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Triple-gated motion and blood pool clearance corrections improve reproducibility of coronary 18F-NaF PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To improve the test–retest reproducibility of coronary plaque 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) uptake measurements.

Methods

We recruited 20 patients with coronary artery disease who underwent repeated hybrid PET/CT angiography (CTA) imaging within 3 weeks. All patients had 30-min PET acquisition and CTA during a single imaging session. Five PET image-sets with progressive motion correction were reconstructed: (i) a static dataset (no-MC), (ii) end-diastolic PET (standard), (iii) cardiac motion corrected (MC), (iv) combined cardiac and gross patient motion corrected (2 × MC) and, (v) cardiorespiratory and gross patient motion corrected (3 × MC). In addition to motion correction, all datasets were corrected for variations in the background activities which are introduced by variations in the injection-to-scan delays (background blood pool clearance correction, BC). Test–retest reproducibility of PET target-to-background ratio (TBR) was assessed by Bland–Altman analysis and coefficient of reproducibility.

Results

A total of 47 unique coronary lesions were identified on CTA. Motion correction in combination with BC improved the PET TBR test–retest reproducibility for all lesions (coefficient of reproducibility: standard = 0.437, no-MC = 0.345 (27% improvement), standard + BC = 0.365 (20% improvement), no-MC + BC = 0.341 (27% improvement), MC + BC = 0.288 (52% improvement), 2 × MC + BC = 0.278 (57% improvement) and 3 × C + BC = 0.254 (72% improvement), all p < 0.001). Importantly, in a sub-analysis of 18F-NaF-avid lesions with gross patient motion > 10 mm following corrections, reproducibility was improved by 133% (coefficient of reproducibility: standard = 0.745, 3 × MC = 0.320).

Conclusion

Joint corrections for cardiac, respiratory, and gross patient motion in combination with background blood pool corrections markedly improve test–retest reproducibility of coronary 18F-NaF PET.

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Abbreviations

18F-NaF:

18F-sodium fluoride

PET:

positron emission tomography

CTA:

coronary computed tomography angiography

MC:

cardiac motion corrected

2 × MC:

cardiac and gross patient motion corrected

3 × MC:

cardiac, respiratory, and gross patient motion corrected

BC:

background blood pool clearance correction

TBR:

tTarget to background ratio

SUV:

Standardized uptake value

VOI:

Volume of Interest

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Funding

This research was supported in part by grant R01HL135557 from the National Heart, Lung, and Blood Institute/National Institutes of Health (NHLBI/NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, the study was supported by Siemens Medical Systems. The study was also supported by a grant (“Cardiac Imaging Research Initiative”) from the Miriam & Sheldon G. Adelson Medical Research Foundation. DEN is supported by the British Heart Foundation (CH/09/002, RM/13/2/30158, RE/13/3/30183) and is the recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA). MRD is supported by the Sir Jules Thorn Biomedical Research Award (JTA/15) and the British Heart Foundation (FS/14/78/31020). None of the other authors have any conflict of interest relevant to this study.

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Authors and Affiliations

  1. Artificial Intelligence in Medicine Program, Cedars-Sinai Medical Center, 8700 Beverly Blvd Ste A047N, California, Los Angeles, 90048, USA

    Martin Lyngby Lassen, Jacek Kwiecinski, Damini Dey, Sebastien Cadet, Guido Germano, Daniel S. Berman & Piotr J. Slomka

  2. British Heart Foundation Centre for Cardiovascular Science, Clinical Research Imaging Centre, Edinburgh Heart Centre, University of Edinburgh, Edinburgh, UK

    Jacek Kwiecinski, Philip D. Adamson, Alastair J. Moss, Marc R. Dweck & David E. Newby

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  1. Martin Lyngby Lassen
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  2. Jacek Kwiecinski
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  3. Damini Dey
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  4. Sebastien Cadet
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  11. Piotr J. Slomka
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Corresponding author

Correspondence to Piotr J. Slomka.

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Ethical approval

All procedures performed in studies involving human participants were approved by the local institutional review board, the Scottish Research Ethics Committee (REC reference: 14/SS/0089 and 15/SS/0203), and the United Kingdom (UK) Administration of Radiation Substances Advisory Committee. The study was performed in accordance with the Declaration of Helsinki. All patients provided written informed consent prior to any study procedures.

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This article is part of the Topical Collection on Cardiology

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Figure S1 is available online. This figure includes Bland–Altman plots of the target to background (TBR) assessment for 18F-NaF-avid lesions only.

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Lassen, M.L., Kwiecinski, J., Dey, D. et al. Triple-gated motion and blood pool clearance corrections improve reproducibility of coronary 18F-NaF PET. Eur J Nucl Med Mol Imaging 46, 2610–2620 (2019). https://doi.org/10.1007/s00259-019-04437-x

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  • DOI: https://doi.org/10.1007/s00259-019-04437-x

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