Quantification of Cerebral Blood Flow and Oxygen Metabolism with 3-Dimensional PET and 15O: Validation by Comparison with 2-Dimensional PET

Quantitative PET with 15O provides absolute values for cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic rate of oxygen (CMRO2), and oxygen extraction fraction (OEF), which are used for assessment of brain pathophysiology. Absolute quantification relies on physically accurate measurement, which, thus far, has been achieved by 2-dimensional PET (2D PET), the current gold standard for measurement of CBF and oxygen metabolism. We investigated whether quantitative 15O study with 3-dimensional PET (3D PET) shows the same degree of accuracy as 2D PET. Methods: 2D PET and 3D PET measurements were obtained on the same day on 8 healthy men (age, 21–24 y). 2D PET was performed using a PET scanner with bismuth germanate (BGO) detectors and a 150-mm axial field of view (FOV). For 3D PET, a 3D-only tomograph with gadolinium oxyorthosilicate (GSO) detectors and a 156-mm axial FOV was used. A hybrid scatter-correction method based on acquisition in the dual-energy window (hybrid dual-energy window [HDE] method) was applied in the 3D PET study. Each PET study included 3 sequential PET scans for C15O, 15O2, and \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(\mathrm{H}_{2}^{15}\mathrm{O}\) \end{document} (3-step method). The inhaled (or injected) dose for 3D PET was approximately one fourth of that for 2D PET. Results: In the 2D PET study, average gray matter values (mean ± SD) of CBF, CBV, CMRO2, and OEF were 53 ± 12 (mL/100 mL/min), 3.6 ± 0.3 (mL/100 mL), 3.5 ± 0.5 (mL/100 mL/min), and 0.35 ± 0.06, respectively. In the 3D PET study, scatter correction strongly affected the results. Without scatter correction, average values were 44 ± 6 (mL/100 mL/min), 5.2 ± 0.6 (mL/100 mL), 3.3 ± 0.4 (mL/100 mL/min), and 0.39 ± 0.05, respectively. With the exception of OEF, values differed between 2D PET and 3D PET. However, average gray matter values of scatter-corrected 3D PET were comparable to those of 2D PET: 55 ± 11 (mL/100 mL/min), 3.7 ± 0.5 (mL/100 mL), 3.8 ± 0.7 (mL/100 mL/min), and 0.36 ± 0.06, respectively. Even though the 2 PET scanners with different crystal materials, data acquisition systems, spatial resolution, and attenuation-correction methods were used, the agreement of the results between 2D PET and scatter-corrected 3D PET was excellent. Conclusion: Scatter coincidence is a problem in 3D PET for quantitative 15O study. The combination of both the present PET/CT device and the HDE scatter correction permits quantitative 3D PET with the same degree of accuracy as 2D PET and with a lower radiation dose. The present scanner is also applicable to conventional steady-state 15O gas inhalation if inhaled doses are adjusted appropriately.