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Diagnostics
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Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT
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Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT

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

Deadline for manuscript submissions: 31 July 2024 | Viewed by 9530

Special Issue Editors

Prof. Dr. Riemer H.J.A. Slart

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Guest Editor
Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
Interests: cardiovascular diseases; PET/CT; SPECT/CT; (hybrid) imaging; multimodality imaging
Special Issues, Collections and Topics in MDPI journals
Dr. Joyce van Sluis

E-Mail Website
Guest Editor
Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
Interests: clinical technology; PET methodology, processing & technology; biomarkers; (pharmacokinetic) quantitative analysis
Prof. Dr. Andor W.J.M. Glaudemans

E-Mail Website
Guest Editor
Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
Interests: infections; inflammatory diseases; PET/CT; imaging; (tumor)immunology; multimodality imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

PET is widely considered the most sensitive technique available for noninvasively studying physiology, metabolism, and molecular pathways in living human beings. The introduction of total body (TB)-, and long-axial-field-of-view (LAFOV) PET/CT instruments has recently initiated a new and exciting era in medical imaging. Two developments offer the potential to dramatically increase the effective sensitivity of PET. First, by increasing the geometric coverage to encompass the entire body, and a sensitivity increased by a factor up to 40 times for total-body imaging. TB/LAFOV PET/CT will allow accurate assessment of the extent of disease, particularly, including the entire axial and appendicular skeleton. Quantitative global disease assessment provided by this new PET/CT approach will be superior to conventional measurements, which do not reflect overall disease activity. TB/LAFOV PET/CT imaging may have a revolutionary impact on day-to-day practice of medicine and may become the leading imaging modality in the future. This Special Issue aims to present the role of TB/LAFOV PET/CT in the diagnosis and imaged-based therapeutic management of different (non)oncological diseases, large vessel vasculitis, and also with a focus on the technical background and developments in the era of TB/LAFOV PET/CT camera systems and quantification methodology. We encourage authors to submit both technical and clinical studies in this field. Clinical studies may include systematic reviews/meta-analysis, original retrospective studies, and prospective studies.

Prof. Dr. Riemer H.J.A. Slart
Dr. Joyce van Sluis
Prof. Dr. Andor W.J.M. Glaudemans
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • total body PET/CT
  • LAFOV PET/CT
  • technical
  • clinical
  • tracers

Published Papers (6 papers)

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13 pages, 2474 KiB  
Article
Attenuation Correction of Long Axial Field-of-View Positron Emission Tomography Using Synthetic Computed Tomography Derived from the Emission Data: Application to Low-Count Studies and Multiple Tracers
by Maria Elkjær Montgomery, Flemming Littrup Andersen, Sabrina Honoré d’Este, Nanna Overbeck, Per Karkov Cramon, Ian Law, Barbara Malene Fischer and Claes Nøhr Ladefoged
Diagnostics 2023, 13(24), 3661; https://doi.org/10.3390/diagnostics13243661 - 14 Dec 2023
Viewed by 904
Abstract
Recent advancements in PET/CT, including the emergence of long axial field-of-view (LAFOV) PET/CT scanners, have increased PET sensitivity substantially. Consequently, there has been a significant reduction in the required tracer activity, shifting the primary source of patient radiation dose exposure to the attenuation [...] Read more.
Recent advancements in PET/CT, including the emergence of long axial field-of-view (LAFOV) PET/CT scanners, have increased PET sensitivity substantially. Consequently, there has been a significant reduction in the required tracer activity, shifting the primary source of patient radiation dose exposure to the attenuation correction (AC) CT scan during PET imaging. This study proposes a parameter-transferred conditional generative adversarial network (PT-cGAN) architecture to generate synthetic CT (sCT) images from non-attenuation corrected (NAC) PET images, with separate networks for [18F]FDG and [15O]H2O tracers. The study includes a total of 1018 subjects (n = 972 [18F]FDG, n = 46 [15O]H2O). Testing was performed on the LAFOV scanner for both datasets. Qualitative analysis found no differences in image quality in 30 out of 36 cases in FDG patients, with minor insignificant differences in the remaining 6 cases. Reduced artifacts due to motion between NAC PET and CT were found. For the selected organs, a mean average error of 0.45% was found for the FDG cohort, and that of 3.12% was found for the H2O cohort. Simulated low-count images were included in testing, which demonstrated good performance down to 45 s scans. These findings show that the AC of total-body PET is feasible across tracers and in low-count studies and might reduce the artifacts due to motion and metal implants. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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18 pages, 4839 KiB  
Article
Optimization of Y-90 Radioembolization Imaging for Post-Treatment Dosimetry on a Long Axial Field-of-View PET/CT Scanner
by Pia M. Linder, Wenhong Lan, Nils F. Trautwein, Julia Brosch-Lenz, Sebastian von Beschwitz, Jürgen Kupferschläger, Gerald Reischl, Gerd Grözinger, Helmut Dittmann, Christian la Fougère and Fabian P. Schmidt
Diagnostics 2023, 13(22), 3418; https://doi.org/10.3390/diagnostics13223418 - 09 Nov 2023
Cited by 1 | Viewed by 1200
Abstract
Background: PET imaging after yttrium-90 (Y-90) radioembolization is challenging because of the low positron fraction of Y-90 (32 × 10−6). The resulting low number of events can be compensated by the high sensitivity of long axial field-of-view (LAFOV) PET/CT scanners. Nevertheless, [...] Read more.
Background: PET imaging after yttrium-90 (Y-90) radioembolization is challenging because of the low positron fraction of Y-90 (32 × 10−6). The resulting low number of events can be compensated by the high sensitivity of long axial field-of-view (LAFOV) PET/CT scanners. Nevertheless, the reduced event statistics require optimization of the imaging protocol to achieve high image quality (IQ) and quantification accuracy sufficient for post-treatment dosimetry. Methods: Two phantoms (NEMA IEC and AbdoMan phantoms, mimicking human liver) filled with Y-90 and a 4:1 sphere (tumor)-to-background ratio were scanned for 24 h with the Biograph Vision Quadra (Siemens Healthineers). Eight patients were scanned after Y-90 radioembolization (1.3–4.7 GBq) using the optimized protocol (obtained by phantom studies). The IQ, contrast recovery coefficients (CRCs) and noise were evaluated for their limited and full acceptance angles, different rebinned scan durations, numbers of iterations and post-reconstruction filters. The s-value-based absorbed doses were calculated to assess their suitability for dosimetry. Results: The phantom studies demonstrate that two iterations, five subsets and a 4 mm Gaussian filter provide a reasonable compromise between a high CRC and low noise. For a 20 min scan duration, an adequate CRC of 56% (vs. 24 h: 62%, 20 mm sphere) was obtained, and the noise was reduced by a factor of 1.4, from 40% to 29%, using the full acceptance angle. The patient scan results were consistent with those from the phantom studies, and the impacts on the absorbed doses were negligible for all of the studied parameter sets, as the maximum percentage difference was −3.89%. Conclusions: With 2i5s, a 4 mm filter and a scan duration of 20 min, IQ and quantification accuracy that are suitable for post-treatment dosimetry of Y-90 radioembolization can be achieved. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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15 pages, 3771 KiB  
Article
Potential Clinical Impact of LAFOV PET/CT: A Systematic Evaluation of Image Quality and Lesion Detection
by Sabrina Honoré d’Este, Flemming Littrup Andersen, Julie Bjerglund Andersen, Annika Loft Jakobsen, Eunice Sanchez Saxtoft, Christina Schulze, Naja Liv Hansen, Kim Francis Andersen, Michala Holm Reichkendler, Liselotte Højgaard and Barbara Malene Fischer
Diagnostics 2023, 13(21), 3295; https://doi.org/10.3390/diagnostics13213295 - 24 Oct 2023
Cited by 2 | Viewed by 1108
Abstract
We performed a systematic evaluation of the diagnostic performance of LAFOV PET/CT with increasing acquisition time. The first 100 oncologic adult patients referred for 3 MBq/kg 2-[18F]fluoro-2-deoxy-D-glucose PET/CT on the Siemens Biograph Vision Quadra were included. A standard imaging protocol of 10 min [...] Read more.
We performed a systematic evaluation of the diagnostic performance of LAFOV PET/CT with increasing acquisition time. The first 100 oncologic adult patients referred for 3 MBq/kg 2-[18F]fluoro-2-deoxy-D-glucose PET/CT on the Siemens Biograph Vision Quadra were included. A standard imaging protocol of 10 min was used and scans were reconstructed at 30 s, 60 s, 90 s, 180 s, 300 s, and 600 s. Paired comparisons of quantitative image noise, qualitative image quality, lesion detection, and lesion classification were performed. Image noise (n = 50, 34 women) was acceptable according to the current standard of care (coefficient-of-varianceref < 0.15) after 90 s and improved significantly with increasing acquisition time (PB < 0.001). The same was seen in observer rankings (PB < 0.001). Lesion detection (n = 100, 74 women) improved significantly from 30 s to 90 s (PB < 0.001), 90 s to 180 s (PB = 0.001), and 90 s to 300 s (PB = 0.002), while lesion classification improved from 90 s to 180 s (PB < 0.001), 180 s to 300 s (PB = 0.021), and 90 s to 300 s (PB < 0.001). We observed improved image quality, lesion detection, and lesion classification with increasing acquisition time while maintaining a total scan time of less than 5 min, which demonstrates a potential clinical benefit. Based on these results we recommend a standard imaging acquisition protocol for LAFOV PET/CT of minimum 180 s to maximum 300 s after injection of 3 MBq/kg 2-[18F]fluoro-2-deoxy-D-glucose. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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14 pages, 2143 KiB  
Article
Image Quality and Quantitative PET Parameters of Low-Dose [18F]FDG PET in a Long Axial Field-of-View PET/CT Scanner
by Eduardo Calderón, Fabian P. Schmidt, Wenhong Lan, Salvador Castaneda-Vega, Andreas S. Brendlin, Nils F. Trautwein, Helmut Dittmann, Christian la Fougère and Lena Sophie Kiefer
Diagnostics 2023, 13(20), 3240; https://doi.org/10.3390/diagnostics13203240 - 18 Oct 2023
Cited by 6 | Viewed by 1511
Abstract
PET/CT scanners with a long axial field-of-view (LAFOV) provide increased sensitivity, enabling the adjustment of imaging parameters by reducing the injected activity or shortening the acquisition time. This study aimed to evaluate the limitations of reduced [18F]FDG activity doses on image [...] Read more.
PET/CT scanners with a long axial field-of-view (LAFOV) provide increased sensitivity, enabling the adjustment of imaging parameters by reducing the injected activity or shortening the acquisition time. This study aimed to evaluate the limitations of reduced [18F]FDG activity doses on image quality, lesion detectability, and the quantification of lesion uptake in the Biograph Vision Quadra, as well as to assess the benefits of the recently introduced ultra-high sensitivity mode in a clinical setting. A number of 26 patients who underwent [18F]FDG-PET/CT (3.0 MBq/kg, 5 min scan time) were included in this analysis. The PET raw data was rebinned for shorter frame durations to simulate 5 min scans with lower activities in the high sensitivity (HS) and ultra-high sensitivity (UHS) modes. Image quality, noise, and lesion detectability (n = 82) were assessed using a 5-point Likert scale. The coefficient of variation (CoV), signal-to-noise ratio (SNR), tumor-to-background ratio (TBR), and standardized uptake values (SUV) including SUVmean, SUVmax, and SUVpeak were evaluated. Subjective image ratings were generally superior in UHS compared to the HS mode. At 0.5 MBq/kg, lesion detectability decreased to 95% (HS) and to 98% (UHS). SNR was comparable at 1.0 MBq/kg in HS (5.7 ± 0.6) and 0.5 MBq/kg in UHS (5.5 ± 0.5). With lower doses, there were negligible reductions in SUVmean and SUVpeak, whereas SUVmax increased steadily. Reducing the [18F]FDG activity to 1.0 MBq/kg (HS/UHS) in a LAFOV PET/CT provides diagnostic image quality without statistically significant changes in the uptake parameters. The UHS mode improves image quality, noise, and lesion detectability compared to the HS mode. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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12 pages, 1422 KiB  
Article
Impact of Reduced Image Noise on Deauville Scores in Patients with Lymphoma Scanned on a Long-Axial Field-of-View PET/CT-Scanner
by Kirsten Korsholm, Nanna Overbeck, André H. Dias, Annika Loft, Flemming Littrup Andersen and Barbara Malene Fischer
Diagnostics 2023, 13(5), 947; https://doi.org/10.3390/diagnostics13050947 - 02 Mar 2023
Cited by 1 | Viewed by 2109
Abstract
Background: Total body and long-axial field-of-view (LAFOV) PET/CT represent visionary innovations in imaging enabling either improved image quality, reduction in injected activity–dose or decreased acquisition time. An improved image quality may affect visual scoring systems, including the Deauville score (DS), which is used [...] Read more.
Background: Total body and long-axial field-of-view (LAFOV) PET/CT represent visionary innovations in imaging enabling either improved image quality, reduction in injected activity–dose or decreased acquisition time. An improved image quality may affect visual scoring systems, including the Deauville score (DS), which is used for clinical assessment of patients with lymphoma. The DS compares SUVmax in residual lymphomas with liver parenchyma, and here we investigate the impact of reduced image noise on the DS in patients with lymphomas scanned on a LAFOV PET/CT. Methods: Sixty-eight patients with lymphoma underwent a whole-body scan on a Biograph Vision Quadra PET/CT-scanner, and images were evaluated visually with regard to DS for three different timeframes of 90, 300, and 600 s. SUVmax and SUVmean were calculated from liver and mediastinal blood pool, in addition to SUVmax from residual lymphomas and measures of noise. Results: SUVmax in liver and in mediastinal blood pool decreased significantly with increasing acquisition time, whereas SUVmean remained stable. In residual tumor, SUVmax was stable during different acquisition times. As a result, the DS was subject to change in three patients. Conclusions: Attention should be drawn towards the eventual impact of improvements in image quality on visual scoring systems such as the DS. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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8 pages, 3131 KiB  
Case Report
Long Axial Field-of-View PET for Ultra-Low-Dose Imaging of Non-Hodgkin Lymphoma during Pregnancy
by Joyce van Sluis, Mar Bellido, Andor W. J. M. Glaudemans and Riemer H. J. A. Slart
Diagnostics 2023, 13(1), 28; https://doi.org/10.3390/diagnostics13010028 - 22 Dec 2022
Cited by 6 | Viewed by 1769
Abstract
Generally, positron emission tomography imaging is not often performed in the case of pregnant patients. The careful weighing of the risks of radiation exposure to the fetus and benefits for cancer staging and the swift onset of treatment for the mother complicates decision [...] Read more.
Generally, positron emission tomography imaging is not often performed in the case of pregnant patients. The careful weighing of the risks of radiation exposure to the fetus and benefits for cancer staging and the swift onset of treatment for the mother complicates decision making in clinical practice. In oncology, the most commonly used PET radiotracer is 2-deoxy-2-[fluorine-18] fluoro-D-glucose (18F-FDG), a glucose analog which has established roles in the daily routines for, among other applications, initial diagnosis, staging, (radiation) therapy planning, and response monitoring. The introduction of long axial Field-of-View (LAFOV) PET systems allows for PET imaging with a reduced level of injected 18F-FDG activity while maintaining the image quality. Here, we discuss the first reported case of a pregnant patient diagnosed with follicular lymphoma using LAFOV PET imaging for the staging and therapy selection. The acquired PET images show diagnostic quality images with clearly distinguishable areas of lymphadenopathy, even with only 34 MBq of injected 18F-FDG activity, leading to a considerable decrease in the level of radiation exposure to the fetus. Full article
(This article belongs to the Special Issue Technical and Clinical Applications on Long-Axial-Field-of-View/Total Body PET-CT)
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