RT Journal Article SR Electronic T1 Triple motion correction including cardiorespiratory and gross patient motion: application in coronary plaque imaging using PET JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 104 OP 104 VO 60 IS supplement 1 A1 Martin Lyngby Lassen A1 Jacek Kwiecinski A1 Damini Dey A1 Sebastien Cadet A1 Guido Germano A1 Daniel Berman A1 Philip Adamson A1 Alastair Moss A1 Marc Dweck A1 David Newby A1 Piotr Slomka YR 2019 UL http://jnm.snmjournals.org/content/60/supplement_1/104.abstract AB 104Objectives: Cardiorespiratory and gross patient motion (GPM) during coronary PET imaging has a detrimental effect on quantitative uptake measurements. The combination of these different motion patterns can translate the lesions as much as 3cm. In this study, we present a novel triple motion correction method (3xMC) and evaluate the coronary PET quantitative test-retest reproducibility with and without 3xMC technique. Methods: The 3xMC technique utilized 4 ECG and 4 respiratory gates of coronary PET imaging with sodium fluoride (18F-NaF), while the number of GPM frames were acquisition dependent. Both respiratory and GPM were detected using data-driven techniques employing only the acquired PET list data. The motion was detected from center-of-mass evaluations (in 3D) of single-slice rebinned sinograms created for every 200ms of the acquisition. The respiratory motion was extracted from the diaphragm only, while the GPM was evaluated for the entire PET field-of-view. For evaluation, 20 patients with coronary artery disease who underwent repeated hybrid 18F-NaF PET/CTA imaging within 3 weeks were analyzed with and without 3xMC technique. Two datasets were reconstructed, a standard end-diastolic dataset with 25% of the total counts (Standard) and a 3xMC dataset. Coronary lesions were identified on CTA images in arteries with diameter ≥2mm, with stenosis of >25% in the coronary segment and no prior stents. Lesion uptake was quantified from spherical Volume of Interests (VOIs) (radius=5mm), while background activities were obtained in the right atrium using a cylindrical VOI (length=15mm, radius=10mm). Lesions with Target to background (TBR) ≥1.25 were considered 18F-NaF avid, while lesions with TBR <1.25 were considered 18F-NaF negative. We report TBR and signal to noise ratios (SNR) for all image sets. Test-retest reproducibility of TBR was assessed by Bland-Altman analysis and coefficient of reproducibility. Results: A total of 47 unique coronary lesions (15 18F-NaF-avid) were identified on CTA. Increased TBR values were reported for all lesions (Standard = 1.18±0.48, 3xMC=1.20±0.48, p=0.12) and in sub-analyzes of 18F-NaF-avid lesions only (Standard=1.65±0.38, 3xMC=1.68±0.29, p=0.26), though non-significant. Reduced noise (increased SNR) was reported for all lesions datasets following 3xMC (Standard = 10.95±6.00, 3xMC = 13.23±9.51, p<0.001) and in sub-analyses of 18F-NaF-avid lesions only (Standard =16.37±4.71, 3xMC=22.11±8.33, p=0.0017). PET TBR test-retest reproducibility was improved for all lesions following 3xMC (coefficient of reproducibility: Standard = 0.437, 3xMC = 0.299 (46% improvement), p<0.001). In sub-analyses of 18F-NaF-avid lesions only, following 3xMC, TBR repeatability improved by 49% (coefficient of reproducibility: Standard = 0.628, 3xMC =0.422) (all lesions) (Figure 1), importantly in lesions with GPM >10mm following corrections reproducibility was improved by 53.8% (coefficient of reproducibility: standard= 0.745, 3xMC= 0.484). In addition, 4 lesions were reclassified following 3xMC (Figure 2). Conclusions: Combined corrections for cardiac, respiratory and gross patient motion improve test-retest reproducibility of coronary 18F-NaF PET.