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Deep-Inspiration Breath-Hold PET/CT of the Thorax

Sadek A. Nehmeh1, Yusuf E. Erdi1, Gustavo S.P. Meirelles2, Olivia Squire2, Steven M. Larson2, John L. Humm1 and Heiko Schöder2

1 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York; and 2 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York


Figure 1
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  		FIGURE 1.  (A) RPM breathing signal of 1 patient showing "Hold" periods on CT and the first PET frame are displayed. Dashed line corresponds to inflation level at which patient was instructed to hold the breath. This was defined on the fly on the basis of the lung inflation level read during DIBH CT session. The "Hold" signal exhibited a relaxation period of 1–2 s before it stabilized (arrows). Therefore, it was necessary to wait for 1–2 s before starting the acquisition. (B) Consistency in lung inflation levels throughout DIBH PET/CT sessions is shown.

 

Figure 2
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  		FIGURE 2.  Transaxial, coronal, and sagittal views of clinical (A) and DIBH (B) fused PET and CT images are shown. Arrows point to a lesion in rib, based on CT images. PET lesion appears partially in lung on clinical images and just partially matching CT lesion because of respiratory motion. DIBH technique allowed improvement of coregistration between PET and CT and lesion localization.

 

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  		FIGURE 3.  DIBH enabled correction for respiratory motion artifacts in diaphragm on CT images (A and B). Because of breathing motion, tissue density in region where the diaphragm moves in and out drops. This yielded a reduced activity concentration in corresponding areas on PET images when CT attenuation correction is performed. This artifact was minimized on DIBH CT attenuation-corrected DIBH PET images.

 




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