arXiv subjects

Ramsey D. Badawi

Publications and source records attributed to Ramsey D. Badawi.

11 recordsLinked to original sources

arXiv2025

Incorporating Tissue Composition Information in Total-Body PET Metabolic Quantification of Bone Marrow through Dual-Energy CT

Bone marrow (BM) metabolic quantification with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is of broad clinical significance for accurate assessment of BM at staging and follow-up, especially when immunotherapy is involved. However, current methods of quantifying BM may be inaccurate because the volume defined to measure bone marrow may also consist of a fraction of trabecular bone in which 18F-FDG activity is negligible, resulting in a potential underestimation of true BM uptake. In this study, we demonstrate this bone-led tissue composition effect and propose a bone fraction correction (BFC) method using X-ray dual-energy computed tomography (DECT) material decomposition. This study included ten scans from five cancer patients who underwent baseline and follow-up dynamic 18F-FDG PET and DECT scans using the uEXPLORER total-body PET/CT system. The voxel-wise bone volume fraction was estimated from DECT and then incorporated into the PET measurement formulas for BFC. The standardized uptake value (SUV), 18F-FDG delivery rate K1, and net influx rate Ki values in BM regions were estimated with and without BFC and compared using the statistical analysis. The results first demonstrated the feasibility of performing voxel-wise material decomposition using DECT for metabolic BM imaging. With BFC, the SUV, K1, and Ki values significantly increased by an average of 13.28% in BM regions compared to those without BFC (all P<0.0001), indicating the impact of BFC for BM quantification. Parametric imaging with BFC further confirmed regional analysis. Our study using DECT suggests current SUV and kinetic quantification of BM are likely underestimated in PET due to the presence of a significant bone volume fraction. Incorporating tissue composition information through BFC may improve BM metabolic quantification.

physics.med-ph↗

arXiv2025

On hallucinations in AI-generated content for nuclear medicine imaging (the DREAM report)

Artificial intelligence-generated content (AIGC) has shown remarkable performance in nuclear medicine imaging (NMI), offering cost-effective software solutions for tasks such as image enhancement, motion correction, and attenuation correction. However, these advancements come with the risk of hallucinations, generating realistic yet factually incorrect content. Hallucinations can misrepresent anatomical and functional information, compromising diagnostic accuracy and clinical trust. This paper presents a comprehensive perspective of hallucination-related challenges in AIGC for NMI, introducing the DREAM report, which covers recommendations for definition, representative examples, detection and evaluation metrics, underlying causes, and mitigation strategies. This position statement paper aims to initiate a common understanding for discussions and future research toward enhancing AIGC applications in NMI, thereby supporting their safe and effective deployment in clinical practice.

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arXiv2025

Anatomically and Metabolically Informed Diffusion for Unified Denoising and Segmentation in Low-Count PET Imaging

Positron emission tomography (PET) image denoising, along with lesion and organ segmentation, are critical steps in PET-aided diagnosis. However, existing methods typically treat these tasks independently, overlooking inherent synergies between them as correlated steps in the analysis pipeline. In this work, we present the anatomically and metabolically informed diffusion (AMDiff) model, a unified framework for denoising and lesion/organ segmentation in low-count PET imaging. By integrating multi-task functionality and exploiting the mutual benefits of these tasks, AMDiff enables direct quantification of clinical metrics, such as total lesion glycolysis (TLG), from low-count inputs. The AMDiff model incorporates a semantic-informed denoiser based on diffusion strategy and a denoising-informed segmenter utilizing nnMamba architecture. The segmenter constrains denoised outputs via a lesion-organ-specific regularizer, while the denoiser enhances the segmenter by providing enriched image information through a denoising revision module. These components are connected via a warming-up mechanism to optimize multi-task interactions. Experiments on multi-vendor, multi-center, and multi-noise-level datasets demonstrate the superior performance of AMDiff.

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arXiv2025

Dose-aware Diffusion Model for 3D PET Image Denoising: Multi-institutional Validation with Reader Study and Real Low-dose Data

Reducing scan times, radiation dose, and enhancing image quality for lower-performance scanners, are critical in low-dose PET imaging. Deep learning techniques have been investigated for PET image denoising. However, existing models have often resulted in compromised image quality when achieving low-count/low-dose PET and have limited generalizability to different image noise-levels, acquisition protocols, and patient populations. Recently, diffusion models have emerged as the new state-of-the-art generative model to generate high-quality samples and have demonstrated strong potential for medical imaging tasks. However, for low-dose PET imaging, existing diffusion models failed to generate consistent 3D reconstructions, unable to generalize across varying noise-levels, often produced visually-appealing but distorted image details, and produced images with biased tracer uptake. Here, we develop DDPET-3D, a dose-aware diffusion model for 3D low-dose PET imaging to address these challenges. Collected from 4 medical centers globally with different scanners and clinical protocols, we evaluated the proposed model using a total of 9,783 18F-FDG studies with low-dose levels ranging from 1% to 50%. With a cross-center, cross-scanner validation, the proposed DDPET-3D demonstrated its potential to generalize to different low-dose levels, different scanners, and different clinical protocols. As confirmed with reader studies performed by board-certified nuclear medicine physicians, experienced readers judged the images to be similar or superior to the full-dose images and previous DL baselines based on qualitative visual impression. Lesion-level quantitative accuracy was evaluated using a Monte Carlo simulation study and a lesion segmentation network. The presented results show the potential to achieve low-dose PET while maintaining image quality. Real low-dose scans was also included for evaluation.

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arXiv2025

LeqMod: Adaptable Lesion-Quantification-Consistent Modulation for Deep Learning Low-Count PET Image Denoising

Deep learning-based positron emission tomography (PET) image denoising offers the potential to reduce radiation exposure and scanning time by transforming low-count images into high-count equivalents. However, existing methods typically blur crucial details, leading to inaccurate lesion quantification. This paper proposes a lesion-perceived and quantification-consistent modulation (LeqMod) strategy for enhanced PET image denoising, via employing downstream lesion quantification analysis as auxiliary tools. The LeqMod is a plug-and-play design adaptable to a wide range of model architectures, modulating the sampling and optimization procedures of model training without adding any computational burden to the inference phase. Specifically, the LeqMod consists of two components, the lesion-perceived modulation (LeMod) and the multiscale quantification-consistent modulation (QuMod). The LeMod enhances lesion contrast and visibility by allocating higher sampling weights and stricter loss criteria to lesion-present samples determined by an auxiliary segmentation network than lesion-absent ones. The QuMod further emphasizes quantification accuracy for both the mean and maximum standardized uptake value (SUVmean and SUVmax) across multiscale sub-regions throughout the entire image, thereby reducing biases of denoised results relative to high-count references. Experiments conducted on large PET datasets from multiple centers and vendors, and varying noise levels demonstrated the LeqMod efficacy across various denoising frameworks. Compared to frameworks without LeqMod, the integration of LeqMod reduces the lesion SUVmax bias by 5.92% on average and increases the peak signal-to-noise ratio (PSNR) by 0.36 on average, when denoising images across participating sites.

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arXiv2024

Feasibility of PET-enabled dual-energy CT imaging: First physical phantom and initial patient results

X-ray computed tomography (CT) in PET/CT is commonly operated with a single energy, resulting in a limitation of lacking tissue composition information. Dual-energy (DE) spectral CT enables material decomposition by using two different x-ray energies and may be combined with PET for improved multimodality imaging, but would either require hardware upgrade or increase radiation dose due to the added second x-ray CT scan. Recently proposed PET-enabled DECT method allows dual-energy spectral imaging using a conventional PET/CT scanner without the need for a second x-ray CT scan. A gamma-ray CT (gCT) image at 511 keV can be generated from the existing time-of-flight PET data with the maximum-likelihood attenuation and activity (MLAA) approach and is then combined with the low-energy x-ray CT image to form dual-energy spectral imaging. To improve the image quality of gCT, a kernel MLAA method was further proposed by incorporating x-ray CT as a priori information. The concept of this PET-enabled DECT has been validated using simulation studies, but not yet with 3D real data. In this work, we developed a general open-source implementation for gCT reconstruction from PET data and use this implementation for the first real data validation with both a physical phantom study and a human subject study on a uEXPLORER total-body PET/CT system. These results have demonstrated the feasibility of this method for spectral imaging and material decomposition.

physics.med-ph↗

arXiv2024

Total-Body Parametric Imaging Using Relative Patlak Plot

Standard Patlak plot is widely used to describe FDG kinetics for dynamic PET imaging. Whole-body Patlak parametric imaging remains constrained due to the need for a full-time input function. Here, we demonstrate the Relative Patlak (RP) plot, which eliminates the need for the early-time input function, for total-body parametric imaging and its application to clinical 20-min scan acquired in list-mode. We demonstrated that the RP intercept b' is equivalent to a ratio of standardized uptake value relative to the blood, while the RP slope Ki' is equal to the standard Patlak Ki multiplied by a global scaling factor for each subject. One challenge in applying RP to a short scan duration (20 min) is the high noise in parametric images. We applied a deep kernel method for noise reduction. Using the standard Patlak plot as the reference, the RP method was evaluated for lesion quantification, lesion-to-background contrast, and myocardial visualization in total-body parametric imaging with uEXPLORER in 22 human subjects who underwent a 1-h dynamic 18F-FDG scan. The RP method was also applied to the dynamic data regenerated from a clinical standard 20-min scan either at 1-h or 2-h post-injection for two cancer patients. We demonstrated that it is feasible to obtain high-quality parametric images from 20-min dynamic scans using the RP plot with a self-supervised deep-kernel noise reduction strategy. The RP Ki' highly correlated with Ki in lesions and major organs, demonstrating its quantitative potential across subjects. Compared to conventional SUVs, the Ki' images significantly improved lesion contrast and enabled visualization of the myocardium for potential cardiac assessment. The application of RP parametric imaging to two clinical scans also showed similar benefits. Total-body PET with the RP plot is feasible to generate parametric images from the dynamic data of a 20-min clinical scan.

physics.med-ph↗

arXiv2022

Supplemental Transmission Aided Attenuation Correction for Quantitative Cardiac PET/MR

Quantitative PET attenuation correction (AC) for combined cardiac PET/MR is a challenging problem. We propose and evaluate an AC approach that uses coincidences from a relatively weak and physically fixed sparse external source, in combination with that from the patient, to correct for PET attenuation based on physics principles alone. The low 30 ml volume of the source makes it easy to fill and place, and the method does not use prior image data or attenuation map assumptions. Our supplemental transmission aided maximum likelihood reconstruction of attenuation and activity (sTX-MLAA) algorithm contains an attenuation map update that maximizes the likelihood of terms representing coincidences originating from tracer in the patient and a weighted expression of counts segmented from the external source alone. Both external source and patient scatter and randoms are fully corrected. We evaluated performance of sTX-MLAA compared to reference standard CT-based AC with FDG PET/CT phantom studies; including modeling a patient with myocardial inflammation. Through an ROI analysis we measured less than 5% bias in activity concentrations for PET images generated with sTX-MLAA relative to CT-AC. PET background variability (from noise and sparse sampling) was substantially reduced with sTX-MLAA compared to using coincidences segmented from the transmission source alone for AC. The study suggests that sTX-MLAA will produce PET images on PET/MR with quantification comparable to PET/CT results during human cardiac exams.

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arXiv2022

Neural KEM: A Kernel Method with Deep Coefficient Prior for PET Image Reconstruction

Image reconstruction of low-count positron emission tomography (PET) data is challenging. Kernel methods address the challenge by incorporating image prior information in the forward model of iterative PET image reconstruction. The kernelized expectation-maximization (KEM) algorithm has been developed and demonstrated to be effective and easy to implement. A common approach for a further improvement of the kernel method would be adding an explicit regularization, which however leads to a complex optimization problem. In this paper, we propose an implicit regularization for the kernel method by using a deep coefficient prior, which represents the kernel coefficient image in the PET forward model using a convolutional neural-network. To solve the maximum-likelihood neural network-based reconstruction problem, we apply the principle of optimization transfer to derive a neural KEM algorithm. Each iteration of the algorithm consists of two separate steps: a KEM step for image update from the projection data and a deep-learning step in the image domain for updating the kernel coefficient image using the neural network. This optimization algorithm is guaranteed to monotonically increase the data likelihood. The results from computer simulations and real patient data have demonstrated that the neural KEM can outperform existing KEM and deep image prior methods.

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arXiv2021

Multiparametric Cardiac 18F-FDG PET: Pilot Comparison of FDG Delivery Rate with 82Rb Myocardial Blood Flow

Myocardial blood flow (MBF) and flow reserve are usually quantified in the clinic with positron emission tomography (PET) using a perfusion-specific radiotracer (e.g. 82Rbchloride). However, the clinical accessibility of existing perfusion tracers remains limited. Meanwhile, 18F-fluorodeoxyglucose (FDG) is a commonly used radiotracer for PET metabolic imaging without similar limitations. In this paper, we explore the potential of 18F-FDG for myocardial perfusion imaging by comparing the myocardial FDG delivery rate K1 with MBF as determined by dynamic 82Rb PET in fourteen human subjects with heart disease. Two sets of FDG K1 were derived from one-hour dynamic FDG scans. One was the original FDG K1 estimates and the other was the corresponding K1 values that were linearly normalized for blood glucose levels. A generalized Renkin-Crone model was used to fit FDG K1 with Rb MBF, which then allowed for a nonlinear extraction fraction correction for converting FDG K1 to MBF. The linear correlation between FDG-derived MBF and Rb MBF was moderate (r=0.79) before the glucose normalization and became much improved (r>0.9) after glucose normalization. The extraction fraction of FDG was also similar to that of Rb-chloride in the myocardium. The results from this pilot study suggest that dynamic cardiac FDG-PET with tracer kinetic modeling has the potential to provide MBF in addition to its conventional use for metabolic imaging.

physics.med-ph↗

arXiv2020

Multiparametric Cardiac 18F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis

Cardiac 18F-FDG PET has been used in clinics to assess myocardial glucose metabolism. Its ability for imaging myocardial glucose transport, however, has rarely been exploited in clinics. Using the dynamic FDG-PET scans of ten patients with coronary artery disease, we investigate in this paper appropriate dynamic scan and kinetic modeling protocols for efficient quantification of myocardial glucose transport. Three kinetic models and the effect of scan duration were evaluated by using statistical fit quality, assessing the impact on kinetic quantification, and analyzing the practical identifiability. The results show that the kinetic model selection depends on the scan duration. The reversible two-tissue model was needed for a one-hour dynamic scan. The irreversible two-tissue model was optimal for a scan duration of around 10-15 minutes. If the scan duration was shortened to 2-3 minutes, a one-tissue model was the most appropriate. For global quantification of myocardial glucose transport, we demonstrated that an early dynamic scan with a duration of 10-15 minutes and irreversible kinetic modeling was comparable to the full one-hour scan with reversible kinetic modeling. Myocardial glucose transport quantification provides an additional physiological parameter on top of the existing assessment of glucose metabolism and has the potential to enable single tracer multiparametric imaging in the myocardium.

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