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Silicon-photomultiplier-based PET/CT reduces the minimum detectable activity of iodine-124.

ABSTRACT: The radioiodine isotope pair ¹²⁴I/¹³¹I is used in a theranostic approach for patient-specific treatment of differentiated thyroid cancer. Lesion detectability is notably higher for ¹²⁴I PET (positron emission tomography) than for ¹³¹I gamma camera imaging but can be limited for small and low uptake lesions. The recently introduced silicon-photomultiplier-based (SiPM-based) PET/CT (computed tomography) systems outperform previous-generation systems in detector sensitivity, coincidence time resolution, and spatial resolution. Hence, SiPM-based PET/CT shows an improved detectability, particularly for small lesions. In this study, we compare the size-dependant minimum detectable ¹²⁴I activity (MDA) between the SiPM-based Biograph Vision and the previous-generation Biograph mCT PET/CT systems and we attempt to predict the response to ¹³¹I radioiodine therapy of lesions additionally identified on the SiPM-based system. A tumour phantom mimicking challenging conditions (derived from published patient data) was used; i.e., 6 small spheres (diameter of 3.7-9.7 mm), 9 low activity concentrations (0.25-25 kBq/mL), and a very low signal-to-background ratio (20:1). List-mode emission data (single-bed position) were divided into frames of 4, 8, 16, and 30 min. Images were reconstructed with ordinary Poisson ordered-subsets expectation maximization (OSEM), additional time-of-flight (OSEM-TOF) or TOF and point spread function modelling (OSEM-TOF+PSF). The signal-to-noise ratio and the MDA were determined. Absorbed dose estimations were performed to assess possible treatment response to high-activity ¹³¹I radioiodine therapy. The signal-to-noise ratio and the MDA were improved from the mCT to the Vision, from OSEM to OSEM-TOF and from OSEM-TOF to OSEM-TOF+PSF reconstructed images, and from shorter to longer emission times. The overall mean MDA ratio of the Vision to the mCT was 0.52 ± 0.18. The absorbed dose estimations indicate that lesions ≥ 6.5 mm with expected response to radioiodine therapy would be detectable on both systems at 4-min emission time. Additional smaller lesions of therapeutic relevance could be detected when using a SiPM-based PET system at clinically reasonable emission times. This study demonstrates that additional lesions with predicted response to ¹³¹I radioiodine therapy can be detected. Further clinical evaluation is warranted to evaluate if negative ¹²⁴I PET scans on a SiPM-based system can be sufficient to preclude patients from blind radioiodine therapy.

SUBMITTER: Kersting D

PROVIDER: S-EPMC8410931 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeThe implementation of photon-counting detectors is widely expected to be the next breakthrough in X-ray computed tomography (CT) instrumentation. A small number of prototype scanners equipped with direct-conversion detectors based on room-temperature semiconductors, such as CdTe and CdZnTe (CZT), are currently installed at medical centers. Here, we investigate the feasibility of using silicon photomultiplier (SiPM)-based scintillation detectors in photon-counting computed tomography (PCCT) scanners, as a potential alternative to CdTe and CZT detectors.MethodsWe introduce a model that allows us to compute the expected energy resolution as well as the expected pulse shape and associated rate capability of SiPM-based PCCT detectors. The model takes into account SiPM saturation and optical crosstalk, because these phenomena may substantially affect the performance of SiPM-based PCCT detectors with sub-mm pixels. We present model validation experiments using a single-pixel detector consisting of a 0.9 × 0.9 × 1.0 mm3 LuAP:Ce scintillation crystal coupled to a 1 × 1 mm2 SiPM. We subsequently use the validated model to compute the expected performance of the fast scintillators LYSO:Ce, LuAP:Ce, and LaBr3 :Ce, coupled to currently available SiPMs, as well as to a more advanced SiPM prototype with improved dynamic range, for sub-mm pixel sizes.ResultsThe model was found to be in good agreement with the validation experiments, both with respect to energy resolution and pulse shape. It shows how saturation progressively degrades the energy resolution of detectors equipped with currently available SiPMs as the pixel size decreases. Moreover, the expected pulse duration is relatively long (~200 ns) with these SiPMs. However, when LuAP:Ce and LaBr3 :Ce are coupled to the more advanced SiPM prototype, the pulse duration improves to less than 60 ns, which is in the same order of magnitude as pulses from CdTe and CZT detectors. It follows that sufficient rate capability can be achieved with pixel sizes of 400 μm or smaller. Moreover, LaBr3 :Ce detectors can provide an energy resolution of 11.5%-13.5% at 60 keV, comparable to CdTe and CZT detectors.ConclusionsThis work provides first evidence that it may be feasible to develop SiPM-based scintillation detectors for PCCT that can compete with CdTe and CZT detectors in terms of energy resolution and rate capability.

Project description:The traditional figures of merit used in the evaluation of positron emission tomography (PET) systems, including system sensitivity and spatial resolution, do not directly reflect the minimum detectable activity (MDA) performance, despite the fact that it is one of the most important tasks for a PET system. MDA, as a combination of the more traditional PET system parameters, is directly related to lesion detection. However, MDA evaluation is task specific and cannot be done by a single measurement. Therefore, a simple method to evaluate system detectability needs to be developed.In this work, an analytical method of MDA estimation was developed, taking into account system sensitivity, spatial resolution, source properties, and noise propagation in image reconstruction by using the Rose criterion and/or the Curie equation as the detection standard. In the implementation, the source background, as well as the intrinsic activity background from the scintillation material of the system, was also taken into consideration. The accuracy of this method was evaluated in two commercially available preclinical PET systems, with phantom experiments that were designed to closely mimic in vivo tumor uptake without introducing finite boundaries between the source and the background.The lesion contrast-to-noise ratio calculated by the analytical evaluation showed good agreement with that obtained from the experiments. Visual assessment of the reconstructed images at the detection limit (based on analytical evaluation) also was in agreement with the Rose criterion. The MDA performance was quantitatively compared between the two preclinical PET systems and showed different detection limits under different imaging conditions, suggesting that the detection limit of a PET system strongly depends on the lesion properties and acquisition settings.An analytical method of evaluating the PET system detectability was developed and validated by experiments. Overall, the analytical MDA calculation provides a simple way to evaluate the signal detectability of a PET system and can be used for comparing different systems. It also provides guidelines for designing new PET tomographs as well as optimizing data acquisition protocols.

Project description:PurposeThere is a continuous search for imaging techniques with high sensitivity and specificity for brain tumors. Positron emission tomography (PET) imaging has shown promise, though many PET agents either have a low tumor specificity or impractical physical half-lives. [124I]CLR1404 is a small molecule alkylphosphocholine analogue that is thought to bind to plasma membrane lipid rafts and has shown high tumor-to-background ratios (TBR) in a previous pilot study in brain tumor patients. This study attempts to define the clinical value of [124I]CLR1404 PET/CT (aka CLR124).ProceduresAdult patients with new or suspected recurrence of high-grade primary or metastatic brain tumors (N = 27) were injected with [124I]CLR1404 followed by PET/CT at 6, 24, and 48 h. Standard uptake values (SUV) and TBR values were calculated for all time points. Uptake of [124I]CLR1404 was qualitatively assessed, compared with magnetic resonance imaging (MRI), and correlated with clinical outcome. Final diagnosis (N = 25) was established based on surgically resected tissue or long-term follow-up.ResultsPositive uptake with high TBR was detected in all but one patient with a final diagnosis of primary/recurrent brain tumor (12/13) and in less than half of patients with treatment-related changes (5/12). Concordance between [124I]CLR1404 uptake and contrast enhancement on MRI was seen in < 40 %, with no concordance between T2-hyperintensities and uptake. No significant difference in overall outcome was found between patients with and without [124I]CLR1404 uptake.ConclusionsThe uptake pattern in these patients suggests a very high sensitivity of [124I]CLR1404 PET/CT for diagnosing tumor tissue; however, tumor specificity needs to be further defined. Relative lack of concordance with standard MRI characteristics suggests that [124I]CLR1404 PET/CT provides additional information about brain tumors compared to MRI alone, potentially improving clinical decision-making.

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Silicon-photomultiplier-based PET/CT reduces the minimum detectable activity of iodine-124.

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