Gating methods acquiring biosignals (such as electrocardiography [ECG] and respiration) during PET enable one to reduce motion effects that potentially lead to image blurring and artifacts. This study evaluated different cardiac and respiratory gating methods: one based on ECG signals for cardiac gating and video signals for respiratory gating; 2 others based on measured inherent list mode events. Methods: Twenty-nine patients with coronary artery disease underwent a 20-min ECG-gated single-bed list mode PET scan of the heart. Of these, 17 were monitored by a video camera registering a marker on the patient's abdomen, thus capturing the respiratory motion for PET gating (video method). Additionally, respiratory and cardiac gating information was deduced without auxiliary measurements by dividing the list mode stream in 50-ms frames and then either determining the number of coincidences (sensitivity method) or computing the axial center of mass and SD of the measured counting rates in the same frames (center-of-mass method). The gated datasets (respiratory and cardiac gating) were reconstructed without attenuation correction. Measured wall thicknesses, maximum displacement of the left ventricular wall, and ejection fraction served as measures of the exactness of gating. Results: All methods successfully captured respiratory motion and significantly decreased motion-induced blurring in the gated images. The center-of-mass method resulted in significantly larger left ventricular wall displacements than did the sensitivity method (P , 0.02); other differences were nonsignificant. List mode-based cardiac gating was found to work well for patients with high 18 F-FDG uptake when the center-of-mass method was used, leading to an ejection fraction correlation coefficient of r 5 0.95 as compared with ECG-based gating. However, the sensitivity method did not always result in valid cardiac gating information, even in patients with high 18 F-FDG uptake. Conclusion: Our study demonstrated that valid gating signals during PET scans cannot be obtained only by tracking the external motion or applying an ECG but also by simply analyzing the PET list mode stream on a frame-by-frame basis. PETi s an established diagnostic tool widely appreciated in the clinical fields of oncology, neurology, cardiology, and several others. PET can show functional, metabolic, and molecular processes in vivo with a high sensitivity and offers the unique feature of absolute quantification of radiotracer distribution. However, several mathematic corrections have to be applied to the measured PET raw data before or during image reconstruction to obtain absolute quantitative data. The most important of these is attenuation correction, that is, correcting for the loss of coincidence photons due to absorption while they are traversing the human body. Accurate attenuation correction requires knowledge of attenuation values in the field of view of the scanner. In stand-alone PET scanners, this information is acquired during an additional transmission scan u...

Hybrid PET/MR combines the exceptional molecular sensitivity of PET with the high resolution and versatility of MR imaging. Simultaneous data acquisition additionally promises the use of MR to enhance the quality of PET images, for example, by respiratory motion correction. This advantage is especially relevant in thoracic and abdominal areas to improve the visibility of small lesions with low radiotracer uptake and to enhance uptake quantification. In this work, the applicability and performance of an MR-based method of respiratory motion correction for PET tumor imaging was evaluated in phantom and patient studies. Methods: PET list-mode data from a motion phantom with 22 Na point sources and 5 patients with tumor manifestations in the thorax and upper abdomen were acquired on a simultaneous hybrid PET/MR system. During the first 3 min of a 5-min PET scan, the respiration-induced tissue deformation in the PET field of view was recorded using a sagittal 2-dimensional multislice gradient echo MR sequence. MR navigator data to measure the location of the diaphragm were acquired throughout the PET scan. Respiration-gated PET data were coregistered using the MR-derived motion fields to obtain a single motion-corrected PET dataset. The effect of motion correction on tumor visibility, delineation, and radiotracer uptake quantification was analyzed with respect to uncorrected and gated images. Results: Image quality in terms of lesion delineation and uptake quantification was significantly improved compared with uncorrected images for both phantom and patient data. In patients, in head-feet line profiles of 14 manifestations, the slope became steeper by 66.7% (P 5 0.001) and full width at half maximum was reduced by 20.6% (P 5 0.001). The mean increase in maximum standardized uptake value, lesion-to-background ratio (contrast), and signal-to-noise ratio was 28.1% (P 5 0.001), 24.7% (P 5 0.001), and 27.3% (P 5 0.003), respectively. Lesion volume was reduced by an average of 26.5% (P 5 0.002). As opposed to the gated images, no increase in background noise was observed.However, motion correction performed worse than gating in terms of contrast (211.3%, P 5 0.002), maximum standardized uptake value (210.7%, P 5 0.003), and slope steepness (219.3%, P 5 0.001). Conclusion: The proposed method for MR-based respiratory motion correction of PET data proved feasible and effective. The short examination time and convenience (no additional equipment required) of the method allow for easy integration into clinical routine imaging. Performance compared with gating procedures can be further improved using list-mode-based motion correction. Hybri d PET/MR imaging systems combine the high molecular sensitivity of PET and the superior resolution and versatility of MR imaging for improved tumor imaging (1). Furthermore, systems capable of simultaneous PET/MR data acquisition can improve PET image quality and radiotracer uptake quantification by the use of MR-based correction methods, for example, for respiratory motion.Respiratory moti...

Simultaneous PET and MRI using new hybrid PET/MRI systems promises optimal spatial and temporal coregistration of structural, functional, and molecular image data. In a pilot study of 10 patients with intracranial masses, the feasibility of tumor assessment using a PET/MRI system comprising lutetium oxyorthosilicate scintillators coupled to avalanche photodiodes was evaluated, and quantification accuracy was compared with conventional PET/CT datasets. Methods: All measurements were performed with a hybrid PET/MRI scanner consisting of a conventional 3-T MRI scanner in combination with an inserted MRI-compatible PET system. Attenuation correction of PET/MR images was computed from MRI datasets. Diagnoses at the time of referral were low-grade astrocytoma (n 5 2), suspicion of low-grade astrocytoma (n 5 1), anaplastic astrocytoma (World Health Organization grade III; n 5 1), glioblastoma (n 5 2), atypical neurocytoma (n 5 1), and meningioma (n 5 3). In the glial tumors, 11 C-methionine was used for PET; in the meningiomas, 68 Ga-DOTATOC was administered. Tumor-togray matter and tumor-to-white matter ratios were calculated for gliomas, and tracer uptake of meningiomas was referenced to nasal mucosa. PET/MRI was performed directly after clinically indicated PET/CT examination. Results: In all patients, the PET datasets showed similar diagnostic image quality on the hybrid PET/MRI and the PET/CT studies; however, slight streak artifacts were visible in coronal and sagittal sections when using the higher intrinsic resolution of the PET/MRI insert. Prefiltering of images with a 4-mm gaussian filter at a resolution comparable to that of the PET/CT system virtually eliminated these artifacts. Although acquisition of the PET/MR images started at 30-60 min after PET/CT (20.4-min half-life of 11 C) acquisition, the signal-to-noise ratio was good enough, thus underlining the high sensitivity of the PET insert, compared with whole-body PET systems. The computed tumor-to-reference tissue ratios exhibited an excellent accordance between the PET/MRI and PET/CT systems, with a Pearson correlation coefficient of 0.98. Mean paired relative error was 7.9% 6 12.2%. No significant artifacts or distortions were detected in the simultaneously acquired MR images using the PET/MRI scanner. Conclusion: Structural, functional, and molecular imaging in patients with brain tumors is feasible with diagnostic imaging quality using simultaneous hybrid PET/MR image acquisition.

Results from 50 therapies show that radioligand therapy with Lu-PSMA-617 is effective and well tolerated and seems to increase overall survival. A future randomized controlled prospective study will be necessary to confirm these results.