Fully automated computational measurement of noise in positron emission tomography.

Objectives: To introduce an automated computational algorithm that estimates the global noise level across the whole imaging volume of PET datasets.

Methods: [F]FDG PET images of 38 patients were reconstructed with simulated decreasing acquisition times (15-120 s) resulting in increasing noise levels, and with block sequential regularized expectation maximization with beta values of 450 and 600 (Q.Clear 450 and 600).

Fluoro-deoxy-glucose uptake in the mylohyoid muscle: a common misconception.

Aim: The mylohyoid muscle is often believed to exhibit high physiologic fluoro-deoxy-glucose (FDG) uptake. Aim of this study was to use PET/MR for adequately assessing the normal FDG distribution in floor of the mouth (FOM) muscles and neighboring major salivary glands.

Materials And Methods: Patients scanned with a simultaneous PET/MRI system for initial staging or follow-up of head and neck tumors, with no malignant lesions in salivary glands or in FOM, were included.

Artificial intelligence for detecting small FDG-positive lung nodules in digital PET/CT: impact of image reconstructions on diagnostic performance.

Objectives: To evaluate the diagnostic performance of a deep learning algorithm for automated detection of small F-FDG-avid pulmonary nodules in PET scans, and to assess whether novel block sequential regularized expectation maximization (BSREM) reconstruction affects detection accuracy as compared to ordered subset expectation maximization (OSEM) reconstruction.

Methods: Fifty-seven patients with 92 F-FDG-avid pulmonary nodules (all ≤ 2 cm) undergoing PET/CT for oncological (re-)staging were retrospectively included and a total of 8824 PET images of the lungs were extracted using OSEM and BSREM reconstruction. Per-slice and per-nodule sensitivity of a deep learning algorithm was assessed, with an expert readout by a radiologist/nuclear medicine physician serving as standard of reference.

Impact of different image reconstructions on PET quantification in non-small cell lung cancer: a comparison of adenocarcinoma and squamous cell carcinoma.

Objective:: Positron emission tomography (PET) using F-fludeoxyglucose (F-FDG) is an established imaging modality for tumor staging in patients with non-small cell lung cancer (NSCLC). There is a growing interest in using F-FDG PET for therapy response assessment in NSCLC which relies on quantitative PET parameters such as standardized uptake values (SUV). Different reconstruction algorithms in PET may affect SUV.

Automated detection of lung cancer at ultralow dose PET/CT by deep neural networks - Initial results.

Objectives: We evaluated whether machine learning may be helpful for the detection of lung cancer in FDG-PET imaging in the setting of ultralow dose PET scans.

Materials And Methods: We studied the performance of an artificial neural network discriminating lung cancer patients (n = 50) from controls (n = 50) without pulmonary malignancies. A total of 3936 PET slices including images in which the lung tumor is visually present and image slices of patients with no lung cancer were exported.

Clinical impact of Ga-PSMA-11 PET on patient management and outcome, including all patients referred for an increase in PSA level during the first year after its clinical introduction.

Purpose: The fast-increasing use of positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) ligand for the imaging of prostate cancer (PCA) biochemical recurrence has led to a rapid change in treatment concepts. Since the superiority of Ga-PSMA-11 PET in detecting recurrent PCA is well established, the aim of our study was to assess its effect on management and outcome in all patients imaged during the first year after its introduction into clinical routine.

Methods: Of 327 patients imaged, 223 were referred for recurrent PCA and gave written informed consent for further analysis of their data for this retrospective consecutive cohort analysis.

Impact of a Bayesian penalized likelihood reconstruction algorithm on image quality in novel digital PET/CT: clinical implications for the assessment of lung tumors.

Background: The aim of this study was to evaluate and compare PET image reconstruction algorithms on novel digital silicon photomultiplier PET/CT in patients with newly diagnosed and histopathologically confirmed lung cancer. A total of 45 patients undergoing 18F-FDG PET/CT for initial lung cancer staging were included. PET images were reconstructed using ordered subset expectation maximization (OSEM) with time-of-flight and point spread function modelling as well as Bayesian penalized likelihood reconstruction algorithm (BSREM) with different β-values yielding a total of 7 datasets per patient.

Local resectability assessment of head and neck cancer: Positron emission tomography/MRI versus positron emission tomography/CT.

Background: The purpose of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/MRI with PET/CT for local resectability of head and neck cancer.

Methods: Sequential contrast-enhanced PET/CT-MRI was performed in 58 patients referred for the staging or restaging of head and neck cancer. Tumors were assessed with PET/CT and PET/MRI for the presence of resectability-defining factors: T4b status (mediastinal invasion, invasion of the prevertebral space, and vascular encasement), and another 8 findings that would imply obstacles for surgical cure (invasion of the laryngeal cartilage, invasion of the preepiglottic fat pad, perineural spread, orbital invasion, bone infiltration, skull base invasion, dural infiltration, and invasion of the brachial plexus).

PET+MR versus PET/CT in the initial staging of head and neck cancer, using a trimodality PET/CT+MR system.

Purpose: To compare the diagnostic accuracy of PET+MR with PET/CT in the initial staging of head and neck cancer.

Materials And Methods: Contrast-enhanced PET/CT+MR was performed in 27 patients with newly diagnosed head and neck cancer. PET/CT and PET+MR were evaluated separately, and the TNM stage and factors influencing treatment were assessed.

PET/MR Outperforms PET/CT in Suspected Occult Tumors.

Background: To compare the diagnostic accuracy of PET/MR and PET/CT in patients with suspected occult primary tumors.

Methods: This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors.

Clinical evaluation of a block sequential regularized expectation maximization reconstruction algorithm in 18F-FDG PET/CT studies.

Purpose: To investigate the clinical performance of a block sequential regularized expectation maximization (BSREM) penalized likelihood reconstruction algorithm in oncologic PET/computed tomography (CT) studies.

Methods: A total of 410 reconstructions of 41 fluorine-18 fluorodeoxyglucose-PET/CT studies of 41 patients with a total of 2010 lesions were analyzed by two experienced nuclear medicine physicians. Images were reconstructed with BSREM (with four different β values) or ordered subset expectation maximization (OSEM) algorithm with/without time-of-flight (TOF/non-TOF) corrections.

Metal artifact reduction in patients with dental implants using multispectral three-dimensional data acquisition for hybrid PET/MRI.

Background: Hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) shows high potential for patients with oropharyngeal cancer. Dental implants can cause substantial artifacts in the oral cavity impairing diagnostic accuracy. Therefore, we evaluated new MRI sequences with multi-acquisition variable-resonance image combination (MAVRIC SL) in comparison to conventional high-bandwidth techniques and in a second step showed the effect of artifact size on MRI-based attenuation correction (AC) with a simulation study.

TNM Staging of Non-Small Cell Lung Cancer: Comparison of PET/MR and PET/CT.

Unlabelled: The purpose of this study was to compare the diagnostic accuracy of whole-body unenhanced PET/MR with that of PET/CT in determining the stage of non-small cell lung cancer.

Methods: This study was approved by the institutional review board and by national government authorities. Forty-two consecutive patients referred for the initial staging of non-small cell lung cancer underwent whole-body imaging with a sequential trimodality PET/CT/MR system.

Intra-individual comparison of PET/CT with different body weight-adapted FDG dosage regimens.

Background: 18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/ computed tomography (CT) imaging demands guidelines to safeguard sufficient image quality at low radiation exposure. Various FDG dose regimes have been investigated; however, body weight-adapted dose regimens and related image quality (IQ) have not yet been compared in the same patient.

Purpose: To investigate the relationship between FDG dosage and image quality in PET/CT in the same patient and determine prerequisites for low dosage scanning.

First clinical results of (D)-18F-Fluoromethyltyrosine (BAY 86-9596) PET/CT in patients with non-small cell lung cancer and head and neck squamous cell carcinoma.

Unlabelled: (D)-(18)F-fluoromethyltyrosine (d-(18)F-FMT), or BAY 86-9596, is a novel (18)F-labeled tyrosine derivative rapidly transported by the l-amino acid transporter (LAT-1), with a faster blood pool clearance than the corresponding l-isomer. The aim of this study was to demonstrate the feasibility of tumor detection in patients with non-small cell lung cancer (NSCLC) or head and neck squamous cell cancer (HNSCC) compared with inflammatory and physiologic tissues in direct comparison to (18)F-FDG.

Methods: 18 patients with biopsy-proven NSCLC (n = 10) or HNSCC (n = 8) were included in this Institutional Review Board-approved, prospective multicenter study.

Whole-body nonenhanced PET/MR versus PET/CT in the staging and restaging of cancers: preliminary observations.

Purpose: To assess the diagnostic performance of whole-body non-contrast material-enhanced positron emission tomography (PET)/magnetic resonance (MR) imaging and PET/computed tomography (CT) for staging and restaging of cancers and provide guidance for modality and sequence selection.

Materials And Methods: This study was approved by the institutional review board and national government authorities. One hundred six consecutive patients (median age, 68 years; 46 female and 60 male patients) referred for staging or restaging of oncologic malignancies underwent whole-body imaging with a sequential trimodality PET/CT/MR system.

Workflow Considerations in PET/MR Imaging.

Many groups attempt to optimize imaging protocols on PET/MR imaging systems. Although research protocols may take as long as 60-90 min, much more efficient clinical workflows are needed to achieve cost-effective examination times of less than 1 h. Considering these difficulties, simultaneous PET/MR imaging is an intriguing research tool, but its clinical applications are uncertain or just beginning to emerge.

Contrast-enhanced PET/MR imaging versus contrast-enhanced PET/CT in head and neck cancer: how much MR information is needed?

Unlabelled: Considering PET/MR imaging as a whole-body staging tool, scan time restrictions in a single body area are mandatory for the cost-effective clinical operation of an integrated multimodality scanner setting. It has to be considered that (18)F-FDG already acts as a contrast agent and that under certain circumstances MR contrast may not yield additional clinically relevant information. The concept of the present study was to understand which portions of the imaging information enhance the sensitivity and specificity of the hybrid examination and which portions are redundant.

Protocol requirements and diagnostic value of PET/MR imaging for liver metastasis detection.

Purpose: To compare the accuracy of PET/MR imaging with that of FDG PET/CT and to determine the MR sequences necessary for the detection of liver metastasis using a trimodality PET/CT/MR set-up.

Methods: Included in this single-centre IRB-approved study were 55 patients (22 women, age 61 ± 11 years) with suspected liver metastases from gastrointestinal cancer. Imaging using a trimodality PET/CT/MR set-up (time-of-flight PET/CT and 3-T whole-body MR imager) comprised PET, low-dose CT, contrast-enhanced (CE) CT of the abdomen, and MR with T1-W/T2-W, diffusion-weighted (DWI), and dynamic CE imaging.

Clinical positron emission tomography/magnetic resonance imaging applications.

Although clinical positron emission tomography (PET)/computed tomography (CT) applications were obvious and have completely replaced PET in oncology, clinical applications of PET/magnetic resonance (MR) are currently not clearly defined. This is due to the lack of clinical data, which is mainly because PET/MR technology is not clinically mature at this point. Open issues are technical and concern ease of obtaining PET attenuation correction maps, dealing with, for example, MR surface coil metal in the PET field-of-view and appropriate workflows leading to a cost-effective examination.

High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: comparison with inflammatory lesions detected by whole body MRI.

Background: This study compares the frequency and distribution of increased activity on 18 F-fluoride PET/CT with the presence of bone marrow edema on whole-body MR imaging in the spine and sacroiliac joints (SIJ) of patients with active ankylosing spondylitis (AS).

Methods: Ten patients (6 men and 4 women), between 30 and 58 years old (median 44) with active AS, were prospectively examined with both whole-body MRI and 18 F-fluoride PET/CT. Patients fulfilled modified NY criteria and had a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of at least 4.

PET/MR imaging of bone lesions--implications for PET quantification from imperfect attenuation correction.

Purpose: Accurate attenuation correction (AC) is essential for quantitative analysis of PET tracer distribution. In MR, the lack of cortical bone signal makes bone segmentation difficult and may require implementation of special sequences. The purpose of this study was to evaluate the need for accurate bone segmentation in MR-based AC for whole-body PET/MR imaging.

Repeatability of FDG quantification in tumor imaging: averaged SUVs are superior to SUVmax.

Purpose: Reliable 18F-fluorodeoxyglucose (FDG) uptake quantification is crucial for cancer treatment monitoring. While interobserver variability has been found to be lower for a maximum standard uptake value (SUV)max than for an averaged SUV (SUVmean), the repeatability has not been investigated yet. In this study, we determined the repeatability of SUV values in two sequential measurements 5 min apart.