Phased Versus Midventilation Attenuation-Corrected Respiration-Correlated PET for Patients with Non–Small Cell Lung Cancer

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FIGURE 1.
Overview of RCCT and RCPET phases with their corresponding amplitudes. Mismatch of position of tumor if 2 different binning methods are used. Blue and red circles indicate tumor location for amplitude binning and phase binning, respectively. Blue and red dashed lines illustrate division of signal into, respectively, equally spaced amplitude bins and equally spaced phase bins.
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FIGURE 2.
Mismatch between RCCT and RCPET phases for patient 10 with large tumor motion inside lung (Tables 2 and 3). Mismatch is smallest at 0% expiration (0%EX) phase. Large mismatches can be seen for 25%EX and 50%EX phases.
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FIGURE 3.
Bland–Altman plots showing absolute difference between MidV-AC and PAC against mean SUV_max in tumor per patient for average and phase 1 values. Blue and green dashed lines represent, respectively, upper and lower 95% limit of agreement.
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FIGURE 4.
Bland–Altman plots showing absolute difference between MidV-AC and PAC against mean tumor volume per patient for average and phase 1 values. Blue and green dashed lines represent, respectively, upper and lower 95% limit of agreement.

TABLE 1

Relevant System Specifications of PET and CT Components of Siemens TruePoint Biograph 40 PET/CT Scanner

System specification	Value
PET
Axial field of view	162 mm
Transaxial field of view	605 mm
Transaxial resolution (34), FWHM at 1 cm	4.2 mm
Axial resolution (34), FWHM at 1 cm	4.5 mm
Reconstructed slice thickness	3 mm
CT
Maximum number of CT slices	40
Transaxial field of view	500 mm
High-contrast resolution	0.6 mm
Reconstructed slice thickness	3 mm
Rotation time	0.5–1 s
Feed/rotation RCCT	2.9 mm
Pitch factor RCCT	0.1

TABLE 2

Patient Average and Phase 1 SUV_max with SD for 8 Phases of PAC RCPET and MidV-AC RCPET

			SUV_max
Patient no.	Motion vector (mm)	Tumor location	PAC average	MidV-AC average	Difference MidV-AC vs. PAC (average values)	PAC phase 1	MidV-AC phase 1	Difference MidV-AC vs. PAC (phase 1 values)
1	4.4	LUL	10.55 ± 0.6	10.61 ± 0.5	0.6%	11.58	11.51	−0.6%
2	4.4	RML	7.49 ± 0.7	7.27 ± 0.5	−2.9%	8.83	8.13	−7.9%
3	3.0	LUL	9.61 ± 1.1	9.57 ± 0.6	−0.4%	10.11	10.30	1.9%
4	6.7	RUL	10.17 ± 2.1	10.12 ± 0.3	−0.5%	10.38	10.48	1.0%
5	12.3	RLL	14.67 ± 0.6	14.72 ± 0.6	0.3%	14.50	14.64	1.0%
6	10.0	RB	6.96 ± 0.6	6.97 ± 0.7	0.1%	6.94	7.23	4.2%
7	3.7	RUL	5.14 ± 0.3	4.99 ± 0.3	−2.9%	5.45	5.52	1.3%
8	6.7	LLL	7.42 ± 0.4	7.36 ± 0.4	−0.8%	7.10	7.10	0.0%
9	4.4	LB	12.37 ± 0.8	12.31 ± 0.8	−0.5%	12.10	12.10	0.0%
10	15.2	RLL	22.00 ± 1.4	21.40 ± 0.5	−2.7%	20.30	21.50	5.9%
11	1.9	RUL	6.91 ± 0.3	6.91 ± 0.3	0.0%	6.84	6.88	0.6%
12	2.5	RB	11.30 ± 0.3	11.25 ± 0.4	−0.4%	11.42	11.45	0.3%
13	4.8	RUL	7.10 ± 0.4	7.00 ± 0.4	−1.4%	7.05	7.13	1.1%
14	2.9	RUL	11.08 ± 0.6	11.00 ± 0.6	−0.7%	10.91	10.92	0.1%
15	6.6	RML	4.82 ± 0.3	4.79 ± 0.3	−0.6%	4.53	4.67	3.1%
16	3.1	LLL	5.39 ± 0.7	5.30 ± 0.7	−1.7%	5.42	5.46	0.7%
17	15.3	LUL	8.38 ± 1	8.30 ± 1	−1.0%	8.30	8.55	3.0%
18	5.8	LUL	9.66 ± 0.3	9.52 ± 0.3	−1.4%	9.42	9.47	0.5%
19	6.8	LLL	13.00 ± 0.4	12.95 ± 0.4	−0.4%	12.64	12.68	0.3%
Average					−0.9% (P = 0.002)			0.9% (P = 0.01)

LUL = left upper lobe; RML = right middle lobe; RUL = right upper lobe; RLL = right lower lobe; RB = right bronchus; LLL = left lower lobe; LB = left bronchus.

TABLE 3

Patient Average and Phase 1 Volumes (cm³) with SD for 8 Phases of PAC- and MidV-AC RCPET

			Volume (cm³)
Patient no.	Motion vector (mm)	Tumor location	PAC average	MidV-AC average	Difference MidV-AC vs. PAC (average values)	PAC phase 1	MidV-AC phase 1	Difference MidV-AC vs.PAC (phase 1 values)
1	4.4	LUL	6.71 ± 0.5	6.72 ± 0.6	0.2%	5.98	6.14	2.7%
2	4.4	RML	1.95 ± 0.1	1.89 ± 0.1	−2.4%	2.23	1.81	−18.8%
3	3.0	LUL	21.82 ± 0.8	22.00 ± 0.9	0.4%	21.43	21.01	−1.9%
4	6.7	RUL	18.63 ± 0.6	18.72 ± 0.7	0.5%	18.26	19.23	5.3%
5	12.3	RLL	45.60 ± 3.6	46.42 ± 3.4	1.8%	44.49	48.58	9.2%
6	10.0	RB	7.55 ± 2.6	7.36 ± 2.7	−2.5%	5.84	4.63	−20.7%
7	3.7	RUL	11.45 ± 1.2	11.23 ± 1.11	−1.9%	9.66	9.92	2.7%
8	6.7	LLL	48.7 ± 6.5	49.5 ± 5.6	1.6%	54.21	54.70	0.9%
9	4.4	LB	1.82 ± 0.3	1.85 ± 0.2	1.9%	1.91	1.92	0.5%
10	15.2	RLL	15.12 ± 0.6	15.28 ± 0.3	1.1%	15.20	15.70	3.3%
11	1.9	RUL	104.2 ± 3.9	103.49 ± 4	−0.7%	106.71	105.53	−1.1%
12	2.5	RB	16.02 ± 0.7	16.08 ± 0.8	0.4%	16.08	16.28	1.3%
13	4.8	RUL	72.89 ± 3.8	73.89 ± 3.5	1.4%	76.25	74.87	−1.8%
14	2.9	RUL	12.06 ± 1.5	12.28 ± 1.4	1.8%	11.27	11.68	3.6%
15	6.6	RML	6.67 ± 0.7	6.72 ± 0.8	0.8%	7.11	7.21	1.4%
16	3.1	LLL	7.04 ± 2.1	6.79 ± 2.1	−3.5%	6.06	5.65	−6.7%
17	15.3	LUL	4.40 ± 0.7	4.42 ± 0.8	0.6%	5.40	5.40	0.0%
18	5.8	LUL	4.28 ± 0.4	4.34 ± 0.4	1.6%	4.47	4.41	−1.4%
19	6.8	LLL	114.95 ± 4.5	114.49 ± 4.4	−0.4%	119.00	120.19	1.0%
Average					0.2% (P = 0.6)			−1.7% (P = 0.6)

LUL = left upper lobe; RML = right middle lobe; RUL = right upper lobe; RLL = right lower lobe; RB = right bronchus; LLL = left lower lobe; LB = left bronchus.

TABLE 4

Average Differences Between 2 Attenuation-Correction Methods for Average and Phase 1 Values for SUV, Image Quality, and Volume

Parameter	Difference MidV-AC vs. PAC (average values)	Difference MidV-AC vs. PAC (phase 1 values)
SUVmax	−0.9% (P = 0.002)	0.9% (P = 0.01)
SUV Mean	−1.0% (P = 0.007)	0.5% (P = 0.1)
Volume	0.2% (P = 0.6)	−1.7% (P = 0.6)
Signal-to-noise ratio	−0.5% (P = 0.3)	−0.9% (P = 0.2)
Contrast	−0.1% (P = 0.4)	−0.1% (P = 0.7)