Assessment of Factors Affecting Accuracy of Standardised Uptake Values in Positron Emission ...

253 Pages·2015·5 MB·English

Assessment of Factors Affecting Accuracy of
Standardised Uptake Values in
Positron Emission Tomography

PETRUS DANIEL DU TOIT

Submitted in fulfilment of the requirements in respect of the Philosophiae Doctor (Ph.D.)
degree qualification in the Department of Medical Physics in the Faculty of Health
Sciences at the University of the Free State.

31 January 2015

Promotor: Dr H. du Raan
Co-promotors: Prof. W.I.D. Rae
Dr D. Visvikis (Brest, France)
1. I, Petrus Daniel du Toit, declare that the doctoral research thesis that I herewith
submit at the University of the Free State, is my independent work and that I have
not previously submitted it for a qualification at another institution of higher
education.
2. I, Petrus Daniel du Toit, hereby declare that I am aware that the copyright is
vested in the University of the Free State.
3. I, Petrus Daniel du Toit, hereby declare that all royalties as regards intellectual
property that was developed during the course of and/or in connection with the
study at the University of the Free State will accrue to the University.
4. I, Petrus Daniel du Toit, hereby declare that I am aware that the research may only
be published with the dean’s approval.

Signed at BLOEMFONTEIN on this THIRTY-FIRST day of JANUARY 2015

PD du Toit
Acknowledgements

I would like to acknowledge Professor Tys Lötter and Professor Andries van
Aswegen for their contributions and advice at the onset of this project.

I would like to thank Dr Frederic Lamare for his assistance with the installation and
use of the GATE and reconstruction software as well as for answering many of my
questions during the course of this study.

I thank Dr Paul Segars for his assistance in providing me with the XCAT phantom
and its use, as well as Dr Assen Kirov and Dr Ross Schmidtlein for their help with
the GATE version of the GE Discovery ST PET scanner.

Albert van Eck at the High Performance Computing Cluster at the University
deserves a special mention for hours of installing software, problem-solving and
ensuring that my simulations did eventually complete.

I thank my colleagues at the Free State PET/CT Centre for letting me use the
scanner and obtaining the FDG for the phantom scans.

The Dean, Professor Gert van Zyl, deserves a thank you for his encouragement and
believing that I would finish this study.

My promotors, Dr Hanlie du Raan, Prof William Rae and Dr Dimitris Visvikis,
deserve the credit for their dedication, for their guidance and for their patience
during this project. Thank you for your availability and for leading me to the end.

I wish to thank my parents, family and special friends for their support and
encouragement throughout the duration of this research. Without those I would not
have succeeded.

I thank Him in whom all Knowledge is vested for His grace and for the abilities I
was given to be who I am.
“In physical science the first essential step in the direction of learning any subject is to
find principles of numerical reckoning and practicable methods for measuring some
quality connected with it. I often say that when you can measure what you are speaking
about, and express it in numbers, you know something about it; but when you cannot
measure it, when you cannot express it in numbers, your knowledge is of a meagre and
unsatisfactory kind; it may be the beginning of knowledge, but you have scarcely in your
thoughts advanced to the state of Science, whatever the matter may be.”

[William Thomson, 1st Baron Kelvin (1824-1907)]
Assessment of Factors Affecting Accuracy of
Standardised Uptake Values in
Positron Emission Tomography

Table of Contents

TABLE OF ABBREVIATIONS ..................................................................................................i
CHAPTER I Introduction ................................................................................................ 1
CHAPTER II Literature Overview ................................................................................... 9
CHAPTER III IEC Body Phantom .................................................................................. 48
CHAPTER IV XCAT Phantom ...................................................................................... 136
CHAPTER V Conclusion ............................................................................................... 229
ABSTRACT ...................................................................................................................... I
OPSOMMING ................................................................................................................... III
i 

I. List of Abbreviations

1D: one-dimensional
2D: Two-dimensional
3D: Three-dimensional
4D: Four-dimensional, including the temporal dimension
ACD: Annihilation coincidence detection
AMIDE: A Medical Image Data Examiner
ASCII: American Standard Code for Information Interchange
BGO: Bismuth Germinate
Bq: becquerel
cm: centimeter
CT: Computed Tomography
EORTC: European Organisation for Research and Treatment of Cancer
FBP: Filtered backprojection
FDG: 2-[18F]fluoro-2deoxy-D-glucose
FORE: Fourier Rebinning algorithm
FoV: Field-of-view
FWHM: Full width at half maximum
g: gram
GATE: Geant 4 Application for Tomographic Emission
GE: General Electric
GTV: Gross Tumour Volume
H : Null hypothesis
0
IEC: International Electrotechnical Commission
kBq: kilobecquerel
keV: kilo electron volt
ii 

kV: kilovolt
LBR: Lesion to Background ratio
LL1: apical lesion in left lung
LL2: mid lesion in left lung
LL3: basal lesion in left lung
LoR: Line of Response
LSO: Lutetium oxyorthosilicate
MHz: megahertz
ML-EM: Maximum-likelihood expectation maximisation
MBq: megabecquerel
ml: millilitre
mm: millimeter
MRI: Magnetic Resonance Imaging
NEMA: National Electrical Manufacturers Association
NURBS: Non-Uniform Rational B-Splines
OPL-EM: One-Pass List-Mode Expectation Maximisation
OSEM: Ordered Subset Expectation Maximisation
PET/CT: Combined Positron Emission Tomography and Computed Tomography
PET: Positron Emission Tomography
PMMA: Poly(methyl methacrylate)
PMT: Photomultiplier tube
PSF: Point Spread Function
PVC: Partial Volume Correction
PVE: Partial Volume Effect
QC: Quality Control
RAM: Random Access Memory
RoI: Region of Interest
iii 

RL1: apical lesion in right lung
RL2: mid lesion in right lung
RL3: basal lesion in right lung
SNR: Signal to Noise Ratio
SPECT: Single Photon Emission Computed Tomography
SSRB: Single Slice Rebinning Algorithm
SUV: Standardised Uptake Value
SUV : The SUV derived from the maximum value of a region or volume
max
SUV : The SUV derived from the mean value of a region or volume
mean
UFS: University of the Free State
VoI: Volume of Interest
XCAT phantom: 4D Extended NURBS-Based Cardiac-Torso Phantom
1
1 Chapter I
Introduction

Table of Contents
1  Chapter I...................................................................................................................... 1 
Table of Contents ................................................................................................................ 1 
1.1  Overview of the use of Positron Emission Tomography .................................... 2 
1.2  Aim ..................................................................................................................... 5 
1.3  References ........................................................................................................... 5
2
1.1 Overview of the use of Positron Emission Tomography

Positron emission tomography (PET) is a non-invasive functional imaging technique that
uses specific tracers labelled with positron emitting isotopes for the monitoring and
evaluation of in vivo molecular processes. Typically a labelled compound is injected into
the body and is distributed throughout the body in a way that is determined by its
biochemical characteristics. The use of a wide range of biologically significant elements
(such as 13N, 11C, 15O and 18F) provides a strong basis for molecular imaging using PET.
The most widely used PET radioisotope to date is an 18F labelled glucose analogue
known as 2-[18F]fluoro-2deoxy-D-glucose (FDG).

PET has been used routinely in clinical practice since the mid 1980s. PET technology
development over the past decades has gone through a number of significant changes,
driven mainly by the request for whole body acquisitions, which dominate diagnostic
oncology investigations. The combination of PET and FDG has already demonstrated its
advantages over conventional imaging modalities in tumour diagnosis and staging for a
large number of oncology applications. These include particular tumours such as
lymphoma, melanoma, lung and colorectal cancer where evidence-based studies in a
number of European Union countries have indicated the need for a PET scanner for every
1–1.5 million inhabitants. (Visvikis et al., 2004)

FDG PET has been proven to be of value in characterising the nature of a lesion by
measuring its metabolic activity. Transport of glucose into the cell across the plasma
membrane is made possible by the glucose plasma proteins. Inside the cell, the glucose is
phosphorylated into glucose-6-phosphate and [18F]-FDG is phosphorylated into [18F]-
FDG-6-phosphate by the enzyme hexokinase. The glucose-6-phosphate is further
metabolised, but the [18F]-FDG-6-phosphate is not and it then remains in the cell in that
form. This happens since [18F]-FDG-6-phosphate is a poor substrate for the enzymes that
are responsible for de-phosphorylation and also because it and its metabolites do not
enter the glycolytic pathway. Imaging can thus be performed without change or washout
of the 18F in the cells (Alazraki et al., 2007; Hallet, 2004). Malignant cells actively