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The importance of correction for tissue fraction effects in lung PET: preliminary findings

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It has recently been recognized that PET/CT may play a role in diffuse parenchymal lung disease. However, interpretation can be confounded due to the variability in lung density both within and between individuals. To address this issue a novel correction method is proposed.


A CT scan acquired during shallow breathing is registered to a PET study and smoothed so as to match the PET resolution. This is used to derive voxel-based tissue fraction correction factors for the individual. The method was evaluated in a lung phantom study in which the lung was simulated by a Styrofoam/water mixture. The method was further evaluated using 18F-FDG in 12 subjects free from pulmonary disease where ranges before and after correction were considered.


Correction resulted in similar activity concentrations for the lung and background regions, consistent with the experimental phantom set-up. Correction resulted in reduced inter- and intrasubject variability in the estimated SUV. The possible application of the method was further demonstrated in five subjects with interstitial lung changes where increased SUV was demonstrated. Single study pre- and post-treatment studies were also analysed to further illustrate the utility of the method.


The proposed tissue fraction correction method is a promising technique to account for variability of density in interpreting lung PET studies.

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  1. Inoue K, Okada K, Taki Y, Goto R, Kinomura S, Fukuda H. 18FDG uptake associated with CT density on PET/CT in lungs with and without chronic interstitial lung diseases. Ann Nucl Med. 2009;23:277–81.

    PubMed  CAS  Google Scholar 

  2. Groves AM, Win T, Screaton NJ, Berovic M, Endozo R, Booth H, et al. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18F-FDG PET/CT. J Nucl Med. 2009;50:538–45.

    PubMed  Google Scholar 

  3. Umeda Y, Demura Y, Ishizaki T, Ameshima S, Miyamori I, Saito Y, et al. Dual-time-point 18F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia. Eur J Nucl Med Mol Imaging. 2009;36:1121–30.

    PubMed  Google Scholar 

  4. Nusair S, Rubinstein R, Freedman NM, Amir G, Bogot NR, Izhar U, et al. Positron emission tomography in interstitial lung disease. Respirology. 2007;12:843–7.

    PubMed  Google Scholar 

  5. Meissner HH, Soo Hoo GW, Khonsary SA, Mandelkern M, Brown CV, Santiago SM. Idiopathic pulmonary fibrosis: evaluation with positron emission tomography. Respiration. 2006;73:197–202.

    PubMed  Google Scholar 

  6. Ambrosini V, Zompatori M, De Luca F, Antonia D, Allegri V, Nanni C, et al. 68Ga-DOTANOC PET/CT allows somatostatin receptor imaging in idiopathic pulmonary fibrosis: preliminary results. J Nucl Med. 2010;51(12):1950–5.

    PubMed  Google Scholar 

  7. Lavalaye J, Grutters JC, van de Garde EM, van Buul MM, van den Bosch JM, Windhorst AD, et al. Imaging of fibrogenesis in patients with idiopathic pulmonary fibrosis with cis-4-[(18)F]-Fluoro-L: -proline PET. Mol Imaging Biol. 2009;11:123–7.

    PubMed  Google Scholar 

  8. Win T, Screaton NJ, Porter JC, Endozo R, Kayani I, Dickson JC, Reubi JC, Ell PJ, Groves AM. Novel PET/CT imaging of diffuse parenchymal lung disease combining a labelled somatostatin receptor analogue and 18F-FDG. Molecular Imaging. 2011 (in press March 2011).

  9. Robinson PJ, Kreel L. Pulmonary tissue attenuation with computed tomography: comparison of inspiration and expiration scans. J Comput Assist Tomogr. 1979;3:740–8.

    PubMed  CAS  Google Scholar 

  10. Verschakelen JA, Van Fraeyenhoven L, Laureys G, Demedts M, Baert AL. Differences in CT density between dependent and nondependent portions of the lung: influence of lung volume. AJR Am J Roentgenol. 1993;161:713–7.

    PubMed  CAS  Google Scholar 

  11. Miyuachi T, Wahl RL. Regional 2-[18F]fluoro-2-deoxy-D-glucose uptake varies in normal lung. Eur J Nucl Med. 1996;23:517–23.

    Google Scholar 

  12. Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imaging. 1994;13:601–9.

    PubMed  CAS  Google Scholar 

  13. American Thoracic Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2002;165:277–304.

    Google Scholar 

  14. Goerres GW, Burger C, Kamel E, Seifert B, Kaim AH, Buck A, et al. Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology. 2003;226:906–10.

    PubMed  Google Scholar 

  15. McQuaid S, Hutton BF. Sources of attenuation-correction artefacts in cardiac PET/CT and SPECT/CT. Eur J Nucl Med Mol Imaging. 2008;35:1117–23.

    PubMed  Google Scholar 

  16. Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med Mol Imaging. 2003;30:588–96.

    PubMed  Google Scholar 

  17. Osman MM, Cohade C, Nakamoto Y, Wahl RL. Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT. Eur J Nucl Med Mol Imaging. 2003;30:603–6.

    PubMed  Google Scholar 

  18. Lau YH, Braun M, Hutton BF. Non-rigid image registration using a median-filtered coarse-to-fine displacement field and a symmetric correlation ratio. Phys Med Biol. 2001;46:1297–319.

    PubMed  CAS  Google Scholar 

  19. Bovik A. The essential guide to image processing. 2nd ed. New York: Academic Press; 2009.

    Google Scholar 

  20. Flaherty KR, Toews GB, Travis WD, et al. Clinical significance of histological classification of idiopathic interstitial pneumonia. Eur Respir J. 2002;19:275–83.

    PubMed  CAS  Google Scholar 

  21. Katzenstein AL, Myers JL. Idiopathic pulmonary fibrosis: clinical relevance of pathologic classification. Am J Respir Crit Care Med. 1998;157:1301–15.

    PubMed  CAS  Google Scholar 

  22. Sanchez-Crespo A, Andreo P, Larsson SA. Positron flight in human tissues and its influence on PET image spatial resolution. Eur J Nucl Med Mol Imaging. 2004;31:44–51.

    PubMed  Google Scholar 

  23. Kemerink GJ, Visser MG, Franssen R, Beijer E, Zamburlini M, Halders SG, et al. Effect of the positron range of 18F, 68Ga and 124I on PET/CT in lung-equivalent materials. Eur J Nucl Med Mol Imaging. 2011;38:940–8.

    PubMed  Google Scholar 

  24. Lehnert W, Gregoire M-C, Reilhac A, Meikle SR. Analytical positron range modeling in heterogeneous media for PET Monte Carlo simulation. Phys Med Biol. 2011;56:3313–35.

    PubMed  Google Scholar 

  25. Zavaletta VA, Bartholmai BJ, Robb RA. High resolution multidetector CT-aided tissue analysis and quantification of lung fibrosis. Acad Radiol. 2007;14:772–87.

    PubMed  Google Scholar 

  26. Rhodes CG, Wollmer P, Fazio F, Jones T. Quantitative measurement of regional extravascular lung density using positron emission and transmission tomography. J Comput Assist Tomogr. 1981;5:783–91.

    PubMed  CAS  Google Scholar 

  27. Evitzky MG. Pulmonary pathophysiology: a clinical approach. 3rd ed (Kindle edition). New York: McGraw-Hill Medical; 2009.

    Google Scholar 

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We acknowledge support for some scan costs and partial salary (T.L.) from GlaxoSmithKline (CRT115549). We also thank Dr. Pauline Lukey and Dr. Aiden Flynn (Fibrosis DPU, GSK) as well as the CRAFT Consortium for useful discussions. Also UCL/UCLH receives a portion of its research funding from the UK Department of Health’s NIHR Biomedical Research Centre funding scheme.

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Correspondence to Brian F. Hutton.

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Lambrou, T., Groves, A.M., Erlandsson, K. et al. The importance of correction for tissue fraction effects in lung PET: preliminary findings. Eur J Nucl Med Mol Imaging 38, 2238–2246 (2011).

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