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Background: Cardiac positron emission tomography (PET) can visualize and quantify the molecular and physiological pathways of cardiac function. However, cardiac and respiratory motion can introduce blurring that reduces PET image quality and quantitative accuracy. Dual cardiac- and respiratory-gated PET reconstruction can mitigate motion artifacts but increases noise as only a subset of data are used for each time frame of the cardiac cycle., Aim: The objective of this study is to create a zero-shot image denoising framework using a conditional generative adversarial networks (cGANs) for improving image quality and quantitative accuracy in non-gated and dual-gated cardiac PET images., Methods: Our study included retrospective list-mode data from 40 patients who underwent an 18 F-fluorodeoxyglucose ( 18 F-FDG) cardiac PET study. We initially trained and evaluated a 3D cGAN-known as Pix2Pix-on simulated non-gated low-count PET data paired with corresponding full-count target data, and then deployed the model on an unseen test set acquired on the same PET/CT system including both non-gated and dual-gated PET data., Results: Quantitative analysis demonstrated that the 3D Pix2Pix network architecture achieved significantly (p value<0.05) enhanced image quality and accuracy in both non-gated and gated cardiac PET images. At 5%, 10%, and 15% preserved count statistics, the model increased peak signal-to-noise ratio (PSNR) by 33.7%, 21.2%, and 15.5%, structural similarity index (SSIM) by 7.1%, 3.3%, and 2.2%, and reduced mean absolute error (MAE) by 61.4%, 54.3%, and 49.7%, respectively. When tested on dual-gated PET data, the model consistently reduced noise, irrespective of cardiac/respiratory motion phases, while maintaining image resolution and accuracy. Significant improvements were observed across all gates, including a 34.7% increase in PSNR, a 7.8% improvement in SSIM, and a 60.3% reduction in MAE., Conclusion: The findings of this study indicate that dual-gated cardiac PET images, which often have post-reconstruction artifacts potentially affecting diagnostic performance, can be effectively improved using a generative pre-trained denoising network., (© 2024. The Author(s), under exclusive licence to The Author(s) under exclusive licence to The Japanese Society of Nuclear Medicine.)

Objective. This work proposes, for the first time, an image-based end-to-end self-normalization framework for positron emission tomography (PET) using conditional generative adversarial networks (cGANs). Approach. We evaluated different approaches by exploring each of the following three methodologies. First, we used images that were either unnormalized or corrected for geometric factors, which encompass all time-invariant factors, as input data types. Second, we set the input tensor shape as either a single axial slice (2D) or three contiguous axial slices (2.5D). Third, we chose either Pix2Pix or polarized self-attention (PSA) Pix2Pix, which we developed for this work, as a deep learning network. The targets for all approaches were the axial slices of images normalized using the direct normalization method. We performed Monte Carlo simulations of ten voxelized phantoms with the SimSET simulation tool and produced 26,000 pairs of axial image slices for training and testing. Main results. The results showed that 2.5D PSA Pix2Pix trained with geometric-factors-corrected input images achieved the best performance among all the methods we tested. All approaches improved general image quality figures of merit peak signal to noise ratio (PSNR) and structural similarity index (SSIM) from ∼15 % to ∼55 %, and 2.5D PSA Pix2Pix showed the highest PSNR (28.074) and SSIM (0.921). Lesion detectability, measured with region of interest (ROI) PSNR, SSIM, normalized contrast recovery coefficient, and contrast-to-noise ratio, was generally improved for all approaches, and 2.5D PSA Pix2Pix trained with geometric-factors-corrected input images achieved the highest ROI PSNR (28.920) and SSIM (0.973). Significance. This study demonstrates the potential of an image-based end-to-end self-normalization framework using cGANs for improving PET image quality and lesion detectability without the need for separate normalization scans., (© 2024 Institute of Physics and Engineering in Medicine.)

Joint effusion due to elbow fractures are common among adults and children. Radiography is the most commonly used imaging procedure to diagnose elbow injuries. The purpose of the study was to investigate the diagnostic accuracy of deep convolutional neural network algorithms in joint effusion classification in pediatric and adult elbow radiographs. This retrospective study consisted of a total of 4423 radiographs in a 3-year period from 2017 to 2020. Data was randomly separated into training (n = 2672), validation (n = 892) and test set (n = 859). Two models using VGG16 as the base architecture were trained with either only lateral projection or with four projections (AP, LAT and Obliques). Three radiologists evaluated joint effusion separately on the test set. Accuracy, precision, recall, specificity, F1 measure, Cohen's kappa, and two-sided 95% confidence intervals were calculated. Mean patient age was 34.4 years (1-98) and 47% were male patients. Trained deep learning framework showed an AUC of 0.951 (95% CI 0.946-0.955) and 0.906 (95% CI 0.89-0.91) for the lateral and four projection elbow joint images in the test set, respectively. Adult and pediatric patient groups separately showed an AUC of 0.966 and 0.924, respectively. Radiologists showed an average accuracy, sensitivity, specificity, precision, F1 score, and AUC of 92.8%, 91.7%, 93.6%, 91.07%, 91.4%, and 92.6%. There were no statistically significant differences between AUC's of the deep learning model and the radiologists (p value > 0.05). The model on the lateral dataset resulted in higher AUC compared to the model with four projection datasets. Using deep learning it is possible to achieve expert level diagnostic accuracy in elbow joint effusion classification in pediatric and adult radiographs. Deep learning used in this study can classify joint effusion in radiographs and can be used in image interpretation as an aid for radiologists., (© 2022. The Author(s).)