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      Myocardial Defect Detection Using PET-CT: Phantom Studies

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          Abstract

          It is expected that both noise and activity distribution can have impact on the detectability of a myocardial defect in a cardiac PET study. In this work, we performed phantom studies to investigate the detectability of a defect in the myocardium for different noise levels and activity distributions. We evaluated the performance of three reconstruction schemes: Filtered Back-Projection (FBP), Ordinary Poisson Ordered Subset Expectation Maximization (OP–OSEM), and Point Spread Function corrected OSEM (PSF–OSEM). We used the Channelized Hotelling Observer (CHO) for the task of myocardial defect detection. We found that the detectability of a myocardial defect is almost entirely dependent on the noise level and the contrast between the defect and its surroundings.

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          Most cited references 10

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          Model observers for assessment of image quality.

          Image quality can be defined objectively in terms of the performance of some "observer" (either a human or a mathematical model) for some task of practical interest. If the end user of the image will be a human, model observers are used to predict the task performance of the human, as measured by psychophysical studies, and hence to serve as the basis for optimization of image quality. In this paper, we consider the task of detection of a weak signal in a noisy image. The mathematical observers considered include the ideal Bayesian, the nonprewhitening matched filter, a model based on linear-discriminant analysis and referred to as the Hotelling observer, and the Hotelling and Bayesian observers modified to account for the spatial-frequency-selective channels in the human visual system. The theory behind these observer models is briefly reviewed, and several psychophysical studies relating to the choice among them are summarized. Only the Hotelling model with channels is mathematically tractable in all cases considered here and capable of accounting for all of these data. This model requires no adjustment of parameters to fit the data and is relatively insensitive to the details of the channel mechanism. We therefore suggest it as a useful model observer for the purpose of assessing and optimizing image quality with respect to simple detection tasks.
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            Impact of time-of-flight on PET tumor detection.

            Time-of-flight (TOF) PET uses very fast detectors to improve localization of events along coincidence lines-of-response. This information is then utilized to improve the tomographic reconstruction. This work evaluates the effect of TOF upon an observer's performance for detecting and localizing focal warm lesions in noisy PET images. An advanced anthropomorphic lesion-detection phantom was scanned 12 times over 3 days on a prototype TOF PET/CT scanner (Siemens Medical Solutions). The phantom was devised to mimic whole-body oncologic (18)F-FDG PET imaging, and a number of spheric lesions (diameters 6-16 mm) were distributed throughout the phantom. The data were reconstructed with the baseline line-of-response ordered-subsets expectation-maximization algorithm, with the baseline algorithm plus point spread function model (PSF), baseline plus TOF, and with both PSF+TOF. The lesion-detection performance of each reconstruction was compared and ranked using localization receiver operating characteristics (LROC) analysis with both human and numeric observers. The phantom results were then subjectively compared to 2 illustrative patient scans reconstructed with PSF and with PSF+TOF. Inclusion of TOF information provides a significant improvement in the area under the LROC curve compared to the baseline algorithm without TOF data (P = 0.002), providing a degree of improvement similar to that obtained with the PSF model. Use of both PSF+TOF together provided a cumulative benefit in lesion-detection performance, significantly outperforming either PSF or TOF alone (P < 0.002). Example patient images reflected the same image characteristics that gave rise to improved performance in the phantom data. Time-of-flight PET provides a significant improvement in observer performance for detecting focal warm lesions in a noisy background. These improvements in image quality can be expected to improve performance for the clinical tasks of detecting lesions and staging disease. Further study in a large clinical population is warranted to assess the benefit of TOF for various patient sizes and count levels, and to demonstrate effective performance in the clinical environment.
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              Evaluation of the novel myocardial perfusion positron-emission tomography tracer 18F-BMS-747158-02: comparison to 13N-ammonia and validation with microspheres in a pig model.

              Positron-emission tomography (PET) tracers for myocardial perfusion are commonly labeled with short-lived isotopes that limit their widespread clinical use. 18F-BMS-747158-02 (18F-BMS) is a novel pyridaben derivative that was evaluated for assessment of myocardial perfusion by comparison with 13N-ammonia (13NH3) and with radioactive microspheres in a pig model. Fourteen pigs injected with 500 MBq of 13NH3 or 100 to 200 MBq of 18F-BMS underwent dynamic PET at rest and during pharmacological stress. In 8 of these pigs, 18F-BMS was injected during stress combined with transient, 2.5-minute constriction of the left anterior descending coronary artery. Radioactive microspheres were coinjected with 18F-BMS. Ratios of myocardial tracer uptake to surrounding tissues were determined, and myocardial blood flow was quantified by compartmental modeling. Both tracers showed high and homogeneous myocardial uptake. Compared with 13NH3, 18F-BMS showed higher activity ratios between myocardium and blood (rest 2.5 versus 4.1; stress 2.1 versus 5.8), liver (rest 1.2 versus 1.8; stress 0.7 versus 2.0), and lungs (rest 2.5 versus 4.2; stress 2.9 versus 6.4). Regional myocardial blood flow assessed with 18F-BMS PET showed good correlation (r=0.88, slope=0.84) and agreement (mean difference -0.10 [25th percentile -0.3, 75th percentile 0.1 mL x min(-1) x g(-1)]) with that measured with radioactive microspheres over a flow range from 0.1 to 3.0 mL x min(-1) x g(-1). The extent of defects induced by left anterior descending coronary artery constriction measured by 18F-BMS and microspheres also correlated closely (r=0.63, slope=1.1). 18F-BMS-747158-02 is a very attractive new PET perfusion tracer that allows quantitative assessment of regional myocardial perfusion over a wide flow range. The long half-life of 18F renders this tracer useful for clinical PET/CT applications in the workup of patients with suspected or proven coronary artery disease.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                5 February 2014
                : 9
                : 2
                Affiliations
                [1 ]Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts, United States of America
                [2 ]Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States of America
                [3 ]A*STAR-NUS Clinical Imaging and Research Centre (CIRC), Singapore, Singapore
                NIH, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: GEF JO. Performed the experiments: AB JO. Analyzed the data: ESM JO. Contributed reagents/materials/analysis tools: JS JO. Wrote the paper: ESM JO. Edited the manuscript: JS.

                Article
                PONE-D-13-43006
                10.1371/journal.pone.0088200
                3914931

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Pages: 6
                Funding
                This research was supported in part by the National Institutes of Health (NIH) Grants R01-HL110241 and T32-EB013180. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Engineering
                Signal Processing
                Image Processing
                Medicine
                Cardiovascular
                Myocardial Infarction
                Clinical Research Design
                Epidemiology
                Diagnostic Medicine
                Test Evaluation
                Epidemiology
                Cardiovascular Disease Epidemiology
                Epidemiological Methods
                Radiology
                Nuclear Medicine
                PET imaging

                Uncategorized

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