Management of respiratory motion in PET/computed tomography

Pépin, Audrey; Daouk, Joël; Bailly, Pascal; Hapdey, Sébastien; Meyer, Marc-Étienne

doi:10.1097/mnm.0000000000000048

Cited by 104 publications

(94 citation statements)

References 65 publications

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“…The 3-cm 3 volume has been chosen arbitrarily to separate small lung lesions from large lung lesions based on previously used measurements reported in the literature [27][28][29].…”

Section: Image Analysismentioning

confidence: 99%

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

et al. 2014

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Purpose: The aim of this study is to assess a software-based method with semiautomated correction for partial volume effect (PVE) to quantify the metabolic activity of pulmonary malignancies in patients who underwent non-gated and respiratory-gated 2-deoxy-2-[ 18 F]fluoro-D-glucose (FDG)-positron emission tomography (PET)/x-ray computed tomography(CT). Procedures: The study included 106 lesions of 55 lung cancer patients who underwent respiratory-gated FDG-PET/CT for radiation therapy treatment planning. Volumetric PET/CT parameters were determined by using 4D PET/CT and non-gated PET/CT images. We used a semiautomated program employing an adaptive contrast-oriented thresholding algorithm for lesion delineation as well as a lesion-based partial volume effect correction algorithm. We compared respiratory-gated parameters with non-gated parameters by using pairwise comparison and interclass correlation coefficient assessment. In a multivariable regression analysis, we also examined factors, which can affect quantification accuracy, including the size of lesion and the location of tumor. Results: This study showed that quantification of volumetric parameters of 4D PET/CT images using an adaptive contrast-oriented thresholding algorithm and 3D lesion-based partial volume correction is feasible. We observed slight increase in FDG uptake by using PET/CT volumetric parameters in comparison of highest respiratory-gated values with non-gated values. After correction for partial volume effect, the mean standardized uptake value (SUVmean) and total lesion glycolysis (TLG) increased substantially (p value G0.001). However, we did not observe a clinically significant difference between partial volume corrected parameters of respiratory-gated and non-gated PET/CT scans. Regression analysis showed that tumor volume was the main predictor of quantification inaccuracy caused by partial volume effect.Electronic supplementary material The online version of this article (doi:10.1007/s11307-014-0776-6) contains supplementary material, which is available to authorized users.Correspondence to: Abass Alavi; e-mail: abass.alavi@uphs.upenn.edu Conclusions: Based on this study, assessment of volumetric PET/CT parameters and partial volume effect correction for accurate quantification of lung malignant lesions by using respiratory non-gated PET images are feasible and it is comparable to gated measurements. Partial volume correction increased both the respiratory-gated and non-gated values significantly and appears to be the dominant source of quantification error of lung lesions.

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“…The 3-cm 3 volume has been chosen arbitrarily to separate small lung lesions from large lung lesions based on previously used measurements reported in the literature [27][28][29].…”

Section: Image Analysismentioning

confidence: 99%

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

et al. 2014

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“…8 The first class of methods does not require respiratory synchronization, i.e. PET-CT in deep inspiration.…”

Section: Introductionmentioning

confidence: 99%

Clinical respiratory motion correction software (reconstruct, register and averaged—RRA), for 18F-FDG-PET-CT: phantom validation, practical implications and patient evaluation

Bouyeure-Petit¹,

Chastan²,

Edet-Sanson³

et al. 2017

The British Journal of Radiology

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Objective: On fluorine-18 fludeoxyglucose ( 18 F-FDG) positron emission tomography (PET) CT of pulmonary or hepatic lesions, standard uptake value (SUV) is often underestimated due to patient breathing. The aim of this study is to validate, on phantom and patient data, a motion correction algorithm [reconstruct, register and averaged (RRA)] implemented on a PET-CT system. Methods: Three phantoms containing five spheres filled with 18 F-FDG and suspended in a water or Styrofoam® 18 F-FDG-filled tank to create different contrasts and attenuation environment were acquired on a Discovery GE710. The spheres were animated with a 2-cm longitudinal respiratory-based movement. Respiratory-gated (RRA) and ungated PET images were compared with static reference images (without movement). The optimal acquisition time, number of phases and the best phase within the respiratory cycle were investigated. The impact of irregular motion was also investigated. Quantification impact was computed on each sphere. Quantification improvement on 28 lung lesions was also investigated. Results: Phantoms: 4 min was required to obtain a stable quantification with the RRA method. The reference phase and the number of phases used for RRA did not affect the quantification which was similar on static acquisitions but different on ungated images. The results showed that the maximum standard uptake value (SUV max ) restoration is majored for the smallest spheres (#2.1 ml). Patients: SUV max on RRA and ungated acquisitions were statistically different to the SUV max on whole-body images (p 5 0.05) but not different from each other (mean SUV max : 7.0 6 7.8 vs 6.9 6 7.8, p 5 0.23 on RRA and ungated images, respectively). We observed a statistically significant correlation between SUV restoration and lesion displacement, with a real SUV quantitation improvement for lesion with movement .1.2 mm. Conclusion: According to the results obtained using phantoms, RRA method is promising, showing a real impact on the lesion quantification on phantom data. With regard to the patient study, our results showed a trend towards an increase in the SUVs and a decrease in the volume between the ungated and RRA data. We also noticed a statistically significant correlation between the quantitative restoration obtained with RRA compared with ungated data and lesion displacement, indicating that the RRA approach should be reserved to patients with small lesions or nodes moving with a displacement larger than 1.2 cm. Advances in knowledge: This article investigates the performances of motion correction software recently introduced in PET. The conclusion revealed that such respiratory motion correction approach shows a real impact on the lesion quantification but must be reserved to the patient for whom lesion displacement was confirmed and high enough to clearly impact lesion evaluation.

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“…4). Other tracking methods might be more appropriate for lesions in different regions in the lungs, such as methods that track the respiration of the patient by measuring the breathed airflow (spirometer) or changing temperature of breathed air (temperature sensor) (10,23). However, these methods are not commonly used in clinical routine (23).…”

Section: Discussionmentioning

confidence: 99%

“…Other tracking methods might be more appropriate for lesions in different regions in the lungs, such as methods that track the respiration of the patient by measuring the breathed airflow (spirometer) or changing temperature of breathed air (temperature sensor) (10,23). However, these methods are not commonly used in clinical routine (23). Another method to gate the PET data is to use reconstructed images with a high time resolution and to use a (elastic) transformation to match each image, known as list-mode gating (24,25).…”

Section: Discussionmentioning

confidence: 99%

“…Another method to gate the PET data is to use reconstructed images with a high time resolution and to use a (elastic) transformation to match each image, known as list-mode gating (24,25). However, this method is not yet implemented in the clinical routine and still has some problems to overcome, for instance, the noise level in the data (23). This suggests that more research is needed to find the best respiratory tracking method for clinical use.…”

Section: Discussionmentioning

confidence: 99%

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Improving the Spatial Alignment in PET/CT Using Amplitude-Based Respiration-Gated PET and Respiration-Triggered CT

et al. 2015

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Respiratory motion during PET can cause inaccuracies in the quantification of radiotracer uptake, which negatively affects PETguided radiotherapy planning. Quantitative accuracy can be improved by respiratory gating. However, additional miscalculation of standardized uptake value (SUV) in PET images can be caused by inappropriate attenuation correction due to a spatial mismatch between gated PET and CT. In this study, the effect of respirationtriggered CT on the spatial match between CT and amplitude-based respiration-gated PET images is investigated. Methods: 18 F-FDG PET/CT was performed in 38 patients. Images were acquired on 2 PET/CT scanners, one without and one with continuous bed motion during PET acquisition. The amplitude limits of the amplitude-based respiration-gated PET were used for the respiration-triggered sequential low-dose CT. Both standard (spiral) and triggered CT scans were used to reconstruct the PET data. Spatial mismatch was quantified using the position difference between the lung-liver boundary in PET and CT images, the distance between PET and CT lung lesions' centroids, and the amount of overlap of lesions indicated by the Jaccard similarity coefficient. Furthermore, the effect of attenuation correction was quantified by measuring SUVs in lung lesions. Results: For triggered CT, the average distance between the lung-liver boundary in PET and CT was significantly reduced (4.5 ± 6.7 mm) when compared with standard CT (9.2 ± 8.1 mm) (P , 0.001). The mean distance between the lesions' centroids in PET and CT images was 6.3 ± 4.0 and 5.6 ± 4.2 mm (P 5 0.424), for the standard and triggered CT, respectively. Similarly, the Jaccard similarity coefficient was 0.30 ± 0.21 and 0.32 ± 0.20 (P 5 0.609) for standard and triggered CT, respectively. For 6 lesions, there was no overlap of PET and CT when the standard CT was used; compared with the triggered CT, these lesions showed (partial) overlap. The maximum and mean SUV increase of the PET/CT compared with the PET/triggered CT was 5.7% ± 11.2% (P , 0.001) and 6.1% ± 10.2% (P 5 0.001), respectively. Conclusion: Amplitude-based respiration-gated PET in combination with respiration-triggered CT resulted in a significantly improved match in the area of the liver dome and a significantly higher SUV for lung lesions. However, lesions in the lungs did not show a consistent improvement in spatial match.

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Management of respiratory motion in PET/computed tomography

Cited by 104 publications

References 65 publications

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

Application of Partial Volume Effect Correction and 4D PET in the Quantification of FDG Avid Lung Lesions

Clinical respiratory motion correction software (reconstruct, register and averaged—RRA), for 18F-FDG-PET-CT: phantom validation, practical implications and patient evaluation

Improving the Spatial Alignment in PET/CT Using Amplitude-Based Respiration-Gated PET and Respiration-Triggered CT

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