This video represents a complete and balanced review of the subject with a broad scope and coverage of quantitative analysis of multimodality molecular medical images, which is growing in importance both for clinical and research applications. It begins with an introduction to the fundamental concepts of quantitative image analysis techniques as they are applied in diagnostic and therapeutic molecular imaging using dual-modality combining PET and CT (PET/CT) or PET and MR (PET/MR) systems. It covers the entire range of quantitative imaging chain from basic principles to various steps required for obtaining quantitatively accurate data from PET images, including data collection methods and algorithms used to correct them for physical degrading factors, image reconstruction algorithms, as well as image processing and analysis techniques used in clinical and research applications.
Impact of physical degrading factors including attenuation of photons and contribution from photons scattered in the patient, partial volume effect and motion on diagnostic quality and quantitative accuracy of medical images will be discussed. The limitations of static imaging and associated PET metrics (mostly relying on the standardized uptake value (SUV) metric) and their applications in oncological imaging will be highlighted.The concept of dynamic PET imaging, which allows for acquisition of valuable spatio-temporal tracer uptake measurements that can be utilized by tracer kinetic modelling methods, thus enabling parametric PET imaging as a promising framework that can enhance quantification by accounting for the physiological time course of PET signal will also be discussed. Special emphasis will be put on recent developments in PET acquisition and imaging frameworks enabling clinically feasible whole-body dynamic PET imaging, thus combining the benefits of multi-bed acquisitions with the ability to obtain, at the voxel level, quantitative estimates of Patlak kinetic macro-parameters from dynamic scans.
Educational aims:

• Understand the basic limitations of quantitative PET imaging and metrics used in clinical routine, and the factors influencing them for subsequent use in assessment of response to treatment
• Understand the limitations of visual contouring and provide and up to date overview of current PET image segmentation algorithms and their subsequent use in assessment of response to treatment or radiation therapy treatment planning

Learning objectives:

• Provide a state-of-the-art review of current PET metrics used in clinical and research settings and their limitations
• Describe recent advances in MRI-guided attenuation correction in PET/MRI
• Provide an overview of the methodological aspects of more advanced quantitative techniques including radiomics and parametric whole-body imaging requiring the use of dynamic imaging protocols

Key points/conclusions:
Quantitative PET imaging will help in charting personalized treatment plans for patients and also in exploring new therapeutic opportunities in the future. The application of novel quantitative methods will enhance the performance of modern hybrid imaging modalities in a variety of clinical settings and will further improve the outcome of many serious diseases and disorders.

1 CPD credit

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