Name: management of respiratory motion artefacts in 18f-fluorodeoxyglucose positron emission tomography using an amplitude-based optimal respiratory gating algorithm
Uploaded: 2020-07-23T14:00:00
Description: Watch this Scientific Journal Video about Management of Respiratory Motion Artefacts in 18F-fluorodeoxyglucose Positron Emission Tomography using an Amplitude-Based Optimal Respiratory Gating Algorith

作者要感谢理查德·拉格胡提供了图1所示的 PET图像。

涉及人类参与者的所有程序都符合Radboud大学医学中心内部审查委员会（IRB）的道德标准，以及1964年赫尔辛基宣言及其后来的修正案或类似的道德标准。ORG 算法是供应商特定的产品，可在西门子传记 mCT PET/CT 扫描仪系列和较新的 PET/CT 型号上找到。
1. 患者准备
<ol><li>患者阿南尼斯<ol>
<li>检查病人的姓名和出生日期。包含条件类似于常规的非封闭 PET 扫描。不需要额外的 in 或 ...

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在核医学界，动动人工制品在PET成像中不断恶化的影响早已得到人们的认可。许多研究表明，呼吸运动人工制品的模糊效应可以显著影响图像的定量和病变的可检测性。虽然已经开发出几种呼吸门控方法，但呼吸门控目前尚未在临床实践中得到广泛应用。这尤其是由于由此产生的图像质量可变、图像采集时间无法接受的延长，以及呼吸门控在临床全身成像协议中的非理想集成。ORG 的优点是，它允...

正电子发射断层扫描（PET）与X射线计算机断层扫描（CT）相结合，是临床实践中广泛接受的成像工具，用于准确诊断和各种疾病的临床分期1。PET成像的优势在于能够可视化和量化体内的无数生物过程，具有高灵敏度和高准确性2。这是通过静脉注射给患者施用放射性标记的化合物（也称为放射追踪器）实现的。根据使用的放射分析器，组织特征，如葡萄糖代谢，细胞增殖，缺氧程度，氨基酸传输，蛋白质和受体的表达，可以可视化和量化2。
虽然已经开发、验证并用于临床实践，但放射性葡萄糖 模拟18F-氟二氧葡萄糖（FDG）是临床实践中使用最广泛的放射跟踪仪。鉴于FDG主要积聚在糖解率升高的细胞中（即葡萄糖吸收率升高的细胞，并转化为丙酮酸盐用于能量生产），因此有可能区分具有不同代谢状态的组织。与葡萄糖类似，FDG吸收的第一步是从血浆膜上细胞外空间运输到细胞内空间，由葡萄糖传输器（GLUT）3促进。一旦FDG进入细胞内空间，由六磷激酶进行磷酸化将导致FDG-6-磷酸盐的生成。然而，与葡萄糖-6-磷酸盐相比，FDG-6-磷酸盐不能进入克雷布斯循环进一步有氧异化，因为在第二（2'）碳位置没有羟基（OH）组。鉴于反向反应，FDG-6磷酸盐回FDG的去磷磷化，在大多数组织中几乎不发生，FDG-6-磷酸盐被困在细胞内3。因此，FDG吸收的程度取决于G胶（特别是G胶1和G胶3）在血浆膜上的表达，以及六角激酶的细胞内酶活性。这种连续吸收和诱捕的FDG的概念被称为代谢诱捕。FDG优先积累在代谢活性升高的组织中的事实如图 1a所示，显示了FDG在患者体内的生理分布。此 FDG-PET 图像显示心脏、大脑和肝脏组织（已知在正常条件下代谢活性器官）的吸收率较高。
由于改变的新陈代谢是许多疾病的重要标志，因此检测组织代谢状态差异的高灵敏度使FDG成为区分正常病组织的优秀放射追踪器。图1b中很容易描述这一点，显示了患有IV期非小细胞肺癌（NSCLC）的患者的FDG-PET图像。在原发性肿瘤和转移性病变中，吸收率增加。除了可视化之外，放射图器吸收的定量在患者的临床管理中起着重要的作用。从PET图像中提取的定量指数，反映放射性拉取器吸收程度，如标准化吸收值（SUV）、代谢体积和总病变糖解（TLG），可用于为不同患者组提供重要的预后信息和测量治疗反应。。在这方面，FDG-PET成像正越来越多地用于个性化肿瘤患者的放射治疗和系统治疗7。此外，还介绍了FDG-PET用于监测急性治疗诱发毒性，如放射诱发食道炎8、肺炎9和全身性炎症反应10等，为做出图像引导治疗决策提供了重要信息。
鉴于PET在患者临床管理中的重要作用，图像质量和定量精度对于根据PET图像适当指导治疗决策非常重要。然而，有许多技术因素，可以降低PET图像的定量精度11。与其他放射性成像模式（通常每个床位位置几分钟）相比，PET 的采集时间较长，是显著影响 PET 图像定量的一个重要因素。因此，患者通常被指示在PET成像期间自由呼吸。结果是PET图像受到呼吸诱导运动的影响，这可能导致胸部和上腹部内的器官明显模糊。这种呼吸诱导的运动模糊会显著影响放射分析器吸收的充分可视化和定量精度，这会影响患者在使用PET图像进行诊断和分期时对患者的临床管理，辐射治疗规划应用的目标体积定义，以及治疗反应的监测12。
已开发出几种呼吸门控方法，试图纠正呼吸运动人工制品的PET图像13。这些方法可分为前瞻性、回顾性和数据驱动的门控策略。前瞻性及追溯性呼吸门控技术通常依赖于在PET成像14期间获取呼吸代理信号。这些呼吸代理信号用于跟踪和监测患者的呼吸周期。呼吸跟踪装置的例子包括使用压力传感器12或光学跟踪系统（如摄像机）15检测胸壁，热电偶测量呼吸空气16的温度，以及测量气流的呼吸计，从而间接估计患者肺部的体积变化17。
然后，呼吸门控通常通过连续同时记录代理信号（指定 S（t））完成，并在图像采集过程中使用 PET 数据。使用采集的代理信号，可选择与特定呼吸相或振幅范围（基于振幅的浇注）对应的PET数据。相位浇注通过将每个呼吸循环划分为固定数量的门来执行，如图2a所示。然后，通过选择在患者呼吸周期的特定阶段获得的数据来进行呼吸门控，用于图像重建。同样，基于振幅的浇注依赖于定义呼吸信号的振幅范围，如图2b 所示。当呼吸信号值在设定的振幅范围内时，相应的PET列表模式数据将用于图像重建。对于回顾性浇注方法，将收集所有数据，并在图像采集后对 PET 数据进行重新装箱。虽然前向呼吸门控方法使用与回顾式浇注方法相同的概念来重新装箱PET数据，但这些方法依赖于在图像采集过程中对数据进行前瞻性收集数据。收集足够数量的 PET 数据后，图像采集将完成。这种前瞻性及追溯性浇注方法的困难在于保持可接受的图像质量，而不会显著延长不规则呼吸时的图像采集时间。在这方面，相基呼吸门控方法对不规则的呼吸模式13、19特别敏感，其中大量PET数据因拒绝不适当的触发因素而被丢弃，导致图像质量大幅降低或图像采集时间延长不可接受的时间。此外，当接受不适当的触发时，呼吸门控算法的性能以及PET图像的运动排斥效果可以降低，因为呼吸门在呼吸循环的不同阶段被定义，如图2a所示。事实上，据报，在呼吸信号13出现不规则时，基于振幅的呼吸门控比相位方法更稳定。虽然基于振幅的呼吸门控算法在存在不规则的呼吸频率时更健壮，但这些算法对呼吸信号的基线漂移更敏感。当患者的肌肉紧张（即患者在图像采集期间过渡到更放松的状态）或呼吸模式发生变化时，基线信号的漂移可能发生。为了防止信号的基线漂移，应注意将跟踪传感器牢固地连接到患者，并定期监测呼吸信号。
虽然这些问题是已知的，传统的呼吸门控算法只允许有限的控制图像质量，通常需要显著延长图像采集时间或增加放射跟踪量给患者。这些因素导致在临床常规中采用此类协议有限。为了规避与呼吸门控图像的可变质量相关的这些问题，提出了一种特定类型的振幅门控算法，也称为最佳呼吸门控（ORG）。使用 ORG 的呼吸门控允许用户通过提供占空比作为算法的输入来指定呼吸门禁图像的图像质量。占空比定义为用于图像重建的获取 PET 列表模式数据的百分比。与许多其他呼吸门控算法相比，这一概念允许用户直接确定重建的PET图像的图像质量。根据指定的占空比，计算出最佳振幅范围，将整个呼吸代理信号的具体特性考虑在内。特定占空比的最佳振幅范围将从呼吸信号的下振幅限（指定 （L） 的不同值的选择开始）来计算。对于每个选定的下限，调整的幅度上限（指定为 （U））的方式使所选 PET 数据的总和（定义为呼吸信号在振幅范围内 （L<S）<U） 中获取的数据）等于指定的占空比。例如，对于获得的 PET 列表模式数据的 50% 和 6 分钟的占空比，振幅范围调整为包括三分钟 （50%）PET 数据。最佳振幅范围 （W） 定义为用于呼吸门控的最小振幅范围，该范围仍包含所需的 PET 数据量（即 ArgMax（+U-L+），如图2c12 所示。因此，通过指定占空比，用户在噪声量和驻留在 ORG PET 图像中的残余运动程度之间进行权衡。降低占空比会增加噪声量，但这也将减少 PET 图像中的残余运动量（反之亦然）。尽管前几次报告都描述了 ORG 的概念和效果，但本手稿的目的是向临床医生提供有关在临床实践中使用 ORG 时特定方案的详细信息。因此，描述了在临床成像方案中使用组织。将提供若干实际方面，包括患者准备、图像采集和重建方案。此外，手稿将涵盖 ORG 软件的用户界面以及在 PET 成像期间执行呼吸门控时可做出的具体选择。最后，讨论了组织对病变可检测性和图像量化的影响，如前几次研究所示。

<table>
	<tbody>
		<tr>
			<td>Sensor Port, sensor, black box, wave deck, elastic band, load cell sensor (complete set)</td>
			<td>anzai medical co.</td>
			<td>respiratory gating system AZ-733V</td>
			<td>http://www.anzai-med.co.jp/en/product/item/az733v</td>
		</tr>
	</tbody>
</table>

management of respiratory motion artefacts in 18f-fluorodeoxyglucose positron emission tomography using an amplitude-based optimal respiratory gating algorithm

正电子发射断层扫描 （PET） 与 X 射线计算机断层扫描 （CT） 相结合是准确诊断和各种疾病的临床分期所需的重要分子成像平台。PET 成像的优势在于能够以高灵敏度和高精度在体内可视化和量化各种生物过程。但是，有多种因素决定了PET图像的图像质量和定量精度。影响胸部和上腹部PET成像图像质量的首要因素之一是呼吸运动，导致呼吸引起的解剖结构运动模糊。为了提供最佳的图像质量和 PET 图像的定量精度，需要校正这些伪像。
已开发出几种呼吸门控技术，通常依靠与 PET 数据同时采集呼吸信号。根据获得的呼吸信号，选择PET数据重建无运动图像。虽然这些方法已被证明可以有效地去除PET图像中的呼吸运动伪像，但性能取决于所获取的呼吸信号的质量。本研究讨论了基于振幅的优化呼吸门控（ORG）算法的使用。与许多其他呼吸门控算法相比，ORG 允许用户控制图像质量与重建的 PET 图像中被拒绝的运动量。这是通过基于采集的代理信号和用户指定的占空比（用于图像重建的 PET 数据的百分比）计算最佳振幅范围实现的。最佳振幅范围定义为仍包含图像重建所需的 PET 数据量的最小振幅范围。结果表明，ORG有效去除胸部和上腹部PET成像中呼吸诱导图像模糊，提高了图像质量和定量精度。

在PET中使用组织可全面减少图像的呼吸引起的模糊。例如，在非小细胞肺癌患者（NSCLC）的临床评估中，ORG导致发现更多的肺病变和肺淋巴结20。图 8 和图 9中很容易证明这一点，显示了 NSCLC 患者的非封闭和 ORG PET 图像。
特别是，ORG 导致早期疾病阶段 （I-IIB） 患者的管理变化，其中淋巴结额外病变的检测可显著?...

Watch this Scientific Journal Video about Management of Respiratory Motion Artefacts in 18F-fluorodeoxyglucose Positron Emission Tomography using an Amplitude-Based Optimal Respiratory Gating Algorith

Management of Respiratory Motion Artefacts in 18F-fluorodeoxyglucose Positron Emission Tomography using an Amplitude-Based Optimal Respiratory Gating Algorithm

基于振幅的最佳呼吸门控 （ORG） 有效地消除了临床 18F-氟氧葡萄糖 （FDG） 正电子发射断层扫描 （PET） 图像中的呼吸诱导运动模糊。修正这些呼吸运动人工制品的FDG-PET图像可提高图像质量、诊断和定量精度。去除呼吸运动人工制品对于使用PET的患者进行充分的临床管理非常重要。

使用基于振幅的最佳呼吸门控算法对 18个F-氟二氧氧葡萄糖正电子发射断层扫描中的呼吸运动人工制品进行管理

Positron emission tomography (PET) combined with X-ray computed tomography (CT) is an important molecular imaging platform that is required for accurate ...

在PET/CT成像中呼吸运动伪影的恶化效应早已得到人们的认可。最佳呼吸门控是用于校正这些运动伪影的PET/CT图像的方法。对于大多数呼吸门控算法来说，保持足够的图像质量是有问题的。最佳的呼吸门控算法允许用户保持和定义足够的图像质量。呼吸运动伪影可以显著影响图像质量和定量精度。因此，从PET图像中删除这些伪影对于提高诊断精度和监测治疗反应的能力非常重要。展示这个程序的将是Jurrian，放射学和核医学系的高级技师。在管理无线电跟踪器之前。测量病人的血糖是重要的。在向患者解释制备和成像程序后，将一个外周静脉管插入患者的前静脉之一，并将带诱饵锁的三向停止锁系统连接到盐水的 20 毫升注射器中。用盐水去除盐，把塞子连接到静脉的管上。用 10 毫升盐水检查管的光度，然后用放射线将注射器连接到三向止血器上。然后转动三向止损阀的阀门，使液体的方向从含有放射拉杆的注射器流向外围静脉管。注射器已放置在一个特殊的钨屏蔽容器中。要管理无线电拉塞，请缓慢压抑容器的注射器柱塞。当所有跟踪器都已传递时。转动塞子的阀门，使含有盐水的注射器连接到放射追踪器注射器，并冲洗注射器以捕获盐水中注射器内任何残留的放射拉杆。然后转动止损器的阀门，将含有残留放射性拉杆的盐水冲洗器交付给患者。在施用最后一次洗涤无线电跟踪器后，取出放射干扰器注射器。通过静脉管，每公斤氟化素提供0.5毫克。在交付氟化碳后，让患者在舒适的位置休息50分钟，然后要求患者使膀胱失效。55 分钟后，护送患者到扫描仪，让患者躺在苏平位置，双臂放在扫描仪床上。使用适当的扶手，使患者尽可能舒适。观察病人的呼吸模式将呼吸带固定在患者胸部或上腹部周围，并放置传感器，以便经过目视检查后可以识别腹部壁偏移。然后使用挂钩和回路闭合系统固定患者周围的皮带，并检查扫描仪显示屏，以确认呼吸信号是否仍位于最小和最大范围的范围内。在患者注册后 60 分钟，选择扫描仪上的全身协议，然后单击最佳封闭采集方案。将扫描仪表移动到正确的位置以获取顶部图。要开始采集顶部图，请按扫描仪控制框上的扫描仪启动键，然后单击顶部图上的鼠标左键以设置扫描范围。然后获得患者的低剂量CT扫描。接下来，设置 PET 床的位置以校正呼吸运动，并设置床位置的图像记录时间。输入采集参数后，按住移动键，直到扫描仪床移回起始位置，然后再次按启动以启动 PET 扫描。在采集过程中，定期检查患者和呼吸信号的质量。在扫描结束时，确认呼吸信号已获取，并启动扫描重建。在PET图像中使用最佳浇注可全面减少图像的呼吸引起的模糊。例如，在非小细胞肺癌患者的临床评估中，最佳浇注导致检测更多的肺病变，以及高孔和中淋巴结。这些差异会对患者管理产生重要影响，特别是在早期疾病阶段的非小细胞肺癌患者中。最佳呼吸门控算法的一个重要优点是图像质量可由用户确定。在此图中，可以观察到两种不同的最佳门控PET和非门控PET图像，这些图像的统计质量不同。而以占空比为35%重建的最优门控PET图像的统计质量保持不变，非门控等效图像保持不变。图像噪声与宠物图像的运动抑制量之间的权衡由占空比决定。虽然使用最佳呼吸门控算法时保持图像质量，但扫描前对皮带进行适当定位对于获取高质量的呼吸信号非常重要。

Research

JoVE Journal

Cancer Research

Management of Respiratory Motion Artefacts in 18F-fluorodeoxyglucose Positron Emission Tomography using an Amplitude-Based Optimal Respiratory Gating Algorithm

Determining the Optimal Inhibitory Frequency for Cancerous Cells Using Tumor Treating Fields (TTFields)

Determining the Optimal Inhibitory Frequency for Cancerous Cells Using Tumor Treating Fields TTFields

确定癌细胞使用肿瘤治疗领域的最佳抑制频率（TTFields）

Tumor Treating Fields (TTFields) are an effective treatment modality delivered via the continuous, noninvasive application of low-intensity (1-3 V/cm), ...

科研

癌症研究

Multimodal Bioluminescent and Positronic-emission Tomography/Computational Tomography Imaging of Multiple Myeloma Bone Marrow Xenografts in NOG Mice

nog 小鼠多发性骨髓瘤异种移植的多模态生物发光和正电子发射成形断层扫描成像

Multiple myeloma (MM) tumors engraft in the bone marrow (BM) and their survival and progression are dependent upon complex molecular and cellular ...

Establishment and Characterization of Three Afatinib-resistant Lung Adenocarcinoma PC-9 Cell Lines Developed with Increasing Doses of Afatinib

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Spatial and Temporal Control of Murine Melanoma Initiation from Mutant Melanocyte Stem Cells

突变黑色素细胞干细胞引发小鼠黑色素瘤的时空控制

Cutaneous melanoma is well known as the most aggressive skin cancer. Although the risk factors and major genetic alterations continue to be documented ...

Semi-automatic PD-L1 Characterization and Enumeration of Circulating Tumor Cells from Non-small Cell Lung Cancer Patients by Immunofluorescence

免疫荧光对非小细胞肺癌患者循环肿瘤细胞的半自动PD-L1特征化及枚举

Circulating tumor cells (CTCs) derived from the primary tumor are shed into the bloodstream or lymphatic system. These rare cells (1&#8722;10 cells per mL ...

Quantifying the Brain Metastatic Tumor Micro-Environment using an Organ-On-A Chip 3D Model, Machine Learning, and Confocal Tomography

使用有机体片 3D 模型、机器学习和共声断层扫描量化脑转移肿瘤微环境

Brain metastases are the most lethal cancer lesions; 10-30% of all cancers metastasize to the brain, with a median survival of only ~5-20 months, ...

Dynamic Imaging of Chimeric Antigen Receptor T Cells with [18F]Tetrafluoroborate Positron Emission Tomography/Computed Tomography

Dynamic Imaging of Chimeric Antigen Receptor T Cells with [18F]Tetrafluoroborate Positron Emission Tomography/Computed Tomography

使用[18F]四氟硼酸盐正电子发射断层扫描/计算机断层扫描对嵌合抗原受体T细胞进行动态成像

T cells genetically engineered to express chimeric antigen receptors (CAR) have shown unprecedented results in pivotal clinical trials for patients with B ...

Preparation of Human Tissues Embedded in Optimal Cutting Temperature Compound for Mass Spectrometry Analysis

用于质谱分析的最佳切割温度化合物中嵌入的人组织制备

Sphingolipids are cellular components that have well-established roles in human metabolism and disease. Mass spectrometry can be used to determine whether ...

Positron Emission Tomography-based Dose Painting Radiation Therapy in a Glioblastoma Rat Model using the Small Animal Radiation Research Platform

使用小动物辐射研究平台在胶质母细胞瘤大鼠模型中基于正电子发射断层扫描的剂量绘画放射治疗

A rat glioblastoma model to mimic chemo-radiation treatment of human glioblastoma in the clinic was previously established. Similar to the clinical ...