Purpose Attenuation correction using CT transmission scanning increases the accuracy of single-photon emission computed tomography (SPECT) and enables quantitative analysis. Current existing SPECT-only systems normally do not support transmission scanning and therefore scans on these systems are susceptible to attenuation artifacts. Moreover, the use of CT scans also increases radiation dose to patients and significant artifacts can occur due to the misregistration between the SPECT and CT scans as a result of patient motion. The purpose of this study is to develop an approach to estimate attenuation maps directly from SPECT emission data using deep learning methods. Methods Both photopeak window and scatter window SPECT images were used as inputs to better utilize the underlying attenuation information embedded in the emission data. The CT-based attenuation maps were used as labels with which cardiac SPECT/CT images of 65 patients were included for training and testing. We implemented and evaluated deep fully convolutional neural networks using both standard training and training using an adversarial strategy. Results The synthetic attenuation maps were qualitatively and quantitatively consistent with the CT-based attenuation map. The globally normalized mean absolute error (NMAE) between the synthetic and CT-based attenuation maps were 3.60% ± 0.85% among the 25 testing subjects. The SPECT reconstructed images corrected using the CT-based attenuation map and synthetic attenuation map are highly consistent. The NMAE between the reconstructed SPECT images that were corrected using the synthetic and CT-based attenuation maps was 0.26% ± 0.15%, whereas the localized absolute percentage error was 1.33% ± 3.80% in the left ventricle (LV) myocardium and 1.07% ± 2.58% in the LV blood pool. Conclusion We developed a deep convolutional neural network to estimate attenuation maps for SPECT directly from the emission data. The proposed method is capable of generating highly reliable attenuation maps to facilitate attenuation correction for SPECT-only scanners for myocardial perfusion imaging.
A novel 18 F-labeled ligand for the norepinephrine transporter (N-[3-bromo-4-(3-18 F-fluoro-propoxy)-benzyl]-guanidine [LMI1195]) is in clinical development for mapping cardiac nerve terminals in vivo using PET. Human safety, whole-organ biodistribution, and radiation dosimetry of LMI1195 were evaluated in a phase 1 clinical trial. Methods: Twelve healthy subjects at 3 clinical sites were injected intravenously with 150-250 MBq of LMI1195. Dynamic PET images were obtained over the heart for 10 min, followed by sequential whole-body images for approximately 5 h. Blood samples were obtained, and heart rate, electrocardiogram, and blood pressure were monitored before and during imaging. Residence times were determined from multiexponential regression of organ region-ofinterest data normalized by administered activity (AA). Radiation dose estimates were calculated using OLINDA/EXM. Myocardial, lung, liver, and blood-pool standardized uptake values were determined at different time intervals. Results: No adverse events due to LMI1195 were seen. Blood radioactivity cleared quickly, whereas myocardial uptake remained stable and uniform throughout the heart over 4 h. Liver and lung activity cleared relatively rapidly, providing favorable target-to-background ratios for cardiac imaging. The urinary bladder demonstrated the largest peak uptake (18.3% AA), followed by the liver (15.5% AA). The mean effective dose was 0.026 ± 0.0012 mSv/MBq. Approximately 1.6% AA was seen in the myocardium initially, remaining above 1.5% AA (decay-corrected) through 4 h after injection. The myocardium-to-liver ratio was approximately unity initially, increasing to more than 2 at 4 h. Conclusion: These preliminary data suggest that LMI1195 is well tolerated and yields a radiation dose comparable to that of other commonly used PET radiopharmaceuticals. The kinetics of myocardial and adjacent organ activity suggest that cardiac imaging should be possible with acceptable patient radiation dose.
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