4d-ct attenuation correction in respiratory-gated pet for hypoxia imaging: Is it really beneficial?

Brandon Driscoll, Douglass Vines, Tina Shek, Julia Publicover, Ivan Yeung, Stephen Breen, David Jaffray

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Previous literature has shown that 4D respiratory-gated positron emission tomography (PET) is beneficial for quantitative analysis and defining targets for boosting therapy. However the case for addition of a phase-matched 4D-computed tomography (CT) for attenuation correction (AC) is less clear. We seek to validate the use of 4D-CT for AC and investigate the impact of motion correction for low signal-to-background PET imaging of hypoxia using radiotracers such as FAZA and FMISO. A new insert for the Modus Medicals’ QUASAR™ Programmable Respiratory Motion Phantom was developed in which a 3D-printed sphere was placed within the “lung” compartment while an additional compartment is added to simulate muscle/blood compartment required for hypoxia quantification. Experiments are performed at 4:1 or 2:1 signal-to-background ratio consistent with clinical FAZA and FMISO imaging. Motion blur was significant in terms of SUVmax, mean, and peak for motion ≥1 cm and could be significantly reduced (from 20% to 8% at 2-cm motion) for all 4D-PET-gated reconstructions. The effect of attenuation method on precision was significant (σ2 hCT-AC = 5.5%/4.7%/2.7% vs s2 4D-CT-AC = 0.5%/0.6%/0.7% [max%/peak%/mean% variance]). The simulated hypoxic fraction also significantly decreased under conditions of 2-cm amplitude motion from 55% to 20% and was almost fully recovered (HF = 0.52 for phase-matched 4D-CT) using gated PET. 4D-gated PET is valuable under conditions of low radiotracer uptake found in hypoxia imaging. This work demonstrates the importance of using 4D-CT for AC when performing gated PET based on its significantly improved precision over helical CT.

Original languageEnglish (US)
Pages (from-to)241-249
Number of pages9
JournalTomography (Ann Arbor, Mich.)
Issue number2
StatePublished - Jun 2020


  • 4D-PET
  • Hypoxia
  • Phantom
  • Quality assurance
  • Respiratory gating

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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