RF-Penetrable PET insert for simultaneous PET/MR imaging.

Compromises in the design of a positron emission tomography (PET) insert for a magnetic resonance imaging (MRI) system should minimize the deterioration of image quality in both modalities, particularly when simultaneous demanding acquisitions are performed. In this work, the advantages of using individually read-out crystals with high-gain silicon photomultipliers (SiPMs) were studied with a small animal PET insert for a 7 T MRI system, in which the SiPM charge was transferred to outside the MRI scanner using coaxial cables. The interferences between the two systems were studied with three radio-frequency (RF) coil configurations. The effects of PET on the static magnetic field, flip angle distribution, RF noise, and image quality of various MRI sequences (gradient echo, spin echo, and echo planar imaging (EPI) at 1H frequency, and chemical shift imaging at 13C frequency) were investigated. The effects of fast-switching gradient fields and RF pulses on PET count rate were studied, while the PET insert and the readout electronics were not shielded. Operating the insert inside a 1H volume coil, used for RF transmission and reception, limited the MRI to T1-weighted imaging, due to coil detuning and RF attenuation, and resulted in significant PET count loss. Using a surface receive coil allowed all tested MR sequences to be used with the insert, with 45–59% signal-to-noise ratio (SNR) degradation, compared to without PET. With a 1H/13C volume coil inside the insert and shielded by a copper tube, the SNR degradation was limited to 23–30% with all tested sequences. The insert did not introduce any discernible distortions into images of two tested EPI sequences. Use of truncated sinc shaped RF excitation pulses and gradient field switching had negligible effects on PET count rate. However, PET count rate was substantially affected by high-power RF block pulses and temperature variations due to high gradient duty cycles.

Hybrid PET-MRI Applications in Movement Disorders.

The purpose of this study was to do a feasibility study on a microstrip transmission line (MS) RF coil for a positron emission tomography (PET) insert in a 7 Tesla human MRI system. The proposed MS coil integrated the RF shield of the PET detector as the ground conductor of the coil. We called the integrated module "MS PET coil." A single-channel MS PET coil was developed with an integrated RF-shielded PET detector module. For comparison, we also studied a conventional MS coil with a single-layer ground conductor. A lutetium fine silicate (LFS) scintillation crystal block (14 × 14 × 4-layer) with a silicon photomultiplier (Hamamatsu Photonics K.K., Shizuoka, Japan) and a front-end readout circuit board were mounted inside the shield cage of the MS PET coil. The MS PET coil was studied with and without PET detectors. All three coil configurations were studied with a homogeneous phantom in a 7T MRI system (Siemens Healthineers, Erlangen, Germany). PET data measurements were conducted using a Cesium-137 radiation point source. The MR images were similar for the MS coil and the empty MS PET coil, as well as for the cases of MS PET coil with and without PET measurements. Compared to the empty MS PET coil (without PET detector and cable RF shield), decreases in SNR, increases in image noise and RF power, and a slight decrease in resonance frequency were seen for the case of the MS PET coil with the detector and cable shield. Differences in the PET energy histograms or in the crystal identification maps with and without MRI measurements were negligible. Both the MRI and PET performances of the MS PET coil showed responses that matched the MS coil responses. The performance variations of MRI data with and without PET measurement and PET data with and without MR imaging were negligible.

Small-animal positron emission tomography as a tool for neuropharmacology

Compton imaging or Compton camera imaging has been studied well, but its advantages in nuclear medicine and molecular imaging have not been demonstrated yet. Therefore, the aim of this work was to compare Compton imaging with positron emission tomography (PET) by using the same imaging platform of whole gamma imaging (WGI). WGI is a concept that combines PET with Compton imaging by inserting a scatterer ring into a PET ring. This concept utilizes diverse types of gamma rays for 3D tomographic imaging. In this paper, we remodeled our previous WGI prototype for small animal imaging, and we developed an image reconstruction method based on a list-mode ordered subset expectation maximization algorithm incorporating detector response function modeling, random correction and normalization (sensitivity correction) for either PET and Compton imaging. To the best of our knowledge, this is the world’s first realization of a full-ring Compton imaging system. We selected 89Zr as an imaging target because a 89Zr nuclide emits a 909 keV single-gamma ray as well as a positron, and we can directly compare Compton imaging of 909 keV photons with PET, a well-established modality. We measured a cylindrical phantom and a small rod phantom filled with 89Zr solutions of 10.3 MBq and 10.2 MBq activity, respectively, for 1 h each. The uniform radioactivity distribution of the cylindrical phantom was reconstructed with normalization in both PET and Compton imaging. Coefficients of variation for region-of-interest values were 4.2% for Compton imaging and 3.3% for PET; the difference might be explained by the difference in the detected count number. The small rod phantom experiment showed that the WGI Compton imaging had spatial resolution better than 3.0 mm at the peripheral region although the center region had lower resolution. PET resolved 2.2 mm rods clearly at any location. We measured a mouse for 1 h, 1 d after injection of 9.8 MBq 89Zr oxalate. The 89Zr assimilated in the mouse bony structures was clearly depicted, and Compton imaging results agreed well with PET images, especially for the region inside the scatterer ring. In conclusion, we demonstrated the performance of WGI using the developed Compton image reconstruction method. We realized Compton imaging with a quality approaching that of PET, which is supporting a future expectation that Compton imaging outperforms PET.

In the management of brainstem lesions, the place of stereotactic biopsy sampling remains debatable. The authors compared the results of magnetic resonance (MR) imaging, positron emission tomography (PET) scanning, and histological studies obtained in 30 patients who underwent MR imaging- and PET-guided stereotactic biopsy procedures for a brainstem mass lesion. Between July 1991 and December 1998, 30 patients harboring brainstem mass lesions underwent a stereotactic procedure in which combined MR imaging and PET scanning guidance were used. Positron emission tomography scanning was performed using [18F]fluorodeoxyglucose in 16 patients, methionine in two patients, and both tracers in 12 patients. Definite diagnosis was established on histological examination of the biopsy samples. Interpretation of MR imaging findings only or PET findings only was in agreement with the histological diagnosis in 63% and 73% of cases, respectively. Magnetic resonance imaging and PET findings were concordant in 19 of the 30 cases; in those cases, imaging data correlated with histological findings in 79%. Treatment based on information derived from MR imaging was concordant with therapy based on histological findings in only 17 patients (57%). Combining MR imaging and PET scanning data, the concordance between the neuroimaging-based treatment and treatments based on histological findings increased to 19 patients (63%). In seven patients who underwent biopsy procedures with one PET-defined and one MR imaging-defined trajectory, at histological examination the PET-guided samples were more representative of the tumor's nature and grade than the MR imaging-guided samples in four cases (57%). In 18 patients PET scanning was used to define a biopsy target and provided a diagnostic yield in 100% of the cases. Although the use of combined PET and MR imaging improves radiological interpretation of a mass lesion in the brainstem, it does not accurately replace histological diagnosis that is provided by a stereotactically obtained biopsy sample. Combining information provided by MR imaging and PET scanning in stereotactic conditions improves the accuracy of targeting and the diagnostic yield of the biopsy sample; an MR imaging- and PET-guided stereotactic biopsy procedure is a safe and efficient modality for the management of mass lesions of the brainstem.

Positron emission tomography (PET) of the brain is an important problem-solving tool in pediatric neuroimaging, neurology, and neurosurgery. Fluorine 18 fluorodeoxyglucose (FDG) PET or dual-modality PET and computed tomographic (CT) imaging (PET/CT), with magnetic resonance (MR) imaging correlation, can be used to evaluate childhood epilepsy and pediatric brain tumors, areas in which PET adds value in patient management. FDG PET has been widely used in pediatric temporal lobe epilepsy, most commonly manifesting as mesial temporal sclerosis, which demonstrates hypometabolism at interictal PET and hypermetabolism during seizures. Recently, FDG PET has shown added value for patients with extratemporal epilepsy, in whom FDG PET can help identify cortical foci of interictal hypometabolism that are undetectable or difficult to detect with MR imaging. These findings can then guide additional investigations and surgery. FDG PET also enhances medical decision making in children with brain tumors, in whom FDG PET can be used to (a) improve the diagnostic yield of stereotactic biopsies by detecting metabolically active areas of tumor, (b) help guide the surgeon in achieving total tumor resection, and (c) increase detection of residual or recurrent tumor. Technologic advances in the past decade have allowed fusion of PET and MR images, combining the high resolution of MR imaging with the low-resolution functional capability of PET. As dual-modality integrated PET/MR imaging systems become available, CT coregistration for PET can be eliminated, thus reducing patient radiation exposure. Increasing familiarity with normal and abnormal appearances of FDG PET brain images correlated with MR images can enhance diagnostic yield and improve the care of children with epilepsy and brain tumors.

Technical performance evaluation of a human brain PET/MRI system. The magnetic field compatible positron emission tomography (PET) insert is based on avalanche photodiode (APD) arrays coupled with lutetium oxyorthosilicate (LSO) crystals and slip-fits into a slightly modified clinical 3-T MRI system. The mutual interference between the two imaging techniques was minimised by the careful design of the hardware to maintain the quality of the B (0) and B (1) field homogeneity. The signal-to-noise ratio (SNR) and the homogeneity of the MR images were minimally influenced by the presence of the PET. Measurements according to the Function Biomedical Informatics Research Network (FBIRN) protocol proved the combined system's ability to perform functional MRI (fMRI). The performance of the PET insert was evaluated according to the National Electrical Manufacturers Association (NEMA) standard. The noise equivalent count rate (NEC) peaked at 30.7 × 10(3) counts/s at 7.3 kBq/mL. The point source sensitivity was greater than 7 %. The spatial resolution in the centre field of view was less than 3 mm. Patient data sets clearly revealed a noticeably good PET and MR image quality. PET and MRI phantom tests and first patient data exhibit the device's potential for simultaneous multiparametric imaging. • Combination of PET and MRI is a new emerging imaging technology. • Evaluated brain PET/MRI enables uncompromised imaging performance. • PET/MRI aims to provide multiparametric imaging allowing acquisition of morphology and metabolism.

The development of integrated imaging systems for magnetic resonance imaging (MRI) and positron emission tomography (PET) is currently being explored in a number of laboratories and industrial settings. PET/MRI scanners for both preclinical and human research applications are being developed. PET/MRI overcomes many limitations of PET/computed tomography (CT), such as limited tissue contrast and high radiation doses delivered to the patient or the animal being studied. In addition, recent PET/MRI designs allow for simultaneous rather than sequential acquisition of PET and MRI data, which could not have been achieved through a combination of PET and CT scanners. In a combined PET/CT scanner, while both scanners share a common patient bed, they are hard-wired back-to-back and therefore do not allow simultaneous data acquisition. While PET/MRI offers the possibility of novel imaging strategies, it also creates considerable challenges for acquiring artifact-free images from both modalities. In this review, we discuss motivations, challenges, and potential research applications of developing PET/MRI technology. A brief overview of both MRI and PET is presented and preclinical and clinical applications of PET/MRI are identified. Finally, issues and concerns about image quality, clinical practice, and economic feasibility are discussed.

Positron emission tomography (PET) detectors that use a dual-ended-scintillator readout to measure depth-of-interaction (DOI) must have an accurate DOI function to provide the relationship between DOI and signal ratios to be used for detector calibration and recalibration. In a previous study, the authors used a novel and simple method to accurately and quickly measure DOI function by irradiating the detector with an external uniform flood source; however, as a practical concern, implementing external uniform flood sources in an assembled PET system is technically challenging and expensive. In the current study, therefore, the authors investigated whether the same method could be used to acquire DOI function from scintillator-generated (i.e., internal) radiation. The authors also developed a method for calibrating the energy scale necessary to select the events within the desired energy window. The authors measured the DOI function of a PET detector with lutetium yttrium orthosilicate (LYSO) scintillators. Radiation events originating from the scintillators' internal Lu-176 beta decay were used to measure DOI functions which were then compared with those measured from both an external uniform flood source and an electronically collimated external point source. The authors conducted these studies with several scintillators of differing geometries (1.5 × 1.5 and 2.0 × 2.0 mm(2) cross-section area and 20, 30, and 40 mm length) and various surface finishes (mirror-finishing, saw-cut rough, and other finishes in between), and in a prototype array. All measured results using internal and external radiation sources showed excellent agreement in DOI function measurement. The mean difference among DOI values for all scintillators measured from internal and external radiation sources was less than 1.0 mm for different scintillator geometries and various surface finishes. The internal radioactivity of LYSO scintillators can be used to accurately measure DOI function in PET detectors, regardless of scintillator geometry or surface finish. Because an external radiation source is not needed, this method of DOI function measurement can be practically applied to individual PET detectors as well as assembled systems.

Purpose: Positron emission tomography (PET) using open dual ring geometry was investigated as an on‐board system for functional imaging and PET marker tracking, specifically with tomotherapy. The dual ring PET would allow measurement of both inter and intra‐fractional variation, facilitating the determination of treatment uncertainties and improving the delineation of tumor volume at any stage in the radiation treatment delivery process. This study demonstrates the field of view (FOV) of various PET ring axial gaps, the sensitivity of each system for each gap, and the image quality as a function of scan time and activity for one specified design. Method and Materials: Investigation of FOV and sensitivity of each design was accomplished via Monte Carlo simulations with GATE, the Geant4 Application for Emission Tomography. Image quality was investigated with a fully 3D OSEM iterative reconstruction algorithm for noiseless data to investigate the FOV and noisy data to investigate the scan time at a specified activity. Results: Even when the axial gap (G) exceeded the axial width (W) for each open ring system as in the extreme case of G = 600 mm (required to avoid actuators holding MLC's) the axial FOV was approximately 200 mm. A continuous axial and transaxial FOV (determined by PET ring diameter) of 360 mm and 450 mm respectively resulted from G=W=120mm. Reconstructed NEMA 2001 phantom images for activity of 15 mCi/70kg and scan times ranging from 10 to 100 seconds was demonstrated without the effect of attenuation, scatter, and random events. `Conclusion: For tomotherapy treatment 200 mm continuous FOV axially was sufficient and was achievable with all gaps simulated in the range from 120 mm to 600 mm. Open dual ring on‐board PET has the potential to acquire images within the time limit of a tomotherapy treatment session.

To compare quantitative values of cerebral blood flow (CBF) derived from dynamic susceptibility contrast (DSC) magnetic resonance (MR) imaging with reference standard positron emission tomography (PET) in patients with confirmed cerebrovascular occlusive disease. Local institutional review board approval and informed consent were obtained for a prospective study of 18 patients (six men, 12 women; age range, 28-71 years; mean age, 45 years ± 10.4 [standard deviation]) with angiographically confirmed Moyamoya (n = 8) or internal carotid artery occlusions (n = 10). DSC MR images and oxygen 15-labeled water (H(2)[(15)O]) PET images were acquired on the same day. DSC images were postprocessed to yield parametric images of CBF (in mL/100 g/min), coregistered, and analyzed using grid-based regions of interest. Mean values of CBF in each region of interest from MR imaging and PET data sets were compared. Correlations for each patient were determined and overall agreement between pooled MR imaging and PET CBF was reported using linear regression analysis and Bland-Altman plots. Strong correlations (r(2) ≥ 0.55) were found between MR imaging and PET CBF values in all patients. Use of the bookend approach was found to underestimate CBF predictably across the patient cohort (mean slope, 0.82; standard deviation, 0.18; slope of aggregated data, 0.75). This allowed for a simple rescaling of MR imaging values producing strong agreement with PET values in the aggregated data (r(2) = 0.66; slope = 1.00; intercept = 0.00). The data show that the bookend MR imaging technique produces similar results for quantitative CBF between DSC MR imaging and H(2)[(15)O] PET. Although MR-derived CBF underestimated PET-derived CBF, the patient-to-patient variability in the slopes of the linear MR and PET relationships was significantly smaller than a competing quantitation technique. As a result, the bookend technique appears to more predictably measure quantitative CBF in a clinical setting.

Abstract.Narayan K, Hicks RJ, Jobling T, Bernshaw D, McKenzie AF. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: Potential impact on treatment.The aim of this study was to assess whether positron emission tomography (PET) or magnetic resonance imaging (MRI) could obviate the need for surgical staging in patients with locally advanced cervical carcinoma being planned for radiotherapy (RT). Imaging findings were compared to surgical staging in 27 patients including three with recent resection of the primary tumor. Both PET and MRI visualized all 24 residual cervical tumors. Primary tumor volume, as measured by MRI scan, ranged from 1.25 cc to 140 cc. In 24 patients evaluable for pelvic nodal status, PET had sensitivity, specificity, and positive and negative predictive values of 83%, 92%, 91% and 85%, respectively, with 88% accuracy. MRI detected only six in 12 (50%) patients with confirmed pelvic nodal disease, all of which were also seen by CT and PET, with an overall accuracy of 75%. PET detected only four in seven (57%) cases with confirmed para-aortic (PA) involvement. All histologically confirmed sites not visualized on PET were <1 cm. Without surgical staging, six in 10 (60%) patients with histologically proven pelvic nodal disease would not have received pelvic boost if guided by MRI alone, compared to two in 10 (20%) patients guided by PET alone or in combination with MRI. All four patients with positive PA on PET were confirmed on histology or clinical follow-up, including one case that proved to be a false negative one on surgery . However, in three cases, PET would have yielded an inadequate radiation volume. In conclusion, the positive predictive value of PET in the pelvis and para-aortic region appears sufficient to obviate lymph nodal sampling, but sampling is still required to exclude small-volume disease cranial to sites of abnormality on PET. MRI has insufficient accuracy for nodal staging to impact management.

<h3>Abstract.</h3> Narayan K, Hicks RJ, Jobling T, Bernshaw D, McKenzie AF. A comparison of MRI and PET scanning in surgically staged loco-regionally advanced cervical cancer: Potential impact on treatment. The aim of this study was to assess whether positron emission tomography (PET) or magnetic resonance imaging (MRI) could obviate the need for surgical staging in patients with locally advanced cervical carcinoma being planned for radiotherapy (RT). Imaging findings were compared to surgical staging in 27 patients including three with recent resection of the primary tumor. Both PET and MRI visualized all 24 residual cervical tumors. Primary tumor volume, as measured by MRI scan, ranged from 1.25 cc to 140 cc. In 24 patients evaluable for pelvic nodal status, PET had sensitivity, specificity, and positive and negative predictive values of 83%, 92%, 91% and 85%, respectively, with 88% accuracy. MRI detected only six in 12 (50%) patients with confirmed pelvic nodal disease, all of which were also seen by CT and PET, with an overall accuracy of 75%. PET detected only four in seven (57%) cases with confirmed para-aortic (PA) involvement. All histologically confirmed sites not visualized on PET were &lt;1 cm. Without surgical staging, six in 10 (60%) patients with histologically proven pelvic nodal disease would not have received pelvic boost if guided by MRI alone, compared to two in 10 (20%) patients guided by PET alone or in combination with MRI. All four patients with positive PA on PET were confirmed on histology or clinical follow-up, including one case that proved to be a false negative one on surgery . However, in three cases, PET would have yielded an inadequate radiation volume. In conclusion, the positive predictive value of PET in the pelvis and para-aortic region appears sufficient to obviate lymph nodal sampling, but sampling is still required to exclude small-volume disease cranial to sites of abnormality on PET. MRI has insufficient accuracy for nodal staging to impact management.

A cost-effective field-programmable-gate-array-based pulse processor for biomedical imaging applications