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1.
  • Ballantyne, Kaye N., et al. (författare)
  • Toward Male Individualization with Rapidly Mutating Y-Chromosomal Short Tandem Repeats
  • 2014
  • Ingår i: Human Mutation. - : John Wiley & Sons. - 1059-7794 .- 1098-1004. ; 35:8, s. 1021-1032
  • Tidskriftsartikel (refereegranskat)abstract
    • Relevant for various areas of human genetics, Y-chromosomal short tandem repeats (Y-STRs) are commonly used for testing close paternal relationships among individuals and populations, and for male lineage identification. However, even the widely used 17-loci Yfiler set cannot resolve individuals and populations completely. Here, 52 centers generated quality-controlled data of 13 rapidly mutating (RM) Y-STRs in 14,644 related and unrelated males from 111 worldwide populations. Strikingly, greater than99% of the 12,272 unrelated males were completely individualized. Haplotype diversity was extremely high (global: 0.9999985, regional: 0.99836-0.9999988). Haplotype sharing between populations was almost absent except for six (0.05%) of the 12,156 haplotypes. Haplotype sharing within populations was generally rare (0.8% nonunique haplotypes), significantly lower in urban (0.9%) than rural (2.1%) and highest in endogamous groups (14.3%). Analysis of molecular variance revealed 99.98% of variation within populations, 0.018% among populations within groups, and 0.002% among groups. Of the 2,372 newly and 156 previously typed male relative pairs, 29% were differentiated including 27% of the 2,378 father-son pairs. Relative to Yfiler, haplotype diversity was increased in 86% of the populations tested and overall male relative differentiation was raised by 23.5%. Our study demonstrates the value of RMY-STRs in identifying and separating unrelated and related males and provides a reference database.
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2.
  • Anand, Aseem, et al. (författare)
  • A preanalytic validation study of automated bone scan index : Effect on accuracy and reproducibility due to the procedural variabilities in bone scan image acquisition
  • 2016
  • Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 57:12, s. 1865-1871
  • Tidskriftsartikel (refereegranskat)abstract
    • The effect of the procedural variability in image acquisition on the quantitative assessment of bone scan is unknown. Here, we have developed and performed preanalytical studies to assess the impact of the variability in scanning speed and in vendor-specific γ-camera on reproducibility and accuracy of the automated bone scan index (BSI). Methods: Two separate preanalytical studies were performed: a patient study and a simulation study. In the patient study, to evaluate the effect on BSI reproducibility, repeated bone scans were prospectively obtained from metastatic prostate cancer patients enrolled in 3 groups (Grp). In Grp1, the repeated scan speed and the γ-camera vendor were the same as that of the original scan. In Grp2, the repeated scan was twice the speed of the original scan. In Grp3, the repeated scan used a different γ-camera vendor than that used in the original scan. In the simulation study, to evaluate the effect on BSI accuracy, bone scans of a virtual phantom with predefined skeletal tumor burden (phantom-BSI) were simulated against the range of image counts (0.2, 0.5, 1.0, and 1.5 million) and separately against the resolution settings of the γ-cameras. The automated BSI was measured with a computer-automated platform. Reproducibility was measured as the absolute difference between the repeated BSI values, and accuracy was measured as the absolute difference between the observed BSI and the phantom-BSI values. Descriptive statistics were used to compare the generated data. Results: In the patient study, 75 patients, 25 in each group, were enrolled. The reproducibility of Grp2 (mean ± SD, 0.35 ± 0.59) was observed to be significantly lower than that of Grp1 (mean ± SD, 0.10 ± 0.13; P < 0.0001) and that of Grp3 (mean ± SD, 0.09 ± 0.10; P < 0.0001). However, no significant difference was observed between the reproducibility of Grp3 and Grp1 (P = 0.388). In the simulation study, the accuracy at 0.5 million counts (mean ± SD, 0.57 ± 0.38) and at 0.2 million counts (mean ± SD, 4.67 ± 0.85) was significantly lower than that observed at 1.5 million counts (mean ± SD, 0.20 ± 0.26; P < 0.0001). No significant difference was observed in the accuracy data of the simulation study with vendor-specific γ-cameras (P 5 0.266). Conclusion: In this study, we observed that the automated BSI accuracy and reproducibility were dependent on scanning speed but not on the vendor-specific γ-cameras. Prospective BSI studies should standardize scanning speed of bone scans to obtain image counts at or above 1.5 million.
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3.
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4.
  • Anand, Aseem, et al. (författare)
  • Automated Bone Scan Index as a quantitative imaging biomarker in metastatic castration-resistant prostate cancer patients being treated with enzalutamide
  • 2016
  • Ingår i: EJNMMI Research. - : Springer. - 2191-219X. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Having performed analytical validation studies, we are now assessing the clinical utility of the upgraded automated Bone Scan Index (BSI) in metastatic castration-resistant prostate cancer (mCRPC). In the present study, we retrospectively evaluated the discriminatory strength of the automated BSI in predicting overall survival (OS) in mCRPC patients being treated with enzalutamide.METHODS: Retrospectively, we included patients who received enzalutamide as a clinically approved therapy for mCRPC and had undergone bone scan prior to starting therapy. Automated BSI, prostate-specific antigen (PSA), hemoglobin (HgB), and alkaline phosphatase (ALP) were obtained at baseline. Change in automated BSI and PSA were obtained from patients who have had bone scan at week 12 of treatment follow-up. Automated BSI was obtained using the analytically validated EXINI Bone(BSI) version 2. Kendall's tau (τ) was used to assess the correlation of BSI with other blood-based biomarkers. Concordance index (C-index) was used to evaluate the discriminating strength of automated BSI in predicting OS.RESULTS: Eighty mCRPC patients with baseline bone scans were included in the study. There was a weak correlation of automated BSI with PSA (τ = 0.30), with HgB (τ = -0.17), and with ALP (τ = 0.56). At baseline, the automated BSI was observed to be predictive of OS (C-index 0.72, standard error (SE) 0.03). Adding automated BSI to the blood-based model significantly improved the C-index from 0.67 to 0.72, p = 0.017. Treatment follow-up bone scans were available from 62 patients. Both change in BSI and percent change in PSA were predictive of OS. However, the combined predictive model of percent PSA change and change in automated BSI (C-index 0.77) was significantly higher than that of percent PSA change alone (C-index 0.73), p = 0.041.CONCLUSIONS: The upgraded and analytically validated automated BSI was found to be a strong predictor of OS in mCRPC patients. Additionally, the change in automated BSI demonstrated an additive clinical value to the change in PSA in mCRPC patients being treated with enzalutamide.
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5.
  • Andersson, Martin, et al. (författare)
  • An internal radiation dosimetry computer program, IDAC 2.0, for estimation of patient doses from radiopharmaceuticals
  • 2014
  • Ingår i: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 0144-8420 .- 1742-3406. ; 162:3, s. 299-305
  • Tidskriftsartikel (refereegranskat)abstract
    • The internal dosimetry computer program internal dose assessment by computer (IDAC) for calculations of absorbed doses to organs and tissues as well as effective doses to patients from examinations with radiopharmaceuticals has been developed. The new version, IDAC2.0, incorporates the International Commission on Radiation Protection (ICRP)/ICRU computational adult male and female voxel phantoms and decay data from the ICRP publication 107. Instead of only 25 source and target regions, calculation can now be made with 63 source regions to 73 target regions. The major advantage of having the new phantom is that the calculations of the effective doses can be made with the latest tissue weighting factors of ICRP publication 103. IDAC2.0 uses the ICRP human alimentary tract (HAT) model for orally administrated activity and for excretion through the gastrointestinal tract and effective doses have been recalculated for radiopharmaceuticals that are orally administered. The results of the program are consistent with published data using the same specific absorption fractions and also compared with published data from the same computational phantoms but with segmentation of organs leading to another set of specific absorption fractions. The effective dose is recalculated for all the 34 radiopharmaceuticals that are administered orally and has been published by the ICRP. Using the new HAT model, new tissue weighting factors and the new adult computational voxel phantoms lead to an average effective dose of half of its earlier estimated value. The reduction mainly depends on electron transport simulations to walled organs and the transition from the stylised phantom with unrealistic interorgan distances to more realistic voxel phantoms.
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6.
  • Andersson, Martin, et al. (författare)
  • An upgrade of the internal dosimetry computer program IDAC
  • 2012
  • Ingår i: Medical Physics in the Baltic States. - : Kaunas University of Technology. - 1822-5721. ; , s. 120-123
  • Konferensbidrag (refereegranskat)abstract
    • A full update of the internal dosimetry computer program IDAC has been conducted. The new update is based on new and more accurate computational phantoms to calculate effective dose and absorbed dose to organs and tissues. The new ICRP Adult Reference Computational Phantoms has been adopted as well as the latest of the ICRP standardized biokinetic models. The updated computer program includes a user-friendly graphical user interface.
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7.
  • Andersson, Martin, et al. (författare)
  • Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors
  • 2014
  • Ingår i: EJNMMI Physics. - : Springer. - 2197-7364. ; 1:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Effective dose represents the potential risk to a population of stochastic effects of ionizing radiation (mainly lethal cancer). In recent years, there have been a number of revisions and updates influencing the way to estimate the effective dose. The aim of this work was to recalculate the effective dose values for the 338 different radiopharmaceuticals previously published by the International Commission on Radiological Protection (ICRP).Method: The new estimations are based on information on the cumulated activities per unit administered activity in various organs and tissues and for the various radiopharmaceuticals obtained from the ICRP publications 53, 80 and 106. The effective dose for adults was calculated using the new ICRP/International Commission on Radiation Units (ICRU) reference voxel phantoms and decay data from the ICRP publication 107. The ICRP human alimentary tract model has also been applied at the recalculations. The effective dose was calculated using the new tissue weighting factors from ICRP publications 103 and the prior factors from ICRP publication 60. The results of the new calculations were compared with the effective dose values published by the ICRP, which were generated with the Medical Internal Radiation Dose (MIRD) adult phantom and the tissue weighting factors from ICRP publication 60.Results: For 79% of the radiopharmaceuticals, the new calculations gave a lower effective dose per unit administered activity than earlier estimated. As a mean for all radiopharmaceuticals, the effective dose was 25% lower. The use of the new adult computational voxel phantoms has a larger impact on the change of effective doses than the change to new tissue weighting factors.Conclusion: The use of the new computational voxel phantoms and the new weighting factors has generated new effective dose estimations. These are supposed to result in more realistic estimations of the radiation risk to a population undergoing nuclear medicine investigations than hitherto available values.
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8.
  • Andersson, Martin, et al. (författare)
  • Improved estimates of the radiation absorbed dose to the urinary bladder wall
  • 2014
  • Ingår i: Physics in Medicine and Biology. - : Institute of Physics Publishing (IOPP). - 0031-9155 .- 1361-6560. ; 59:9, s. 2173-2182
  • Tidskriftsartikel (refereegranskat)abstract
    • Specific absorbed fractions (SAFs) have been calculated as a function of the content in the urinary bladder in order to allow more realistic calculations of the absorbed dose to the bladder wall. The SAFs were calculated using the urinary bladder anatomy from the ICRP male and female adult reference computational phantoms. The urinary bladder and its content were approximated by a sphere with a wall of constant mass, where the thickness of the wall depended on the amount of urine in the bladder. SAFs were calculated for males and females with 17 different urinary bladder volumes from 10 to 800 mL, using the Monte Carlo computer program MCNP5, at 25 energies of mono-energetic photons and electrons ranging from 10 KeV to 10 MeV. The decay was assumed to be homogeneously distributed in the urinary bladder content and the urinary bladder wall, and the mean absorbed dose to the urinary bladder wall was calculated. The Monte Carlo simulations were validated against measurements made with thermoluminescent dosimeters. The SAFs obtained for a urine volume of 200 mL were compared to the values calculated for the urinary bladder wall using the adult reference computational phantoms. The mean absorbed dose to the urinary wall from F-18-FDG was found to be 77 mu Gy/MBq formales and 86 mu Gy/MBq for females, while for (99)mTc-DTPA the mean absorbed doses were 80 mu Gy/MBq for males and 86 mu Gy/MBq for females. Compared to calculations using a constant value of the SAF from the adult reference computational phantoms, the mean absorbed doses to the bladder wall were 60% higher for F-18-FDG and 30% higher for (99)mTc-DTPA using the new SAFs.
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9.
  • Andersson, Martin, et al. (författare)
  • ORGAN DOSES AND EFFECTIVE DOSE FOR FIVE PET RADIOPHARMACEUTICALS
  • 2016
  • Ingår i: Radiation Protection Dosimetry. - : Oxford University Press (OUP). - 1742-3406 .- 0144-8420. ; 169:1-4, s. 8-253
  • Tidskriftsartikel (refereegranskat)abstract
    • Diagnostic investigations with positron-emitting radiopharmaceuticals are dominated by (18)F-fluorodeoxyglucose ((18)F-FDG), but other radiopharmaceuticals are also commercially available or under development. Five of them, which are all clinically important, are (18)F-fluoride, (18)F-fluoroethyltyrosine ((18)F-FET), (18)F-deoxyfluorothymidine ((18)F-FLT), (18)F-fluorocholine ((18)F-choline) and (11)C-raclopride. To estimate the potential risk of stochastic effects (mainly lethal cancer) to a population, organ doses and effective dose values were updated for all five radiopharmaceuticals. Dose calculations were performed using the computer program IDAC2.0, which bases its calculations on the ICRP/ICRU adult reference voxel phantoms and the tissue weighting factors from ICRP publication 103. The biokinetic models were taken from ICRP publication 128. For organ doses, there are substantial changes. The only significant change in effective dose compared with previous estimations was a 46 % reduction for (18)F-fluoride. The estimated effective dose in mSv MBq(-1) was 1.5E-02 for (18)F-FET, 1.5E-02 for (18)F-FLT, 2.0E-02 for (18)F-choline, 9.0E-03 for (18)F-fluoride and 4.4E-03 for (11)C-raclopride.
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10.
  • Bjöersdorff, Mimmi, et al. (författare)
  • Impact of penalizing factor in a block-sequential regularized expectation maximization reconstruction algorithm for 18 F-fluorocholine PET-CT regarding image quality and interpretation
  • 2019
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Recently, the block-sequential regularized expectation maximization (BSREM) reconstruction algorithm was commercially introduced (Q.Clear, GE Healthcare, Milwaukee, WI, USA). However, the combination of noise-penalizing factor (β), acquisition time, and administered activity for optimal image quality has not been established for 18 F-fluorocholine (FCH). The aim was to compare image quality and diagnostic performance of different reconstruction protocols for patients with prostate cancer being examined with 18 F-FCH on a silicon photomultiplier-based PET-CT. Thirteen patients were included, injected with 4 MBq/kg, and images were acquired after 1 h. Images were reconstructed with frame durations of 1.0, 1.5, and 2.0 min using β of 150, 200, 300, 400, 500, and 550. An ordered subset expectation maximization (OSEM) reconstruction with a frame duration of 2.0 min was used for comparison. Images were quantitatively analyzed regarding standardized uptake values (SUV) in metastatic lymph nodes, local background, and muscle to obtain contrast-to-noise ratios (CNR) as well as the noise level in muscle. Images were analyzed regarding image quality and number of metastatic lymph nodes by two nuclear medicine physicians. Results: The highest median CNR was found for BSREM with a β of 300 and a frame duration of 2.0 min. The OSEM reconstruction had the lowest median CNR. Both the noise level and lesion SUV max decreased with increasing β. For a frame duration of 1.5 min, the median quality score was highest for β 400-500, and for a frame duration of 2.0 min the score was highest for β 300-500. There was no statistically significant difference in the number of suspected lymph node metastases between the different image series for one of the physicians, and for the other physician the number of lymph nodes differed only for one combination of image series. Conclusions: To achieve acceptable image quality at 4 MBq/kg 18 F-FCH, we propose using a β of 400-550 with a frame duration of 1.5 min. The lower β should be used if a high CNR is desired and the higher if a low noise level is important.
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11.
  • Cerić Andelius, Irma, et al. (författare)
  • First clinical experience of a ring-configured cadmium zinc telluride camera : A comparative study versus conventional gamma camera systems
  • 2024
  • Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 44:1, s. 79-88
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: A novel semiconductor cadmium zinc telluride (CZT) gamma camera system using a block sequential regularized expectation maximization (BSREM) reconstruction algorithm is now clinically available. Here we investigate how a multi-purpose ring-configurated CZT system can be safely applied in clinics and describe the initial optimization process.METHOD: Seventy-six patients (bone-, cardiac- and lung scan) were scanned on a conventional gamma camera (planar and/or single-photon emission computed tomography [SPECT]/SPECT-CT) used in clinical routine and on the ring-configurated CZT camera Starguide (GE Healthcare). These data were used to validate and optimize the Starguide system for routine clinical use.RESULTS: Comparable image quality for the Starguide system, to that of the conventional gamma camera, was achieved for bone scan (4 min/bed position [BP] using a relative difference prior [RDP] with gamma 2 and beta 0.4, along with 10 iterations and 10 subsets), cardiac scan (8 min [stress] and 3 min 20 s [rest] using median root prior [MRP] with beta 0.07 non attenuation corrected and 0.008 attenuation corrected and 50 interations and 10 subsets for both stress and rest) and lung scan (10 min [vent] and 5 min [perf] using RDP with gamma 0.5 and beta 0.03 [vent] and 0.02 [perf] and 20 interations and 10 subsets for both vent and perf).CONCLUSIONS: It was possible to transition from a conventional gamma camera to the Starguide system as part of the clinical routine, with acceptable image quality. Images from the Starguide system were deemed to be at least as good as those from a conventional gamma camera.
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12.
  • Garpered, Sabine, et al. (författare)
  • Evaluation of 18F-FDG uptake in lung parenchyma compensating for tissue fraction : Comparison between non-enhanced low dose CT and intravenous contrast-enhanced diagnostic CT
  • 2020
  • Ingår i: Nuklearmedizin. - : Georg Thieme Verlag KG. - 0029-5566 .- 2567-6407. ; 59:1, s. 20-25
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: To determine how the presence of intravenous (IV) contrast-enhanced CT influences SUV measurements corrected for both attenuation and tissue fraction. MATERIAL AND METHODS: Eighteen patients with different malignancies, free from lung disorders, lung cancer or metastasis, were prospectively recruited when referred for staging with combined 18F-FDG-PET/CT examination. A non-enhanced low-dose CT over the chest was immediately followed by a whole-body IV contrast-enhanced diagnostic CT and finally the PET acquisition. PET data were reconstructed with attenuation correction based on the two CT data sets. The lungs were segmented in the CT images and lung density was measured. Uptake of 18F-FDG in lung parenchyma was recorded using both non-enhanced and IV contrast-enhanced CT as well as with and without compensation for lung aeration. A comparison of SUV values of corrected and uncorrected PET images was performed. RESULTS: There was no significant difference between low dose PET/CT and IV contrast-enhanced PET/CT when removing the impact of air fraction (p = 0.093 for the right lung and p = 0.085 for the left lung). When tissue fraction was not corrected for, there was a significant difference between low dose PET/CT and IV contrast enhanced PET/CT used for attenuation correction (p = 0.006 for the right lung and p = 0.015 for the left lung). CONCLUSION: There was only a marginal effect on the assessement of SUV in the lung tissue when using IV contrast enhanced CT for attenuation correction when the air fraction was accounted for.
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13.
  • Garpered, Sabine, et al. (författare)
  • Measurement of airway inflammation in current smokers by positron emission tomography
  • 2019
  • Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 39:6, s. 393-398
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Accumulation of activated neutrophilic leucocytes is known to increase uptake of F-18-fluorodeoxyglucose (F-18-FDG) into lung tissue. Available evidence suggests that smokers and subjects with chronic obstructive pulmonary disease (COPD) have neutrophilic inflammation in peripheral airways. The aim of this study was to examine whether current smokers have higher lung tissue uptake of F-18-FDG than never-smokers when correcting for air fraction of the lungs. Methods We prospectively recruited 33 current smokers and 33 never-smokers among subjects referred for diagnosis or staging of cancer, other than lung cancer, with combined positron emission tomography/computed tomography (PET/CT) with F-18-FDG. Subjects with focal F-18-FDG uptake or focal CT abnormalities in the lungs were excluded. The lungs were segmented in the CT image, and lung density measured. F-18-FDG uptake was measured in the corresponding volume and corrected for air fraction. Results Lung uptake of F-18-FDG, corrected for air fraction, was 12 center dot 5 and 8 per cent higher in the right and left lungs, respectively, in current smokers than in never-smokers (P<0 center dot 05). Conclusion Abnormal lung tissue uptake of F-18-FDG may be masked by reduced lung density if the uptake is not related to air fraction. Increased uptake of F-18-FDG in lung tissue in current smokers relative to never-smokers may reflect inflammation in peripheral airways. Measurements of F-18-FDG uptake in the lung tissue may be useful for animal and human studies of airways disease in COPD and the relation between airway and systemic inflammation.
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14.
  • Gustafsson, Agneta, et al. (författare)
  • A multicentre simulation study of planar whole-body bone scintigraphy in Sweden
  • 2022
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Whole-body bone scintigraphy is a clinically useful non-invasive and highly sensitive imaging method enabling detection of metabolic changes at an early stage of disease, often earlier than with conventional radiologic procedures. Bone scintigraphy is one of the most common nuclear medicine methods used worldwide. Therefore, it is important that the examination is implemented and performed in an optimal manner giving the patient added value in the subsequent care process. The aim of this national multicentre survey was to investigate Swedish nuclear medicine departments compliance with European practice guidelines for bone scintigraphy. In addition, the effect of image acquisition parameters on the ability to detect metabolic lesions was investigated. Methods: Twenty-five hospital sites participated in the study. The SIMIND Monte Carlo (MC) simulation and the XCAT phantom were used to simulate ten fictive patient cases with increased metabolic activity distributed at ten different locations in the skeleton. The intensity of the metabolic activity was set into six different levels. Individual simulations were performed for each site, corresponding to their specific camera system and acquisition parameters. Simulated image data sets were then sent to each site and were visually evaluated in terms of if there was one or several locations with increased metabolic activity relative to normal activity. Result: There is a high compliance in Sweden with the EANM guidelines regarding image acquisition parameters for whole-body bone scintigraphy. However, up to 40% of the participating sites acquire lower count density in the images than recommended. Despite this, the image quality was adequate to maintain a stable detection level. None of the hospital sites or individual responders deviated according to the statistical analysis. There is a need for at least 2.5 times metabolic activity compared to normal for a lesion to be detected. Conclusion: The imaging process is well harmonized throughout the country and there is a high compliance with the EANM guidelines. There is a need for at least 2.5 times the normal metabolic activity for a lesion to be detected as abnormal.
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15.
  • Gålne, Anni, et al. (författare)
  • AI-based quantification of whole-body tumour burden on somatostatin receptor PET/CT
  • 2023
  • Ingår i: European Journal of Hybrid Imaging. - 2510-3636. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Segmenting the whole-body somatostatin receptor-expressing tumour volume (SRETVwb) on positron emission tomography/computed tomography (PET/CT) images is highly time-consuming but has shown value as an independent prognostic factor for survival. An automatic method to measure SRETVwb could improve disease status assessment and provide a tool for prognostication. This study aimed to develop an artificial intelligence (AI)-based method to detect and quantify SRETVwb and total lesion somatostatin receptor expression (TLSREwb) from [68Ga]Ga-DOTA-TOC/TATE PET/CT images. Methods: A UNet3D convolutional neural network (CNN) was used to train an AI model with [68Ga]Ga-DOTA-TOC/TATE PET/CT images, where all tumours were manually segmented with a semi-automatic method. The training set consisted of 148 patients, of which 108 had PET-positive tumours. The test group consisted of 30 patients, of which 25 had PET-positive tumours. Two physicians segmented tumours in the test group for comparison with the AI model. Results: There were good correlations between the segmented SRETVwb and TLSREwb by the AI model and the physicians, with Spearman rank correlation coefficients of r = 0.78 and r = 0.73, respectively, for SRETVwb and r = 0.83 and r = 0.81, respectively, for TLSREwb. The sensitivity on a lesion detection level was 80% and 79%, and the positive predictive value was 83% and 84% when comparing the AI model with the two physicians. Conclusion: It was possible to develop an AI model to segment SRETVwb and TLSREwb with high performance. A fully automated method makes quantification of tumour burden achievable and has the potential to be more widely used when assessing PET/CT images.
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16.
  • Hvittfeldt, Erland, et al. (författare)
  • Biokinetics and dosimetry of 18F-PSMA-1007 in patients with prostate cancer
  • 2022
  • Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 42:6, s. 443-452
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Positron emission tomography-computed tomography (PET-CT) using prostate-specific membrane antigen (PSMA) ligands is a method for imaging prostate cancer. A recent tracer, 18F-PSMA-1007, offers advantages concerning production and biokinetics compared to the standard tracer (68Ga-PSMA-11). Until now, radiation dosimetry data for this ligand was limited to the material of three healthy volunteers. The purpose of this study is to study the biokinetics and dosimetry of 18F-PSMA-1007. Methods: Twelve patients with prostate cancer were injected with 4 MBq/kg 18F-PSMA-1007. Eight PET-CT scans with concomitant blood sampling were performed up to 330 min after injection. Urine was collected until the following morning. Volumes of interest for radiation-sensitive organs and organs with high uptake of 18F-PSMA-1007 were drawn in the PET images. A biokinetic compartment model was developed using activity data from PET images and blood and urine samples. Time-activity curves and time-integrated activity coefficients for all delineated organs were calculated. The software IDAC-dose 2.1 was used to calculate the absorbed and effective doses. Results: High concentrations of activity were noted in the liver, kidneys, parts of the small intestine, spleen, salivary glands, and lacrimal glands. The elimination through urine was 8% of injected activity in 20 h. The highest absorbed doses coefficients were in the lacrimal glands, kidneys, salivary glands, liver, and spleen (98–66 µGy/MBq). The effective dose coefficient was 25 µSv/MBq. Conclusion: The effective dose of 18F-PSMA-1007 is 6.0–8.0 mSv for a typical patient weighing 80 kg injected with 3–4 MBq/kg.
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17.
  • Hvittfeldt, Erland, et al. (författare)
  • PET/CT imaging 2 h after injection of [18F]PSMA-1007 can lead to higher staging of prostate cancer than imaging after 1 h
  • 2023
  • Ingår i: European journal of hybrid imaging. - 2510-3636. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: [18F]PSMA-1007 is a prostate specific membrane antigen (PSMA) ligand for positron emission tomography (PET) imaging of prostate cancer. Current guidelines recommend imaging 90–120 min after injection but strong data about optimal timing is lacking. Our aim was to study whether imaging after 1 h and 2 h leads to a different number of detected lesions, with a specific focus on lesions that might lead to a change in treatment. Methods: 195 patients underwent PET with computed tomography imaging 1 and 2 h after injection of [18F]PSMA-1007. Three readers assessed the status of the prostate or prostate bed and suspected metastases. We analyzed the location and number of found metastases to determine N- and M-stage of patients. We also analyzed standardized uptake values (SUV) in lesions and in normal tissue. Results: Significantly more pelvic lymph nodes and bone metastases were found and higher N- and M-stages were seen after 2 h. In twelve patients (6.1%) two or three readers agreed on a higher N- or M-stage after 2 h. Conversely, in two patients (1.0%), two readers agreed on a higher stage at 1 h. SUVs in suspected malignant lesions and in normal tissues were higher at 2 h, but lower in the blood pool and urinary bladder. Conclusions: Imaging at 2 h after injection of [18F]PSMA-1007 leads to more suspected metastases found than after 1 h, with higher staging in some patients and possible effect on patient treatment.
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18.
  • Kaboteh, Reza, et al. (författare)
  • Evaluation of changes in Bone Scan Index at different acquisition time-points in bone scintigraphy
  • 2018
  • Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961. ; 38:6, s. 1015-1020
  • Tidskriftsartikel (refereegranskat)abstract
    • Bone Scan Index (BSI) is a validated imaging biomarker to objectively assess tumour burden in bone in patients with prostate cancer, and can be used to monitor treatment response. It is not known if BSI is significantly altered when images are acquired at a time difference of 1h. The aim of this study was to investigate if automatic calculation of BSI is affected when images are acquired 1hour apart, after approximately 3 and 4h. We prospectively studied patients with prostate cancer who were referred for bone scintigraphy according to clinical routine. The patients performed a whole-body bone scan at approximately 3h after injection of radiolabelled bisphosphonate and a second 1h after the first. BSI values for each bone scintigraphy were obtained using EXINI bone(BSI) software. A total of 25 patients were included. Median BSI for the first acquisition was 005 (range 0-1193) and for the second acquisition 021 (range 0-1306). There was a statistically significant increase in BSI at the second image acquisition compared to the first (P<0001). In seven of 25 patients (28%) and in seven of 13 patients with BSI>0 (54%), a clinically significant increase (>03) was observed. The time between injection and scanning should be fixed when changes in BSI are important, for example when monitoring therapeutic efficacy.
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19.
  • Lindgren Belal, Sarah, et al. (författare)
  • Applications of Artificial Intelligence in PSMA PET/CT for Prostate Cancer Imaging
  • 2024
  • Ingår i: Seminars in Nuclear Medicine. - 1558-4623 .- 0001-2998. ; 54:1, s. 141-149
  • Forskningsöversikt (refereegranskat)abstract
    • Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has emerged as an important imaging technique for prostate cancer. The use of PSMA PET/CT is rapidly increasing, while the number of nuclear medicine physicians and radiologists to interpret these scans is limited. Additionally, there is variability in interpretation among readers. Artificial intelligence techniques, including traditional machine learning and deep learning algorithms, are being used to address these challenges and provide additional insights from the images. The aim of this scoping review was to summarize the available research on the development and applications of AI in PSMA PET/CT for prostate cancer imaging. A systematic literature search was performed in PubMed, Embase and Cinahl according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 publications were included in the synthesis. The included studies focus on different aspects of artificial intelligence in PSMA PET/CT, including detection of primary tumor, local recurrence and metastatic lesions, lesion classification, tumor quantification and prediction/prognostication. Several studies show similar performances of artificial intelligence algorithms compared to human interpretation. Few artificial intelligence tools are approved for use in clinical practice. Major limitations include the lack of external validation and prospective design. Demonstrating the clinical impact and utility of artificial intelligence tools is crucial for their adoption in healthcare settings. To take the next step towards a clinically valuable artificial intelligence tool that provides quantitative data, independent validation studies are needed across institutions and equipment to ensure robustness.
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20.
  • Ly, John, et al. (författare)
  • Post-reconstruction enhancement of [18F]FDG PET images with a convolutional neural network
  • 2021
  • Ingår i: EJNMMI Research. - : Springer Science and Business Media LLC. - 2191-219X. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of the study was to develop and test an artificial intelligence (AI)-based method to improve the quality of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) images. Methods: A convolutional neural network (CNN) was trained by using pairs of excellent (acquisition time of 6 min/bed position) and standard (acquisition time of 1.5 min/bed position) or sub-standard (acquisition time of 1 min/bed position) images from 72 patients. A test group of 25 patients was used to validate the CNN qualitatively and quantitatively with 5 different image sets per patient: 4 min/bed position, 1.5 min/bed position with and without CNN, and 1 min/bed position with and without CNN. Results: Difference in hotspot maximum or peak standardized uptake value between the standard 1.5 min and 1.5 min CNN images fell short of significance. Coefficient of variation, the noise level, was lower in the CNN-enhanced images compared with standard 1 min and 1.5 min images. Physicians ranked the 1.5 min CNN and the 4 min images highest regarding image quality (noise and contrast) and the standard 1 min images lowest. Conclusions: AI can enhance [18F]FDG-PET images to reduce noise and increase contrast compared with standard images whilst keeping SUVmax/peak stability. There were significant differences in scoring between the 1.5 min and 1.5 min CNN image sets in all comparisons, the latter had higher scores in noise and contrast. Furthermore, difference in SUVmax and SUVpeak fell short of significance for that pair. The improved image quality can potentially be used either to provide better images to the nuclear medicine physicians or to reduce acquisition time/administered activity.
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21.
  • Ly, John, et al. (författare)
  • The use of a proposed updated EARL harmonization of 18F-FDG PET-CT in patients with lymphoma yields significant differences in Deauville score compared with current EARL recommendations
  • 2019
  • Ingår i: EJNMMI Research. - : Springer Science and Business Media LLC. - 2191-219X. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The Deauville score (DS) is a clinical tool, based on the comparison between lesion and reference organ uptake of 18F-fluorodeoxyglucose (FDG), used to stratify patients with lymphoma into categories reflecting their disease status. With a plethora of positron emission tomography with computed tomography (PET-CT) hard- and software algorithms, standard uptake value (SUV) in lesions and reference organs may differ which affects DS classification and therefore medical treatment. The EANM Research Ltd. (EARL) harmonization program from the European Association of Nuclear Medicine (EANM) partly mitigates this issue, but local preferences are common in clinical practice. We have investigated the discordance in DS calculated from patients with lymphoma referred for 18F-FDG PET-CT reconstructed with three different algorithms: the newly introduced block-sequential regularization expectation-maximization algorithm commercially sold as Q. Clear (QC, GE Healthcare, Milwaukee, WI, USA), compliant with the newly proposed updated EARL recommendations, and two settings compliant with the current EARL recommendations (EARLlower and EARLupper, representing the lower and upper limit of the EARL recommendations). Methods: Fifty-two patients with non-Hodgkin and Hodgkin lymphoma were included (18 females and 34 males). Segmentation of mediastinal blood pool and liver were semi-automatically performed, whereas segmentation of lesions was done manually. From these segmentations, SUVmax and SUVpeak were obtained and DS calculated. Results: There was a significant difference in DS between the QC algorithm and EARLlower/EARLupper (p < 0.0001 for both) but not between EARLlower and EARLupper (p = 0.102) when SUVmax was used. For SUVpeak, there was a significant difference between QC and EARLlower (p = 0.001), but not for QC vs EARLupper (p = 0.071) or EARLlower vs EARLupper (p = 0.102). Five non-responders (DS 4–5) for QC were classified as responders (DS 1–3) when EARLlower/EARLupper was used, both when SUVmax and SUVpeak were investigated. Conclusion: Using the proposed updated EARL recommendations compared with the current recommendations will significantly change DS classification. In select cases, the discordance would affect the choice of medical treatment. Specifically, the current EARL recommendations were more often prone to classify patients as responders.
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22.
  • Minarik, David, et al. (författare)
  • 90Y Bremsstrahlung Imaging for Absorbed-Dose Assessment in High-Dose Radioimmunotherapy.
  • 2010
  • Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 51:12, s. 1974-1978
  • Tidskriftsartikel (refereegranskat)abstract
    • This feasibility study demonstrates (90)Y quantitative bremsstrahlung imaging of patients undergoing high-dose myeloablative (90)Y-ibritumomab treatment. METHODS: The study includes pretherapy (111)In SPECT/CT and planar whole-body (WB) imaging at 7 d and therapy (90)Y SPECT/CT at 6 d and (90)Y WB imaging at 1 d. Time-activity curves and organ-absorbed doses derived from (90)Y SPECT images were compared with pretherapy (111)In estimates. Organ activities derived from (90)Y WB images at the first day were compared with corresponding pretherapy estimates. RESULTS: Pretherapy (111)In images from 3 patients were similar to the (90)Y images. Differences between absorbed-dose estimates from pretherapy (111)In and (90)Y therapy were within 25%, except for the lungs. Corresponding activity differences derived from WB images were within 25%. Differences were ascribed to incomplete compensation methods and real differences in pharmacokinetics between pretherapy and therapy. CONCLUSION: Quantitative bremsstrahlung imaging to estimate organ activities and absorbed doses is feasible.
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23.
  •  
24.
  • Minarik, David (författare)
  • Activity quantification based on scintillation camera imaging - Application to 111In/90Y radioimmunotherapy
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Radionuclide therapy (RNT), is important for the treatment of certain benign and malignant diseases. 90Y-Zevalin™ therapy has become an established method of treating patients with non-Hodgkin B-cell lymphoma. Several observ¬ations regarding the outcome of therapy have prompted the use of higher absorbed doses by administering larger amounts of activity than those indicated in standard protocols. This type of treatment, which generally requires bone marrow support, increases the risk of deterministic effects on healthy organs and, therefore, requires the use of reliable patient-specific internal dosimetry. An important part of patient-specific dosimetry is the quantification of the activity of the radiopharmaceutical by means of scintillation camera imaging. The aim of the work presented in this thesis was thus to develop quantitative scintillation camera imaging methods in 2 and 3 dimensions. A method for planar activity quantification and absorbed dose assess¬ment is presented and evaluated (Paper I). The planar quantification method requires a narrow-beam, patient-specific attenuation map, which can be obtained through a transmission study using an external radionuclide source. This method has clear drawbacks, which prompted investigations of the use of a whole-body X-ray image for attenuation correction. The method is based on acquiring a whole-body X-ray image using the CT unit on a hybrid SPECT/CT system (Paper II). 90Y only emits β-particles, and has previously been considered difficult to image. The radionuclide 111Indium has therefore been used as a substitute tracer for imaging purposes. However, free unbound 111In and 90Y behave differently in vivo. It would thus be of interest to be able to image 90Y alone, without an admixture of 111In. This could be done by detecting the bremsstrahlung that is produced when β-particles interact with tissue. The feasibility of quantitative bremsstrahlung SPECT (paper III) and quantitative planar whole-body imaging (paper IV) have been investigated by means of simulations and measure¬ments using phantoms. The feasibility of these 90Y bremsstrahlung imaging procedures has also been investigated using data from patients undergoing 90Y-Zevalin treatment for B-cell lymphoma (Paper V).
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25.
  • Minarik, David, et al. (författare)
  • Denoising of Scintillation Camera Images Using a Deep Convolutional Neural Network: A Monte Carlo Simulation Approach
  • 2020
  • Ingår i: Journal of Nuclear Medicine. - : Society of Nuclear Medicine. - 0161-5505 .- 2159-662X. ; 61:2, s. 298-303
  • Tidskriftsartikel (refereegranskat)abstract
    • Scintillation camera images contain a large amount of Poisson noise. We have investigated whether noise can be removed in whole-body bone scans using convolutional neural networks (CNNs) trained with sets of noisy and noiseless images obtained by Monte Carlo simulation. Methods: Three CNNs were generated using 3 different sets of training images: simulated bone scan images, images of a cylindric phantom with hot and cold spots, and a mix of the first two. Each training set consisted of 40,000 noiseless and noisy image pairs. The CNNs were evaluated with simulated images of a cylindric phantom and simulated bone scan images. The mean squared error between filtered and true images was used as difference metric, and the coefficient of variation was used to estimate noise reduction. The CNNs were compared with gaussian and median filters. A clinical evaluation was performed in which the ability to detect metastases for CNN- and gaussian-filtered bone scans with half the number of counts was compared with standard bone scans. Results: The best CNN reduced the coefficient of variation by, on average, 92%, and the best standard filter reduced the coefficient of variation by 88%. The best CNN gave a mean squared error that was on average 68% and 20% better than the best standard filters, for the cylindric and bone scan images, respectively. The best CNNs for the cylindric phantom and bone scans were the dedicated CNNs. No significant differences in the ability to detect metastases were found between standard, CNN-, and gaussian-filtered bone scans. Conclusion: Noise can be removed efficiently regardless of noise level with little or no resolution loss. The CNN filter enables reducing the scanning time by half and still obtaining good accuracy for bone metastasis assessment.
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26.
  • Minarik, David, et al. (författare)
  • Evaluation of quantitative (90)Y SPECT based on experimental phantom studies.
  • 2008
  • Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 1361-6560 .- 0031-9155. ; 53:20, s. 5689-5703
  • Tidskriftsartikel (refereegranskat)abstract
    • In SPECT imaging of pure beta emitters, such as (90)Y, the acquired spectrum is very complex, which increases the demands on the imaging protocol and the reconstruction. In this work, we have evaluated the quantitative accuracy of bremsstrahlung SPECT with focus on the reconstruction algorithm including model-based attenuation, scatter and collimator-detector response (CDR) compensations. The scatter and CDR compensation methods require pre-calculated point-spread functions, which were generated with the SIMIND MC program. The SIMIND program is dedicated for simulation of scintillation camera imaging and only handles photons. The aim of this work was therefore twofold. The first aim was to implement simulation of bremsstrahlung imaging into the SIMIND code and to validate simulations against experimental measurements. The second was to investigate the quality of bremsstrahlung SPECT imaging and to evaluate the possibility of quantifying the activity in differently shaped sources. In addition, a feasibility test was performed on a patient that underwent treatment with (90)Y-Ibritumomab tiuxetan (Zevalin(R)). The MCNPX MC program was used to generate bremsstrahlung photon spectra which were used as source input in the SIMIND program. The obtained bremsstrahlung spectra were separately validated by experimental measurement using a HPGe detector. Validation of the SIMIND generated images was done by a comparison to gamma camera measurements of a syringe containing (90)Y. Results showed a slight deviation between simulations and measurements in image regions outside the source, but the agreement was sufficient for the purpose of generating scatter and CDR kernels. For the bremsstrahlung SPECT experiment, the RSD torso phantom with (90)Y in the liver insert was measured with and without background activities. Projection data were obtained using a GE VH/Hawkeye system. Image reconstruction was performed by using the OSEM algorithm with and without different combinations of model-based attenuation, scatter and CDR compensations. The reconstructed images were then evaluated in terms of the accuracy of the total activity estimate in the liver insert. It was found that the activity in a large source such as the liver was estimated with a bias of around -70%, when no compensations were included in the reconstruction, whereas when compensations were included the bias obtained was between -10 and 16%. It is concluded that although the (90)Y bremsstrahlung spectrum is continuous with no pronounced peak and the count rate is low, it is possible to achieve reasonably accurate activity estimates from bremsstrahlung SPECT images if proper compensations are applied in the reconstruction. This conclusion was also confirmed by the patient study.
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27.
  • Minarik, David, et al. (författare)
  • Evaluation of quantitative planar (90)Y bremsstrahlung whole-body imaging.
  • 2009
  • Ingår i: Physics in Medicine and Biology. - : IOP Publishing. - 1361-6560 .- 0031-9155. ; 54:19, s. 5873-5883
  • Tidskriftsartikel (refereegranskat)abstract
    • With high-dose administration of (90)Y labeled antibodies, it is possible to image (90)Y without an admixture of (111)In. We have earlier shown that it is possible to perform quantitative (90)Y bremsstrahlung SPECT for dosimetry purposes with reasonable accuracy. However, whole-body (WB) activity quantification with the conjugate view method is not as time consuming as SPECT and has been the method of choice for dosimetry. We have investigated the possibility of using a conjugate view method where scatter-, backscatter- and septal-penetration compensations are performed by inverse filtering and attenuation correction is performed with a WB x-ray image, for total-body and organ activity quantification of (90)Y. The method was evaluated using both Monte Carlo simulated scintillation camera images using realistic source distributions, and by an experimental phantom study. The method was evaluated in terms of image quality and accuracy of the activity quantification. The experimental phantom study was performed using the RSD torso phantom with (90)Y activity uniformly distributed in the liver insert. A GE Discovery VH/Hawkeye system was used to acquire the image. The simulation study was performed for a realistic activity distribution in the NCAT anthropomorphic phantom where (90)Y bremsstrahlung images were generated using the SIMIND MC program. Two different phantom configurations and two activity distributions were simulated. To mimic the RSD phantom experiment one simulation study was also made with (90)Y activity located only in the liver. The SIMIND program was configured to resemble a GE Discovery VH/Hawkeye system. An x-ray projector program was used to generate whole-body x-ray images from the NCAT phantom for attenuation correction in the conjugate view method. Organ activities were calculated from ROIs that exactly covered the organs. Corrections for background activity, overlapping activity and source extension in the depth direction were applied on the ROI data. The total-body activities for the simulated images were generally overestimated by around 10%, which is reasonable since the correction for source extension was not applied on the total-body values. The accuracy of the organ activities was mostly within 15% for both the simulation study and the experimental study. The results suggest that it is possible to quantify (90)Y activity in ROIs with reasonable accuracy using this method.
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28.
  • Minarik, David, et al. (författare)
  • Perfusion vector-a new method to quantify myocardial perfusion scintigraphy images: a simulation study with validation in patients.
  • 2015
  • Ingår i: EJNMMI Research. - : Springer Science and Business Media LLC. - 2191-219X. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • The interpretation of myocardial perfusion scintigraphy (MPS) largely relies on visual assessment by the physician of the localization and extent of a perfusion defect. The aim of this study was to introduce the concept of the perfusion vector as a new objective quantitative method for further assisting the visual interpretation and to test the concept using simulated MPS images as well as patients.
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29.
  • Munck af Rosenschöld, Per, et al. (författare)
  • Prompt gamma tomography during BNCT – a feasibility study
  • 2006
  • Ingår i: Journal of Instrumentation. - 1748-0221. ; 1
  • Tidskriftsartikel (refereegranskat)abstract
    • The success of clinical boron neutron capture therapy (BNCT) lies in the ability to manage the radiobiological effect on the tumour and healthy tissue, and thus, accurate dosimetry measurements is pertinent for each individual patient. In the present work we investigate the possibility of performing online prompt gamma tomography (PGT) during BNCT. A prototype detector system was constructed, which is in principle a pin-hole collimator with a HPGe crystal to be mounted on a C-bow device, with shielding of lithium-plastic and lead. The detector system was used to measure on a phantom placed in an epithermal neutron beam and on a 137Cs-source. The possibility of tomographic reconstruction using the detector system was tested on a phantom filled with a 131I-solution with a smaller sphere inserted containing a higher specific activity (ratio 10:1). The detector system was possible to operate up to about 6 × 108 cm-2 s-1 thermal neutron fluence at the peak in the phantom, at which time it was saturated. A 478 keV boron-peak was visible in the measured spectra but the signal-to-noise-ratio was rather low. No post-irradiation damage or neutron activation was detectable. A tomographic reconstruction of the phantom filled with 131I-solutions was performed using an algorithm developed in house and based on the MLEM method. The image quality is fairly good and the results provide a clear indication that the detector system can be used to obtain data that enables tomographic reconstruction. A spatial resolution of the detector system of about 2 cm was obtained from both the measurement on the 137Cs-source and the 131I-phantom. In conclusion, the presented feasibility study on a prototype PGT system is encouraging further studies specifically directed at improving the signal-to-noise-ratio in measurements in epithermal neutron beams.
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30.
  • Nakajima, K., et al. (författare)
  • Improved quantification of small hearts for gated myocardial perfusion imaging
  • 2013
  • Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 40:8, s. 1163-1170
  • Tidskriftsartikel (refereegranskat)abstract
    • In patients with a small heart, defined as an end-systolic volume (ESV) of a parts per thousand currency sign20 mL calculated using the Quantitative Gated SPECT (QGS) program, underestimation of ESV and overestimation of ejection fraction (EF) using gated myocardial perfusion imaging are considered errors caused by inappropriate delineation of the left ventricle (LV). The aim of this study was to develop a new method for delineation of the LV and to evaluate it in studies using a digital phantom, normal subjects and patients. The active shape-based method for LV delineation, EXINI heart (ExH), was adjusted to more accurately process small hearts. In small hearts, due to the partial volume effect and the short distance to the opposite ventricular wall, the endocardial and the epicardial surfaces are shifted in the epicardial direction depending on the midventricular volume. The adjusted method was evaluated using digital XCAT phantoms with Monte Carlo simulation (8 virtual patients), a Japanese multicentre normal database (69 patients) and consecutive Japanese patients (116 patients). The LV volumes, EF and diastolic parameters derived from ExH and QGS were compared. The digital phantom studies showed a mean ESV of 87 % +/- 9 % of the true volume calculated using ExH and 22 % +/- 18 % calculated using QGS. In the normal database, QGS gave higher EFs in women than in men (71.4 +/- 6.0 % vs. 67.2 +/- 6.0 %, p = 0.0058), but ExH gave comparable EFs (70.7 +/- 4.9 % and 71.4 +/- 5 % in men and women, respectively, p = ns). QGS gave higher EFs in subjects with a small heart than in those with a normal-sized heart (74.5 +/- 5.1 % vs. 66.1 +/- 4.9 %), but ExH gave comparable values (70.0 +/- 5.9 % vs. 71.6 +/- 4.2 %, respectively, p = ns). In consecutive patients, the average EFs with QGS in patients with ESV > 20 mL, 11-20 mL and a parts per thousand currency sign10 mL were 57.9 %, 71.9 % and 83.2 %, but with ExH the differences among these groups were smaller (65.2 %, 67.8 % and 71.5 %, respectively). The volume-dependent edge correction algorithm was able to effectively reduce the effects on ESV and EF of a small heart. The uniform normal values might be applicable to both men and women and to both small and normal-sized hearts.
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31.
  • Oddstig, Jenny, et al. (författare)
  • Comparison of conventional and Si-photomultiplier-based PET systems for image quality and diagnostic performance
  • 2019
  • Ingår i: BMC Medical Imaging. - : Springer Science and Business Media LLC. - 1471-2342. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: A new generation of positron emission tomography with computed tomography (PET-CT) was recently introduced using silicon (Si) photomultiplier (PM)-based technology. Our aim was to compare the image quality and diagnostic performance of a SiPM-based PET-CT (Discovery MI; GE Healthcare, Milwaukee, WI, USA) with a time-of-flight PET-CT scanner with a conventional PM detector (Gemini TF; Philips Healthcare, Cleveland, OH, USA), including reconstruction algorithms per vendor's recommendations. METHODS: Imaging of the National Electrical Manufacturers Association IEC body phantom and 16 patients was carried out using 1.5 min/bed for the Discovery MI PET-CT and 2 min/bed for the Gemini TF PET-CT. Images were analysed for recovery coefficients for the phantom, signal-to-noise ratio in the liver, standardized uptake values (SUV) in lesions, number of lesions and metabolic TNM classifications in patients. RESULTS: In phantom, the correct (> 90%) activity level was measured for spheres ≥17 mm for Discovery MI, whereas the Gemini TF reached a correct measured activity level for the 37-mm sphere. In patient studies, metabolic TNM classification was worse using images obtained from the Discovery MI compared those obtained from the Gemini TF in 4 of 15 patients. A trend toward more malignant, inflammatory and unclear lesions was found using images acquired with the Discovery MI compared with the Gemini TF, but this was not statistically significant. Lesion-to-blood-pool SUV ratios were significantly higher in images from the Discovery MI compared with the Gemini TF for lesions smaller than 1 cm (p < 0.001), but this was not the case for larger lesions (p = 0.053). The signal-to-noise ratio in the liver was similar between platforms (p = 0.52). Also, shorter acquisition times were possible using the Discovery MI, with preserved signal-to-noise ratio in the liver. CONCLUSIONS: Image quality was better with Discovery MI compared to conventional Gemini TF. Although no gold standard was available, the results indicate that the new PET-CT generation will provide potentially better diagnostic performance.
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32.
  • Oddstig, Jenny, et al. (författare)
  • Head-to-head comparison of a Si-photomultiplier-based and a conventional photomultiplier-based PET-CT system
  • 2021
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 8:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A novel generation of PET scanners based on silicon (Si)-photomultiplier (PM) technology has recently been introduced. Concurrently, there has been development of new reconstruction methods aimed at increasing the detectability of small lesions without increasing image noise. The combination of new detector technologies and new reconstruction algorithms has been found to increase image quality. However, it is unknown to what extent the demonstrated improvement of image quality is due to scanner hardware development or improved reconstruction algorithms. To isolate the contribution of the hardware, this study aimed to compare the ability to detect small hotspots in phantoms using the latest generation SiPM-based PET/CT scanner (GE Discovery MI) relative to conventional PM-based PET/CT scanner (GE Discovery 690), using identical reconstruction protocols. Materials and methods: Two different phantoms (NEMA body and Jasczcak) with fillable spheres (31 μl to 26.5 ml) and varying sphere-to-background-ratios (SBR) were scanned in one bed position for 15–600 s on both scanners. The data were reconstructed using identical reconstruction parameters on both scanners. The recovery-coefficient (RC), noise level, contrast (spherepeak/backgroundpeak-value), and detectability of each sphere were calculated and compared between the scanners at each acquisition time. Results: The RC-curves for the NEMA phantom were near-identical for both scanners at SBR 10:1. For smaller spheres in the Jaszczak phantom, the contrast was 1.22 higher for the DMI scanner at SBR 15:1. The ratio decreased for lower SBR, with a ratio of 1.03 at SBR 3.85:1. Regarding the detectability of spheres, the sensitivity was 98% and 88% for the DMI and D690, respectively, for SBR 15:1. For SBR 7.5, the sensitivity was 75% and 83% for the DMI and D690, respectively. For SBR 3.85:1, the sensitivity was 43% and 30% for the DMI and D690, respectively. Conclusion: Marginally higher contrast in small spheres was seen for the SiPM-based scanner but there was no significant difference in detectability between the scanners. It was difficult to detect differences between the scanners, suggesting that the SiPM-based detectors are not the primary reason for improved image quality.
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33.
  • Sartor, Hanna, et al. (författare)
  • Auto-segmentations by convolutional neural network in cervical and anorectal cancer with clinical structure sets as the ground truth
  • 2020
  • Ingår i: Clinical and Translational Radiation Oncology. - : Elsevier BV. - 2405-6308. ; 25, s. 37-45
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: It is time-consuming for oncologists to delineate volumes for radiotherapy treatment in computer tomography (CT) images. Automatic delineation based on image processing exists, but with varied accuracy and moderate time savings. Using convolutional neural network (CNN), delineations of volumes are faster and more accurate. We have used CTs with the annotated structure sets to train and evaluate a CNN. Material and methods: The CNN is a standard segmentation network modified to minimize memory usage. We used CTs and structure sets from 75 cervical cancers and 191 anorectal cancers receiving radiation therapy at Skåne University Hospital 2014-2018. Five structures were investigated: left/right femoral heads, bladder, bowel bag, and clinical target volume of lymph nodes (CTVNs). Dice score and mean surface distance (MSD) (mm) evaluated accuracy, and one oncologist qualitatively evaluated auto-segmentations. Results: Median Dice/MSD scores for anorectal cancer: 0.91–0.92/1.93–1.86 femoral heads, 0.94/2.07 bladder, and 0.83/6.80 bowel bag. Median Dice scores for cervical cancer were 0.93–0.94/1.42–1.49 femoral heads, 0.84/3.51 bladder, 0.88/5.80 bowel bag, and 0.82/3.89 CTVNs. With qualitative evaluation, performance on femoral heads and bladder auto-segmentations was mostly excellent, but CTVN auto-segmentations were not acceptable to a larger extent. Discussion: It is possible to train a CNN with high overlap using structure sets as ground truth. Manually delineated pelvic volumes from structure sets do not always strictly follow volume boundaries and are sometimes inaccurately defined, which leads to similar inaccuracies in the CNN output. More data that is consistently annotated is needed to achieve higher CNN accuracy and to enable future clinical implementation.
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34.
  • Sjögreen Gleisner, Katarina, et al. (författare)
  • The LundADose Method for Planar Image Activity Quantification and Absorbed-Dose Assessment in Radionuclide Therapy.
  • 2005
  • Ingår i: Cancer Biotherapy & Radiopharmaceuticals. - : Mary Ann Liebert Inc. - 1557-8852 .- 1084-9785. ; 20:1, s. 92-97
  • Tidskriftsartikel (refereegranskat)abstract
    • A new method for absorbed-dose assessment in radionuclide therapy is presented in this paper. The method is based on activity quantification by the conjugate-view methodology, applied to serial whole-body, anterior-posterior, scintillation-camera scans. The quantification method is an extension of previous studies, and includes separate corrections for attenuation, scatter, and overlapping organs. Further development has now been undertaken to take into account the capabilities of new dual-head camera systems with a built-in X-ray tube for anatomical imaging. Furthermore, the modeling of time-activity data is included, and dosimetric calculations based on the formalism by the Medical Internal Radiation Dose (MIRD) committee. To streamline absorbed-dose assessments for a large number of patient studies, the programs for quantification, image registration, and absorbed-dose calculations have been embedded in an envelop program termed LundADose, where calculations, to a great extent, are performed automatically. Evaluation of the whole-body activity quantification is performed for patients undergoing radioimmunotherapy by monoclonal antibodies labeled with In-111 or Y-90.
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35.
  • Trägårdh, Elin, et al. (författare)
  • Evaluation of inter-departmental variability of ejection fraction and cardiac volumes in myocardial perfusion scintigraphy using simulated data
  • 2015
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 2:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Myocardial perfusion scintigraphy (MPS) is a clinically useful noninvasive imaging modality for diagnosing patients with suspected coronary artery disease. By utilizing gated MPS, the end diastolic volume (EDV) and end systolic volume (ESV) can be measured and the ejection fraction (EF) calculated, which gives incremental prognostic value compared with assessment of perfusion only. The aim of this study was to evaluate the inter-departmental variability of EF, ESV, and EDV during gated MPS in Sweden.Methods: Seventeen departments were included in the study. The SIMIND Monte Carlo (MC) program together with the XCAT phantom was used to simulate three patient cases with different EDV, ESV, and EF. Individual simulations were performed for each department, corresponding to their specific method of performing MPS. Images were then sent to each department and were evaluated according to clinical routine. EDV, ESV, and EF were reported back.Results: There was a large underestimation of EDV and ESV for all three cases. Mean underestimation for EDV varied between 26% and 52% and for ESV between 15% and 60%. EF was more accurately measured, but mean bias still varied between an underestimation of 24% to an overestimation of 14%. In general, the intra-departmental variability for EDV, ESV, and EF was small, whereas inter-departmental variability was larger.Conclusions: Left ventricular volumes were generally underestimated, whereas EF was more accurately estimated. There was, however, large inter-departmental variability.
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36.
  • Trägårdh, Elin, et al. (författare)
  • Impact of acquisition time and penalizing factor in a block-sequential regularized expectation maximization reconstruction algorithm on a Si-photomultiplier-based PET-CT system for 18F-FDG
  • 2019
  • Ingår i: EJNMMI Research. - : Springer Science and Business Media LLC. - 2191-219X. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Block-sequential regularized expectation maximization (BSREM), commercially Q. Clear (GE Healthcare, Milwaukee, WI, USA), is a reconstruction algorithm that allows for a fully convergent iterative reconstruction leading to higher image contrast compared to conventional reconstruction algorithms, while also limiting noise. The noise penalization factor β controls the trade-off between noise level and resolution and can be adjusted by the user. The aim was to evaluate the influence of different β values for different activity time products (ATs = administered activity × acquisition time) in whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) regarding quantitative data, interpretation, and quality assessment of the images. Twenty-five patients with known or suspected malignancies, referred for clinical 18F-FDG PET-CT examinations acquired on a silicon photomultiplier PET-CT scanner, were included. The data were reconstructed using BSREM with β values of 100–700 and ATs of 4–16 MBq/kg × min/bed (acquisition times of 1, 1.5, 2, 3, and 4 min/bed). Noise level, lesion SUVmax, and lesion SUVpeak were calculated. Image quality and lesion detectability were assessed by four nuclear medicine physicians for acquisition times of 1.0 and 1.5 min/bed position. Results: The noise level decreased with increasing β values and ATs. Lesion SUVmax varied considerably between different β values and ATs, whereas SUVpeak was more stable. For an AT of 6 (in our case 1.5 min/bed), the best image quality was obtained with a β of 600 and the best lesion detectability with a β of 500. AT of 4 generated poor-quality images and false positive uptakes due to noise. Conclusions: For oncologic whole-body 18F-FDG examinations on a SiPM-based PET-CT, we propose using an AT of 6 (i.e., 4 MBq/kg and 1.5 min/bed) reconstructed with BSREM using a β value of 500–600 in order to ensure image quality and lesion detection rate as well as a high patient throughput. We do not recommend using AT < 6 since the risk of false positive uptakes due to noise increases.
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37.
  • Trägårdh, Elin, et al. (författare)
  • Myocardial Perfusion Imaging
  • 2022. - 1
  • Ingår i: Handbook of Nuclear Medicine and Molecular Imaging for Physicists : Radiopharmaceuticals and Clinical Applications, Volume III - Radiopharmaceuticals and Clinical Applications, Volume III. - 9780429489501 - 9781138593312 ; 3
  • Bokkapitel (refereegranskat)abstract
    • Ischemic heart disease (IHD) is the leading cause of death for men and women worldwide, and it also causes substantial disability and loss of productivity. The diagnosis of IHD involves clinical evaluation, including identifying risk factors, and specific cardiac investigations such as stress testing or coronary artery imaging. The arsenal of imaging modalities to detect and manage patients with IHD is large: Coronary computed tomography angiography, myocardial perfusion scintigraphy (MPS), positron emission tomography (PET), stress echocardiography, and cardiac magnetic resonance imaging. In this chapter we cover the nuclear medicine tests MPS and PET. Pathophysiology of IHD and indications of the tests are described. The procedures of both MPS and PET include a test at stress and at rest, and images are acquired. The chapter also covers reconstruction and reorientation of images, as well as evaluation of images, both quantitatively and qualitatively. Testing for ischemia by non-invasive imaging is not expected to decrease – rather the opposite, since exercise tests are no longer generally recommended for diagnosing ischemia. Also, the prevalence of IHD is increasing. Therefore, good knowledge of state-of-the-art cardiac nuclear medicine techniques are essential for medical physicists.
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38.
  • Trägårdh, Elin, et al. (författare)
  • Optimization of [18F]PSMA-1007 PET-CT using regularized reconstruction in patients with prostate cancer
  • 2020
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Prostate-specific membrane antigen (PSMA) radiotracers such as [18F]PSMA-1007 used with positron emission tomography-computed tomography (PET-CT) is promising for initial staging and detection of recurrent disease in prostate cancer patients. The block-sequential regularization expectation maximization algorithm (BSREM) is a new PET reconstruction algorithm, which provides higher image contrast while also reducing noise. The aim of the present study was to evaluate the influence of different acquisition times and different noise-suppressing factors in BSREM (β values) in [18F]PSMA-1007 PET-CT regarding quantitative data as well as a visual image quality assessment. We included 35 patients referred for clinical [18F]PSMA-1007 PET-CT. Four megabecquerels per kilogramme were administered and imaging was performed after 120 min. Eighty-four image series per patient were created with combinations of acquisition times of 1–4 min/bed position and β values of 300–1400. The noise level in normal tissue and the contrast-to-noise ratio (CNR) of pathological uptakes versus the local background were calculated. Image quality was assessed by experienced nuclear medicine physicians. Results: The noise level in the liver, spleen, and muscle was higher for low β values and low acquisition times (written as activity time products (ATs = administered activity × acquisition time)) and was minimized at maximum AT (16 MBq/kg min) and maximum β (1400). There was only a small decrease above AT 10. The median CNR increased slowly with AT from approximately 6 to 12 and was substantially lower at AT 4 and higher at AT 14–16. At AT 4–6, many images were regarded as being of unacceptable quality. For AT 8, β values of 700–900 were considered of acceptable quality. Conclusions: An AT of 8 (for example as in our study, 4 MB/kg with an acquisition time of 2 min) with a β value of 700 performs well regarding noise level, CNR, and visual image quality assessment.
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39.
  • Valind, Kristian, et al. (författare)
  • [18F]PSMA-1007 PET is comparable to [99mTc]Tc-DMSA SPECT for renal cortical imaging.
  • 2023
  • Ingår i: European journal of hybrid imaging. - 2510-3636. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Scintigraphy using technetium-99m labelled dimercaptosuccinic acid ([99mTc]Tc-DMSA), taken up in the proximal tubules, is the standard in functional imaging of the renal cortex. Recent guidelines recommend performing [99mTc]Tc-DMSA scintigraphy with single photon emission computed tomography (SPECT). Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) is used for staging and localization of recurrence in prostate cancer. A high renal uptake is often seen on PSMA PET, concordant with known PSMA expression in proximal tubules. This suggests PSMA PET could be used analogous to [99mTc]Tc-DMSA scintigraphy for renal cortical imaging. [18F]PSMA-1007 is a promising radiopharmaceutical for this purpose due to low urinary clearance. In this study, we aimed to compare [18F]PSMA-1007 PET to [99mTc]Tc-DMSA SPECT regarding split renal uptake and presence of renal uptake defects, in patients with prostate cancer. Three readers interpreted PET and SPECT images regarding presence of renal uptake defects, with each kidney split into cranial, mid and caudal segments. Kidneys were segmented in PET and SPECT images, and left renal uptake as a percentage of total renal uptake was measured. RESULTS: Twenty patients with prostate cancer were included. 2 participants had single kidneys; thus 38 kidneys were evaluated. A total of 29 defects were found on both [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET. Cohen's kappa for concordance regarding presence of any defect was 0.76 on a per-segment basis and 0.67 on a per-kidney basis. Spearman's r for left renal uptake percentage between [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET was 0.95. CONCLUSIONS: [18F]PSMA-1007 PET is comparable to [99mTc]Tc-DMSA SPECT for detection of uptake defects in this setting. Measurements of split renal function made using [18F]PSMA-1007 PET are valid and strongly correlated to measurements made with [99mTc]Tc-DMSA SPECT.
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40.
  • Valind, Kristian, et al. (författare)
  • [18F]PSMA-1007 renal uptake parameters: Reproducibility and relationship to estimated glomerular filtration rate
  • 2023
  • Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-097X .- 1475-0961. ; 43:2, s. 128-135
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundScintigraphy with technetium-99m-labelled dimercaptosuccinic acid ([99mTc]Tc-DMSA) is widely used for renal cortical imaging. Uptake of [99mTc]Tc-DMSA has been shown to correlate with glomerular filtration rate (GFR). Prostate-specific membrane antigen (PSMA) radiopharmaceuticals used for positron emission tomography (PET) show high renal uptake and are being investigated for renal imaging. [68Ga]Ga-PSMA-11 PET parameters have been shown to correlate with estimated GFR (eGFR). The aim of this study was to investigate the relationship between renal [18F]PSMA-1007 uptake and eGFR.MethodsHundred and eighty-five patients underwent PET imaging at 1 and 2 h after injection of 4.0 ± 0.2 MBq [18F]PSMA-1007. Serum creatinine levels were measured and GFR estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations. Fifteen patients were excluded due to missing or incorrect data. Thus, data from 170 patients were analyzed. Kidneys were segmented in the PET images using a convolutional neural network with manual correction. For each kidney, mean standardized uptake value (SUVmean) and segmentation volume in millilitres were measured. Linear regression analyses were performed with eGFR as the outcome variable.ResultsVariation in the eGFR values was explained to a significant degree by SUVmean and renal segmentation volume in both the 1 and 2 h images. This correlation was stronger for CKD-EPI eGFR (1 h R2 = 0.64; 2 h R2 = 0.64) than for MDRD eGFR (1 h R2 = 0.47; 2 h R2 = 0.45).ConclusionRenal [18F]PSMA-1007 uptake parameters correlate with eGFR and are indicative of renal cortical function.
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41.
  • Valind, Kristian, et al. (författare)
  • Dose-reduced [18F]PSMA-1007 PET is feasible for functional imaging of the renal cortex
  • 2021
  • Ingår i: EJNMMI Physics. - : Springer Science and Business Media LLC. - 2197-7364. ; 8, s. 1-11
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundIn Prostate-specific membrane antigen (PSMA) positron emission tomography with computed tomography (PET-CT), there is significant renal uptake. The standard in renal cortical functional imaging is scintigraphy with technetium-99m labeled dimercaptosuccinic acid (DMSA). Using [68Ga]Ga-PSMA-11 PET for renal imaging has been suggested, but using [18F]PSMA-1007 has not been explored. The aims of this study were to establish the optimal time point for renal imaging after [18F]PSMA-1007 injection, to investigate the reproducibility of split renal uptake measurements, and to determine the margin for reduction in administered activity.MethodsTwelve adult male patients with prostate cancer underwent [18F]PSMA-1007 PET-CT at 8 time points up to 5.5 h post-injection (p.i.). List-mode data were binned to durations of 10 to 120 s per bed position (bp). Left renal percentage of total renal uptake (LRU%) was measured, and the difference between highest and lowest measurement per patient (“delta max”) was calculated. Images acquired at 1 h, 2 h, and 5.5 h p.i. with durations of 10 to 120 s/bp were rated regarding image quality.ResultsImaging at 2 h p.i. with 60 s/bp yielded acceptable quality in all cases. Increasing acquisition time to 15 min for a single bp would allow reducing administered activity to 0.27 MBq/kg, resulting in an effective dose of 0.4 mSv for a 1-year old child weighing 10 kg. The median delta max of LRU% measurements was 2.7% (range 1.8–7.3%).ConclusionsRenal [18F]PSMA-1007 PET-CT is feasible, with imaging 2 h p.i., acceptable split renal uptake variability, and effective dose and acquisition time comparable to those of [99mTc]Tc-DMSA scintigraphy.
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42.
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