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

      research-article
      , 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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          Abstact

          Objectives

          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.

          Methods

          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.

          Results

          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%.

          Conclusion

          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 references29

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          The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience.

          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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            Phantom and Clinical Evaluation of the Bayesian Penalized Likelihood Reconstruction Algorithm Q.Clear on an LYSO PET/CT System.

            Q.Clear, a Bayesian penalized-likelihood reconstruction algorithm for PET, was recently introduced by GE Healthcare on their PET scanners to improve clinical image quality and quantification. In this work, we determined the optimum penalization factor (beta) for clinical use of Q.Clear and compared Q.Clear with standard PET reconstructions.
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              Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing.

              Cardiac sarcoidosis (CS) causes substantial morbidity and sudden death. Early diagnosis and risk stratification are warranted. Ambulatory patients with sarcoidosis were interviewed to determine whether they experienced palpitations, syncope, or presyncope, and were evaluated with ECG, Holter monitoring, and echocardiography (transthoracic echocardiogram [TTE]). Those with symptoms or abnormal results were studied with cardiac MRI (CMRI) or positron emission tomography (PET) scanning. The diagnosis of CS was based on abnormalities detected by these imaging studies. Patients with CS were referred for risk stratification by electrophysiology study (EPS). Among the 62 patients evaluated, the prevalence of CS was 39%. Patients with CS had more cardiac symptoms than those without CS (46% vs 5%, respectively; p < 0.001), and were more likely to have abnormal Holter monitoring findings (50% vs 3%, respectively; p < 0.001) and TTE findings (25% vs 5%, respectively; p = 0.02). The degree of pulmonary impairment did not predict CS. Two of the 17 patients who underwent EPS had abnormal test findings and received implantable cardioverter-defibrillators. No patients died, had ventricular arrhythmias that triggered defibrillator therapy, or had heart failure develop during almost 2 years of follow-up. This diagnostic approach was more sensitive than the established criteria for identifying CS. CS is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with PET scanning or CMRI is more sensitive than the established criteria for the identification of CS. Sarcoidal lesions seen on CMRI or PET scanning do not predict arrhythmias in ambulatory patients with preserved cardiac function, who appear to be at low risk for short-term mortality.
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                Author and article information

                Contributors
                +44 (0) 20 7188 1496 , jim.odoherty@kcl.ac.uk
                Journal
                J Nucl Cardiol
                J Nucl Cardiol
                Journal of Nuclear Cardiology
                Springer US (New York )
                1071-3581
                1532-6551
                19 July 2016
                19 July 2016
                2017
                : 24
                : 1
                : 282-290
                Affiliations
                [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
                Article
                554
                10.1007/s12350-016-0554-8
                5084874
                27435278
                579206b5-d6d8-4599-9ec6-f888cbaa6f62
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), 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.

                History
                : 24 March 2016
                : 5 May 2016
                Categories
                Original Article
                Custom metadata
                © American Society of Nuclear Cardiology 2017

                Cardiovascular Medicine
                n-13 ammonia,pet,physics of imaging
                Cardiovascular Medicine
                n-13 ammonia, pet, physics of imaging

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