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Research ArticleAdult Brain
Open Access

Generative Adversarial Network–Enhanced Ultra-Low-Dose [18F]-PI-2620 τ PET/MRI in Aging and Neurodegenerative Populations

K.T. Chen, R. Tesfay, M.E.I. Koran, J. Ouyang, S. Shams, C.B. Young, G. Davidzon, T. Liang, M. Khalighi, E. Mormino and G. Zaharchuk
American Journal of Neuroradiology September 2023, 44 (9) 1012-1019; DOI: https://doi.org/10.3174/ajnr.A7961
K.T. Chen
aFrom the Department of Biomedical Engineering (K.T.C.), National Taiwan University, Taipei, Taiwan
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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R. Tesfay
cMeharry Medical College (R.T.), Nashville, Tennessee
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M.E.I. Koran
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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J. Ouyang
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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S. Shams
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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C.B. Young
dDepartment of Neurology and Neurological Sciences (C.B.Y., E.M.), Stanford University, Stanford, California
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G. Davidzon
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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T. Liang
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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M. Khalighi
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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E. Mormino
dDepartment of Neurology and Neurological Sciences (C.B.Y., E.M.), Stanford University, Stanford, California
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G. Zaharchuk
bDepartment of Radiology (K.T.C., M.E.I.K., J.O., S.S., G.D., T.L., M.K., G.Z.), Stanford University, Stanford, California
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  • FIG 1.
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    FIG 1.

    A schematic of the GAN (generator network, upper image; discriminator network, lower image) used in this work and its input and output channels. The arrows denote computational operations, and the tensors are denoted by boxes, with the number of channels indicated above each box. BN indicates batch normalization; Conv, convolution; Max, maximum; ReLU, rectified linear unit; tanh, hyperbolic tangent.

  • FIG 2.
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    FIG 2.

    Representative τ PET images and their corresponding T1-weighted MR image in 2 individuals positive for amyloid. The enhanced PET image shows greatly reduced noise compared with the ultra-low-dose PET image. Arrows correspond to regions of abnormal elevated τ uptake. MCI indicates mild cognitive impairment.

  • FIG 3.
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    FIG 3.

    Image-quality metrics comparing the ultra-low-dose PET (LD) and the ultra-low-dose enhanced PET (E) images with the ground truth full-dose PET image. PSNR indicates peak signal-to-noise ratio; SSIM, structural similarity; RMSE, root mean square error.

  • FIG 4.
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    FIG 4.

    Mean (SD) of SUVR coefficient of variation in selected brain regions. E indicates enhanced images; FD, full-dose images; Inf. Cerebel, inferior cerebellum; MTL, medial temporal lobe; LD, ultra-low-dose image; Inf. Temporal, inferior temporal cortex

  • FIG 5.
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    FIG 5.

    Bland-Altman plots comparing mean SUVRs in the ultra-low-dose PET and the enhanced PET with the full-dose PET images. The red dots denote healthy controls positive for amyloid, and the regions selected are the FreeSurfer labels, which make up the bilateral medial temporal lobe (entorhinal, amygdala) and the bilateral inferior temporal cortex.

  • FIG 6.
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    FIG 6.

    Quality scores of different image types as rated by 3 expert readers. Image quality scores: 1, uninterpretable; 2, bad; 3, adequate; 4, good; 5, excellent. FD indicates full-dose; LD, ultra-low-dose; E, enhanced.

Tables

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    Table 1:

    Demographics and clinical indications of study population

    Healthy ControlADCBSMCIPSPsvPPA
    No.3151412
    Age (mean) (yr)70.13 (SD, 6.43)67.8 (SD, 13.48)7671.5 (SD, 10.54)7166, 78
    Sex (female)1230201
    Amyloid status7 P, 21 N4 P3 P, 1 N
    • Note:—CBS indicates cortical basal syndrome; MCI, mild cognitive impairment; N, negative; P, positive; PSP, progressive supranuclear palsy; svPPA, semantic variant primary-progressive aphasia.

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    Table 2:

    Gwet's AC1 between and within readers of 10 randomly selected full-dose images on the tracer uptake in relevant brain regions and on the subjective image quality

    Gwet's AC1InterreaderReproducibility (Reader 1)Reproducibility (Reader 2)Reproducibility (Reader 3)
    Normal0.6770.7270.6281
    Entorhinal cortex0.813110.883
    Hipp./Amyg./Parahipp.0.6770.77111
    Inferior/mesial temporal0.901111
    Other cortex0.8300.8720.6691
    Primary eloquent cortex0.967111
    Quality (high vs low)0.79710.5990.760
    • Note:—Normal indicates no abnormal uptake in any of the selected regions; Hipp., hippocampus; Amyg., amygdala; Parahipp., parahippocampal gyrus.

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    Table 3:

    Accuracy, sensitivity, and specificity of ultra-low-dose images and enhanced images compared with the full-dose images

    MetricFull-Dose vs Ultra-Low-DoseFull-Dose vs Enhanced
    Accuracy (%)Sensitivity (%)Specificity (%)Accuracy (%)Sensitivity (%)Specificity (%)
    Normal86.489.777.184.887.677.1
    Entorhinal cortex92.450.097.593.942.998.3
    Hipp./Amyg./Parahipp.87.954.295.488.666.793.5
    Inferior/mesial temporal95.583.397.493.277.895.6
    Other cortex87.973.990.888.687.089.0
    Primary eloquent cortex95.580.096.199.280.0100
    • Note:— Normal indicates no abnormal uptake in any of the selected regions; Hipp., hippocampus; Amyg., amygdala; Parahipp., parahippocampal gyrus.

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American Journal of Neuroradiology: 44 (9)
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K.T. Chen, R. Tesfay, M.E.I. Koran, J. Ouyang, S. Shams, C.B. Young, G. Davidzon, T. Liang, M. Khalighi, E. Mormino, G. Zaharchuk
Generative Adversarial Network–Enhanced Ultra-Low-Dose [18F]-PI-2620 τ PET/MRI in Aging and Neurodegenerative Populations
American Journal of Neuroradiology Sep 2023, 44 (9) 1012-1019; DOI: 10.3174/ajnr.A7961

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Ultra-Low-Dose [18F]-PI-2620 PET/MRI in Aging
K.T. Chen, R. Tesfay, M.E.I. Koran, J. Ouyang, S. Shams, C.B. Young, G. Davidzon, T. Liang, M. Khalighi, E. Mormino, G. Zaharchuk
American Journal of Neuroradiology Sep 2023, 44 (9) 1012-1019; DOI: 10.3174/ajnr.A7961
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