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- Kockum, Karin, 1981-
(författare)
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Imaging in Idiopathic Normal Pressure Hydrocephalus : The value of structured radiological evaluation
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Idiopathic normal pressure hydrocephalus (iNPH) is a neurological condition where the symptoms include disturbed gait, balance, cognition and continence. The diagnostic guidelines are based on typical symptoms combined with imaging showing enlarged ventricles. Several scales for evaluating symptoms exist, but no corresponding tool is in use for imaging. The aim of this thesis was to construct a radiological scoring system, the iNPH Radscale, to facilitate radiological evaluation and systematic reporting of changes. Further, to test the reliability and accuracy of the scale and evaluate the usefulness for longitudinal monitoring.Methods: In paper I 168 individuals over 65 years of age from the general population underwent computed tomography (CT) of the brain and a neurological examination, and the same cohort was followed up 2 years later in paper IV. The iNPH Radscale was developed in these papers and further validated in papers II and III. Papers II and III included surgically treated iNPH patients with preoperative imaging of the brain. Thirty-five patients were included in paper II comparing preoperative CT and magnetic resonance imaging (MRI) using the iNPH Radscale. Paper III included 75 shunt responsive patients and 55 asymptomatic controls to evaluate the accuracy of the iNPH Radscale.Results: In paper I, seven parameters summarized as a total iNPH Radscale score were significantly associated with clinical iNPH symptoms (r = 0.55, p < 0.001). In paper II, the agreement between CT and MRI was substantial to almost perfect (kappa and intraclass correlation, 0.60–0.91, p < 0.001) for all parameters except periventricular white matter changes. In paper III the iNPH Radscale score was significantly higher in the iNPH group than the control group (p <0.001). Receiver operating characteristics analysis yielded an area under the curve of 99.7 %, and an iNPH Radscale score £ 4 identified those without iNPH (sensitivity 100 %, specificity 96 % and overall accuracy 98.5 %). In paper IV, symptomatic participants had significantly higher iNPH Radscale scores at baseline and follow-up.Conclusions: The iNPH Radscale summarizes seven imaging features from the diagnostic guidelines and is applicable to both CT and MRI. INPH is very likely in patients with an iNPH Radscale score ³ 8 and corresponding clinical symptoms. On the other hand, the diagnosis should be questioned when the iNPH Radscale score is less than the cut-off of 4. In summary, the iNPH Radscale may become a relevant diagnostic tool for standardized evaluation in the workup of patients with suspected iNPH, as a diagnostic checklist and as a screening tool for detection with the potential for ruling out the disease.
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- Strandberg, Sara, 1976-
(författare)
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11C-Acetate-PET/CT in Primary Staging of High-Risk Prostate Cancer
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prostate cancer (PC) is the second most common cancer in men worldwide, affecting ~12%. Although most are clinically insignificant low-risk cancers, the more aggressive high-risk cancers require correct staging, prior to curative radiotherapy or surgery. Standard staging procedures and tools include clinical examination, estimated nomogram risk of pelvic lymph node (LN) metastases, and bone scintigraphy (BS). Additional staging information can be obtained with magnetic resonance imaging (MRI), computed tomography (CT) and positron-emission tomography/computed tomography (PET/CT). PET/CT can provide information on both functional and morphological changes.The aims of the present thesis were to investigate the diagnostic and prognostic value of 11C-acetate (ACE)-PET/CT in high-risk PC, and to optimize the ACE-PET protocol. In study I and II, higher detection rates of LN metastases and bone metastases were found with ACE-PET/CT, than with standard methods nomogram risk and BS. The higher ACE uptake in the prostate (prostate lipogenic tumor burden), the higher the risk of suspected LN metastases (N+ disease) on PET/CT. ACE-PET/CT findings correlated better than BS with follow-up data, and influenced therapy in 11-43%. In study III, PET reconstruction algorithm with resolution recovery showed more accurate functional tumor volumes compared to CT, and higher measurements of lipogenic activity, than reconstruction algorithm without resolution recovery. Study IV was part of an interventional radiotherapy study (PARAPLY) on high-risk PC, with addition of image-guided simultaneous integrated boost to delineated prostate tumors and pelvic LN metastases reported in ACE-PET/CT and MRI. Comparative analyses of clinical risk parameters and baseline ACE-PET/CT parameters showed significant associations between nomogram risk and prostate lipogenic tumor burden, between N+ disease on PET/CT and prostate lipogenic tumor burden, but surprisingly not between nomogram risk and N+ disease on PET/CT. PET with resolution recovery was superior in detection of N+ disease.In conclusion, ACE-PET/CT showed a higher detection rate of suspected metastases compared to standard methods clinical nomogram and BS, in high-risk PC. PET reconstruction with resolution recovery seems to improve the diagnostic added value of ACE-PET/CT. Prostate lipogenic tumor burden could serve as a predictor of N+ disease. The prognostic value of ACE-PET/CT remains to be investigated in future studies.
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| 3. |
- Wallstén, Elin, 1985-
(författare)
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Error reduction strategies for quantitative PET with focus on hybrid PET/MRI
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Positron Emission Tomography (PET) is an important tool for detection, staging and follow-up in a wide range of diseases, including cancer and neurological disorders. As a functional imaging tool, PET can visualize biological processes, where positron emitting radioactive isotopes are connected to molecules with different functions in the body. While PET-images can be visually interpreted, they can also be used for quantitative measurements, where functions such as glucose metabolism, dopamine receptor function, and blood-flow can be quantified. Measurements can be performed in static imaging, or in dynamic imaging where graphical methods can be used for analysis.PET images benefit from fusion with anatomical images which facilitates the interpretation. The combination of PET with computed tomography (CT) as in PET/CT hybrid equipment is a well-established imaging method. Magnetic Resonance Imaging (MRI) has some advantages over CT such as the high soft tissue contrast, but the combination with PET in a fully integrated system is far more technically challenging. Most of the technical concerns have been solved, and PET/MRI modalities are now commercially available.Among the remaining challenges, the attenuation correction is still not yet completely solved, where the attenuation maps on the PET/MRI modalities are approximate and bone is not accounted for in all parts of the body. There are also challenges with quantitative PET in general, where for example low spatial resolution and presence of noise can lead to quantitative errors. The purpose of this thesis was to investigate and develop strategies to reduce quantitative errors in PET imaging with special focus on PET/MRI.In study I, we studied the limits for quantification of size and uptake in small lesions in PET images reconstructed with a resolution modelling algorithm. We constructed a phantom of small balloons and reconstructed images with three different algorithms and measured volume and activity concentration in the images. The measured activity concentration in the lesions was corrected for the low resolution that yields partial-volume effects (PVE). We found that resolution modelling improved quantification of all lesions, and that in combination with correction factors, lesions larger than ~9 mm diameter could be correctly quantified.Study II is focused on the effect of frame time length on the graphical Logan-analysis for dynamic studies with 11C-raclopride. Logan analysis is reported to be sensitive to noise, and image noise is heavily dependent on the frame time length. Noise can also generate bias when using iterative reconstruction methods. Weivconcluded that with region-based analyses, a bias of approximately 10% in the non-displaceable binding potential was found when using the shortest time frames, and that the bias was mainly caused by the reconstruction algorithm. Long time frames generated stable parameters.The last two studies focused on the attenuation correction in PET/MRI hybrid equipment. In study III, a method for attenuation correction in PET/MRI was implemented and evaluated. The method is developed for the pelvic region and is based on statistical decomposition of T2-weighted images. We found that the new method improved quantification, especially in regions in vicinity of bone. In study IV, we proposed a concept for patient-specific quality assurance of attenuation maps, based on measurements of the MRI B0-field. The method shows potential to find errors in the attenuation map related to metallic implants, air, and patient contour.The work in this thesis has contributed to increased knowledge about the effect of resolution and noise for quantification in PET images. It has also introduced a new method for attenuation correction in PET/MRI, and a concept for quality assurance of PET/MRI attenuation maps.
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