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Accuracy of Image Fusion Using a Fixation Device for Whole-Body Cancer Imaging

Department of Image-Based Medicine, Institute of Biomedical Research and Innovation, 2-2 Minatojima Minamimachi, Chuo-Ku, Kobe 650-0047, Japan.

View larger version (135K): [in a new window]   Fig. 1A. —Photographs show patient on vacuum cushion undergoing PET and CT. Patient was fixed in individually molded cushion, and PET was performed first (A), followed by CT (B) with the patient on the same vacuum cushion. Once air is drawn from cushion, this fixation device is rigid enough so that patient is in same position for both examinations.

View larger version (134K): [in a new window]   Fig. 1B. —Photographs show patient on vacuum cushion undergoing PET and CT. Patient was fixed in individually molded cushion, and PET was performed first (A), followed by CT (B) with the patient on the same vacuum cushion. Once air is drawn from cushion, this fixation device is rigid enough so that patient is in same position for both examinations.

View larger version (10K): [in a new window]   Fig. 2. —Graph shows differences between PET and CT for each margin in liver. Mismatches between PET and CT images of 0-10 mm (white bars), 10-20 mm (gray bars), and more than 20 mm (black bars) are shown. In liver, percentage of consistency is low in lower and upper margins, suggesting mislocalization due to respiratory motion.

View larger version (14K): [in a new window]   Fig. 3A. —Graphs show average displacement and SD of center of PET images and center of CT images. Compared with CT images, PET images generally tended to show center of organs cephalad, posterior, and shifted to right. Graph shows average displacement ± SD (bars) for liver. C-C = craniocaudal, A-P = anteroposterior, R-L = right-left, = craniocaudal, = anteroposterior, = right-left.

View larger version (10K): [in a new window]   Fig. 3B. —Graphs show average displacement and SD of center of PET images and center of CT images. Compared with CT images, PET images generally tended to show center of organs cephalad, posterior, and shifted to right. Graph shows average displacement ± SD (bars) for right () and left () kidneys.

View larger version (11K): [in a new window]   Fig. 4. —Graph shows average deviation of center of pathologic uptake between PET and CT images with mean ± SD (bar). Lesions were classified into four groups—that is, pulmonary nodules (group A), mediastinal and supraclavicular lymph nodes or pleural dissemination (group B), liver metastasis or peritoneal dissemination (group C), and paraaortic and inguinal lymph nodes or local recurrence of rectal carcinoma (group D). Although respiratory motion may have influenced localization between the two techniques, especially in groups A and C, no significant differences were observed among the groups (one-factor analysis of variance, p = 0.098).

View larger version (12K): [in a new window]   Fig. 5. —Graph shows relationship between patient body mass index and 3D displacement of the center of pathologic lesions. No significant correlation was observed (r = -0.047, p = 0.74), indicating that patient's body did not affect deviation of pathologic lesions between the two techniques.

View larger version (98K): [in a new window]   Fig. 6A. —47-year-old man with suspected recurrent colon cancer. CT image shows mass (arrow) that was accurately diagnosed as positive for recurrent colon cancer.

View larger version (69K): [in a new window]   Fig. 6B. —47-year-old man with suspected recurrent colon cancer. PET image that corresponds to A shows intense uptake located behind bladder (arrow), but finding may be difficult to recognize as abnormal only by PET image because it is hard to differentiate it from physiologic uptake of right ureter.

View larger version (73K): [in a new window]   Fig. 6C. —47-year-old man with suspected recurrent colon cancer. Fused image of CT (A) and PET (B) shows mass (arrow).

View larger version (99K): [in a new window]   Fig. 6D. —47-year-old man with suspected recurrent colon cancer. CT image (D) and PET image (E) show focus (arrow), but diagnosis is difficult.

View larger version (82K): [in a new window]   Fig. 6E. —47-year-old man with suspected recurrent colon cancer. CT image (D) and PET image (E) show focus (arrow), but diagnosis is difficult.

View larger version (70K): [in a new window]   Fig. 6F. —47-year-old man with suspected recurrent colon cancer. Fused image of CT (D) and PET (E) clearly shows dissemination (arrow). These lesions were confirmed by surgery.

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