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Effect of Bayesian-penalized likelihood reconstruction on [13N]-NH3 rest perfusion quantification

, PhD, CSci , 1 , , PhD, CSci 2 , 3 , , MSc 1 , , MBBS, MSc, FRCP, FRCR, MD 1

Journal of Nuclear Cardiology

Springer US

N-13 ammonia, PET, physics of imaging

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      Myocardial blood flow (MBF) imaging is used in patients with suspected cardiac sarcoidosis, and also in stress/rest studies. The accuracy of MBF is dependent on imaging parameters such as new reconstruction methodologies. In this work, we aim to assess the impact of a novel PET reconstruction algorithm (Bayesian-penalized likelihood—BPL) on the values determined from the calculation of [13N]-NH3 MBF values.


      Data from 21 patients undergoing rest MBF evaluation [13N]-NH3 as part of sarcoidosis imaging were retrospectively analyzed. Each scan was reconstructed with a range of BPL coefficients (1-500), and standard clinical FBP and OSEM reconstructions. MBF values were calculated via an automated software routine for all datasets.


      Reconstruction of [13N]-NH3 dynamic data using the BPL, OSEM, or FBP reconstruction showed no quantitative differences for the calculation of territorial or global MBF ( P = .97). Image noise was lower using OSEM or BPL reconstructions than FBP and noise from BPL reached levels seen in OSEM images between B = 300 and B = 400. Intrasubject differences between all reconstructions over all patients in respect of all cardiac territories showed a maximum coefficient of variation of 9.74%.


      Quantitation of MBF via kinetic modeling of cardiac rest MBF by [13N]-NH3 is minimally affected by the use of a BPL reconstruction technique, with BPL images presenting with less noise.

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      Most cited references 33

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        Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. The 1993 guidelines of the Ministry of Health, Labour, and Welfare (MHLW) of Japan have been used as the diagnostic gold standard and for comparison with imaging modalities. (18)F-FDG PET is not currently included in the guidelines. However, studies have shown promising data using (18)F-FDG PET. We conducted a systematic review of studies that evaluated the accuracy of (18)F-FDG PET for the diagnosis of cardiac sarcoidosis compared with MHLW guidelines. Data from a prospective Ontario provincial registry are also reported and included in the metaanalysis. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies that satisfied predetermined criteria. Quality evaluation using the Quality Assessment for Diagnostic Accuracy Studies was performed by 2 independent masked observers. Data were extracted and analyzed to measure study-specific and pooled accuracy for (18)F-FDG PET compared with the MHLW as the reference. A total of 519 titles was identified; 7 studies, including the Ontario registry, were selected for inclusion. Metaanalysis of these 7 studies was conducted, with a total of 164 patients, most of whom had been diagnosed with systemic sarcoidosis. The prevalence of cardiac sarcoidosis was 50% in the whole population. Pooled estimates for (18)F-FDG PET yielded 89% sensitivity (95% confidence interval [CI], 79%-96%), 78% specificity (95% CI, 68%-86%), a 4.1 positive likelihood ratio (95% CI, 1.7-10), and a 0.19 negative likelihood ratio (95% CI, 0.1-0.4). The overall diagnostic odds ratio was 25.6 (95% CI, 7.3-89.5), and the area under the summary receiver operator characteristic curve was 93% ± 3.5. The Ontario study yielded sensitivity and specificity of 79% and 70%, respectively. The high diagnostic accuracy determined for (18)F-FDG PET in this metaanalysis suggests potential value for diagnosis of cardiac sarcoidosis compared with the MHLW guidelines. These results may affect patient care by providing supportive evidence for more effective use of (18)F-FDG PET in the diagnosis of cardiac sarcoidosis. Large-scale multicenter studies are required to further evaluate this role.
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          Resolution modeling in PET imaging: theory, practice, benefits, and pitfalls.

          In this paper, the authors review the field of resolution modeling in positron emission tomography (PET) image reconstruction, also referred to as point-spread-function modeling. The review includes theoretical analysis of the resolution modeling framework as well as an overview of various approaches in the literature. It also discusses potential advantages gained via this approach, as discussed with reference to various metrics and tasks, including lesion detection observer studies. Furthermore, attention is paid to issues arising from this approach including the pervasive problem of edge artifacts, as well as explanation and potential remedies for this phenomenon. Furthermore, the authors emphasize limitations encountered in the context of quantitative PET imaging, wherein increased intervoxel correlations due to resolution modeling can lead to significant loss of precision (reproducibility) for small regions of interest, which can be a considerable pitfall depending on the task of interest.

            Author and article information

            [1 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, , King’s College London, King’s Health Partners, St. Thomas’ Hospital, ; 1st Floor, Lambeth Wing, London, SE1 7EH United Kingdom
            [2 ]ISNI 0000 0004 1936 8948, GRID grid.4991.5, Department of Oncology, , University of Oxford, ; Old Road Campus Research Building, Oxford, OX3 7DQ United Kingdom
            [3 ]ISNI 0000 0001 0440 1440, GRID grid.410556.3, Radiation Physics and Protection, Churchill Hospital, , Oxford University Hospitals NHS Foundation Trust, ; Oxford, OX3 7LE United Kingdom
            +44 (0) 20 7188 1496 ,
            J Nucl Cardiol
            J Nucl Cardiol
            Journal of Nuclear Cardiology
            Springer US (New York )
            19 July 2016
            19 July 2016
            : 24
            : 1
            : 282-290
            27435278 5084874 554 10.1007/s12350-016-0554-8
            © The Author(s) 2016

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

            Original Article
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            © American Society of Nuclear Cardiology 2017

            Cardiovascular Medicine

            physics of imaging, pet, n-13 ammonia


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