical research has, in some examples, already shown an association between imaging metrics and clinical diagnosis, but the applications, in general, lack proper validation because of the absence of a ground truth measurement. Meanwhile, additive manufacturing or 3D printing has seen rapid improvements, increasing its uptake in medical imaging. Three-dimensional printed phantoms have already made a significant impact on quantitative imaging, a trend that is likely to increase in the future. In this review, we summarize the data of recent literature to underpin our premise that the validation of diagnostic applications in nuclear medicine using application-specific phantoms is within reach given the current state-of-the-art in additive manufacturing or 3D printing. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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1 pages, 669 KiB  
Correction
Correction: Rijnsdorp et al. Impact of the Noise Penalty Factor on Quantification in Bayesian Penalized Likelihood (Q.Clear) Reconstructions of 68Ga-PSMA PET/CT Scans. Diagnostics 2021, 11, 847
by Sjoerd Rijnsdorp, Mark J. Roef and Albert J. Arends
Diagnostics 2021, 11(8), 1371; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11081371 - 30 Jul 2021
Cited by 1 | Viewed by 910
Abstract
In the original article [...] Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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10 pages, 1570 KiB  
Case Report
Quantitative, Dynamic 18F-FDG PET/CT in Monitoring of Smoldering Myeloma: A Case Report
by Christos Sachpekidis, Matthias Türk and Antonia Dimitrakopoulou-Strauss
Diagnostics 2021, 11(4), 649; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11040649 - 03 Apr 2021
Cited by 2 | Viewed by 1703
Abstract
We report on a 52-year-old patient with an initial diagnosis of smoldering myeloma (SMM), who was monitored by means of dynamic and static positron emission tomography/computed tomography (PET/CT) with the radiotracer 1⁸F-fluorodeoxyglucose (18F-FDG). Baseline PET/CT revealed no pathological signs. Six [...] Read more.
We report on a 52-year-old patient with an initial diagnosis of smoldering myeloma (SMM), who was monitored by means of dynamic and static positron emission tomography/computed tomography (PET/CT) with the radiotracer 1⁸F-fluorodeoxyglucose (18F-FDG). Baseline PET/CT revealed no pathological signs. Six months later, a transition to symptomatic, multiple myeloma (MM) was diagnosed. The transition was not accompanied by focal, hypermetabolic lesions on PET/CT. However, a diffusely increased 18F-FDG uptake in the bone marrow, accompanied by a marked increase of semi-quantitative (standardized uptake value, SUV) and quantitative, pharmacokinetic 18F-FDG parameters, was demonstrated. After successful treatment, including tandem autologous transplantation, the diffuse uptake in the bone marrow as well as the semi-quantitative and quantitative parameters showed a marked remission. This response was also confirmed by the clinical follow-up of the patient. These findings suggest that in MM a diffuse 18F-FDG uptake in the bone marrow may indeed reflect an actual bone marrow infiltration by plasma cells. Moreover, SUV values and kinetic parameters, not only from myeloma lesions but also from random bone marrow samples, may be used for MM monitoring. This could be particularly helpful in the follow-up of myeloma patients negative for 18F-FDG-avid focal lesions. Full article
(This article belongs to the Special Issue Quantitative PET and SPECT)
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