Identifying Image Artifacts, Their Causes and How to Fix Them: PET. Brad J Kemp, PhD Mayo Clinic, Rochester, MN
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1 Identifying Image Artifacts, Their Causes and How to Fix Them: PET Brad J Kemp, PhD Mayo Clinic, Rochester, MN
2 Case 1 Can we scan with a defective block detector? Daily Quality Assurance Results Singles Coincidence Timing Energy 2
3 Case 1 Uniform phantom of F-18 in water Current Day Defective Block Previous Day System Okay non-tof TOF 3
4 Case 1 Uniform phantom of F-18 in water Current Day Defective Block Previous Day System Okay SUV:non-TOF SUV: TOF non-tof TOF 3
5 Case 1 Uniform phantom of F-18 in water Current Day Defective Block Previous Day System Okay SUV:non-TOF SUV: TOF non-tof TOF Discussion: Artifacts will depend on whether system is PET-only or hybrid number of blocks and their location within scanner activity distribution within the object SUVs will be affected 3
6 Case 2 Description: Streaks throughout reconstructed PET images N-13 ammonia cardiac PET study Transaxial image Coronal image 4
7 Case 2 Cause: Failure of two modules (16 block detectors) during the day Daily Quality Assurance Results (mid-day) Transaxial image Singles Coincidence Timing Resolution: Reboot system Replace hardware 5
8 Case 3 Description: Streaks in coronal PET images Large photopenic areas with no apparent uptake CT PET/CT Fused PET with CTAC 6
9 Case 3 PET/CT Fused PET with CTAC 7
10 Case 3 PET/CT Fused PET with CTAC PET NAC 7
11 Case 3 PET/CT Fused PET with CTAC PET NAC Cause: Patient motion between CT and PET scans Activity appears to be outside the body Overcorrection of scatter There will be errors in attenuation correction too 7
12 Case 3 PET/CT Fused PET with CTAC PET NAC PET with CTAC No scatter correction PET with CTAC Limit scatter correction Cause: Patient motion between CT and PET scans Activity appears to be outside the body Overcorrection of scatter There will be errors in attenuation correction too Resolution: Do not apply scatter correction Limit the scatter correction 7
13 Case 4 Description: Photopenic areas over diaphragm and dome of liver CT CT PET with CTAC 8
14 Case 4 CT PET with CTAC 9
15 Case 4 CT PET with CTAC PET NAC 9
16 Case 4 CT PET with CTAC PET NAC PET with CTAC TOF 9
17 Case 4 CT PET with CTAC PET NAC PET with CTAC TOF Cause: Respiratory motion Misregistration of PET and CT at the diaphragm Undercorrection of attenuation Resolution: Breathing techniques Respiratory gated PET and CT Apply TOF 9
18 Case 5 Description: Reduced blood flow in anterior region of an N-13 ammonia myocardial blood flow study SA slices: Apex to base Polar Map 10
19 Case 5 Cause: Respiratory motion Misregistration of the myocardium in PET and CT Undercorrection of attenuation Original Images Corrected Images Resolution: Re-align CT AC images onto PET images Re-reconstruct PET data with re-aligned CT AC images Limitations: Rigid body realignment with translations only Apply TOF Polar Map SA slices: Apex to base 11
20 Case 5 Patient moves between CT and PET Original images Z-scores, compared with normals database Corrected images (re-aligned, re-reconstructed with proper attenuation correction) Z-scores, compared with normals database 12
21 Case 6 Description: Increased uptake in abdomen CT PET/CT Fused PET with CTAC 13
22 Case 6 CT PET with CTAC 14
23 Case 6 CT PET with CTAC PET NAC 14
24 Case 6 CT PET with CTAC PET NAC PET with CTAC Contrast Correction Cause: Overcorrection of attenuation due to presence of contrast Resolution: Apply bilinear HU μ conversion with contrast correction 14
25 Recommendations If artifacts are present: Investigate the PET data Review sinograms Review PET NAC Investigate the attenuation correction data Review AC maps (especially for PET/MR studies) Are PET and AC maps registered? Is contrast media, metal, truncation present? To reduce artifacts: better algorithms reduce patient motion use TOF whenever possible 15
26 References Elhami E, Samiee M, et al. On the significance of defective block detectors in clinical 18F-FDG PET/ CT. Mol Imaging Biol 2011;13: Gould KL, Pan T, et al. Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: a definitive analysis of causes, consequences and corrections. J Nucl Med 2007; 48: Lodge MA, Mhlanga JC, Wahl RL. Effect of patient arm motion in whole-body PET/CT. J Nucl Med 2011;52:464P. Sureshbabu W, Mawlawi O. PET/CT imaging artifacts. J Nucl Med Tech 2005;33: Surti S. Update on time-of-flight PET imaging. J Nucl Med 2015;56:
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