The impact of respiratory gated positron emission tomography on clinical staging and management of patients with lung cancer

Grootjans, Willem; Hermsen, Rick; Heijden, Erik H F M van der; Schuurbiers-Siebers, Olga C.J.; Visser, Eric P.; Oyen, Wim J.G.; Geus-Oei, Lioe-Fee de

doi:10.1016/j.lungcan.2015.09.016

Cited by 20 publications

(9 citation statements)

References 25 publications

(28 reference statements)

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“…Such artifacts impede the provision of appropriate patient care. For example, use of fluorine 18 FDG PET/ CT for oncologic imaging is subject to the limitations and artifacts imposed by respiratory motion; subsequent corrections could affect initial staging and subsequent treatment response monitoring, thus altering patient management, as previously shown (33,34). The objective improvements we saw in image resolution (decreased lesion FWHM) and quantification of radiotracer uptake (increased FDG SUV max ) Note.-ND = lesion not definable with a FWHM measurement (eg, lesion-to-background ratio was too low), SD = standard deviation.…”

Section: Discussionmentioning

confidence: 99%

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

et al. 2016

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Purpose To assess the performance of hardware- and software-gating technologies in terms of qualitative and quantitative characteristics of respiratory motion in positron emission tomography (PET) imaging. Materials and Methods Between 2010 and 2013, 219 fluorine 18 fluorodeoxyglucose PET examinations were performed in 116 patients for assessment of pulmonary nodules. All patients provided informed consent in this institutional review board-approved study. Acquisitions were reconstructed as respiratory-gated images by using hardware-derived respiratory triggers and software-derived signal (via an automated postprocessing method). Asymmetry was evaluated in the joint distribution of reader preference, and linear mixed models were used to evaluate differences in outcomes according to gating type. Results In blind reviews of reconstructed gated images, software was selected as superior 16.9% of the time (111 of 657 image sets; 95% confidence interval [CI]: 14.0%, 19.8%), and hardware was selected as superior 6.2% of the time (41 of 657 image sets; 95% CI: 4.4%, 8.1%). Of the image sets, 76.9% (505 of 657; 95% CI: 73.6%, 80.1%) were judged as having indistinguishable motion quality. Quantitative analysis demonstrated that the two gating strategies exhibited similar performance, and the performance of both was significantly different from that of nongated images. The mean increase ± standard deviation in lesion maximum standardized uptake value was 42.2% ± 38.9 between nongated and software-gated images, and lesion full width at half maximum values decreased by 9.9% ± 9.6. Conclusion Compared with vendor-supplied respiratory-gating hardware methods, software gating performed favorably, both qualitatively and quantitatively. Fully automated gating is a feasible approach to motion correction of PET images. (©) RSNA, 2016 Online supplemental material is available for this article.

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Section: Discussionmentioning

confidence: 99%

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

et al. 2016

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“…The amount of administered 18 F-FDG was adjusted to each patient's weight (3.2 6 0.3 MBq/kg). Full details on image acquisition and reconstruction have been described previously (12,16). In short, imaging of the thorax and upper abdomen was performed in list mode at 6 min per bed position, and the respiratory signal was obtained using an AZ-733V respiratory gating system (Anzai Medical Co. Ltd.).…”

Section: Image Acquisition and Reconstructionmentioning

confidence: 99%

The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on ¹⁸F-FDG PET Imaging of Lung Cancer

et al. 2016

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Accurate measurement of intratumor heterogeneity using parameters of texture on PET images is essential for precise characterization of cancer lesions. In this study, we investigated the influence of respiratory motion and varying noise levels on quantification of textural parameters in patients with lung cancer. Methods: We used an optimal-respiratory-gating algorithm on the list-mode data of 60 lung cancer patients who underwent 18 F-FDG PET. The images were reconstructed using a duty cycle of 35% (percentage of the total acquired PET data). In addition, nongated images of varying statistical quality (using 35% and 100% of the PET data) were reconstructed to investigate the effects of image noise. Several global image-derived indices and textural parameters (entropy, high-intensity emphasis, zone percentage, and dissimilarity) that have been associated with patient outcome were calculated. The clinical impact of optimal respiratory gating and image noise on assessment of intratumor heterogeneity was evaluated using Cox regression models, with overall survival as the outcome measure. The threshold for statistical significance was adjusted for multiple comparisons using Bonferroni correction. Results: In the lower lung lobes, respiratory motion significantly affected quantification of intratumor heterogeneity for all textural parameters (P , 0.007) except entropy (P . 0.007). The mean increase in entropy, dissimilarity, zone percentage, and high-intensity emphasis was 1.3% ± 1.5% (P 5 0.02), 11.6% ± 11.8% (P 5 0.006), 2.3% ± 2.2% (P 5 0.002), and 16.8% ± 17.2% (P 5 0.006), respectively. No significant differences were observed for lesions in the upper lung lobes (P . 0.007). Differences in the statistical quality of the PET images affected the textural parameters less than respiratory motion, with no significant difference observed. The median follow-up time was 35 mo (range, 7-39 mo). In multivariate analysis for overall survival, total lesion glycolysis and high-intensity emphasis were the two most relevant image-derived indices and were considered to be independent significant covariates for the model regardless of the image type considered. Conclusion: The tested textural parameters are robust in the presence of respiratory motion artifacts and varying levels of image noise.

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“…For the first method, to maintain image quality, respiratory gating requires a longer scan time and/or a higher injected activity. Therefore, respiratory gating is nowadays not routinely used for diagnostic imaging [ 49 , 50 ]. However, it is more commonly applied for radiotherapy planning, where an accurate delineation and quantification is even more important [ 51 – 53 ].…”

Section: Introductionmentioning

confidence: 99%

Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET

Vos

Koopman

Rijnsdorp

et al. 2017

Eur J Nucl Med Mol Imaging

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In recent years, there have been multiple advances in positron emission tomography/computed tomography (PET/CT) that improve cancer imaging. The present generation of PET/CT scanners introduces new hardware, software, and acquisition methods. This review describes these new developments, which include time-of-flight (TOF), point-spread-function (PSF), maximum-a-posteriori (MAP) based reconstruction, smaller voxels, respiratory gating, metal artefact reduction, and administration of quadratic weight-dependent 18F–fluorodeoxyglucose (FDG) activity. Also, hardware developments such as continuous bed motion (CBM), (digital) solid-state photodetectors and combined PET and magnetic resonance (MR) systems are explained. These novel techniques have a significant impact on cancer imaging, as they result in better image quality, improved small lesion detectability, and more accurate quantification of radiopharmaceutical uptake. This influences cancer diagnosis and staging, as well as therapy response monitoring and radiotherapy planning. Finally, the possible impact of these developments on the European Association of Nuclear Medicine (EANM) guidelines and EANM Research Ltd. (EARL) accreditation for FDG-PET/CT tumor imaging is discussed.

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The impact of respiratory gated positron emission tomography on clinical staging and management of patients with lung cancer

Cited by 20 publications

References 25 publications

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on ¹⁸F-FDG PET Imaging of Lung Cancer

Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET

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The impact of respiratory gated positron emission tomography on clinical staging and management of patients with lung cancer

Cited by 20 publications

References 25 publications

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

Validation of Software Gating: A Practical Technology for Respiratory Motion Correction in PET

The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on 18F-FDG PET Imaging of Lung Cancer

Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET

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The Impact of Optimal Respiratory Gating and Image Noise on Evaluation of Intratumor Heterogeneity on ¹⁸F-FDG PET Imaging of Lung Cancer