Date Published: April 19, 2019
Publisher: Public Library of Science
Author(s): Jakob M. Slipsager, Andreas H. Ellegaard, Stefan L. Glimberg, Rasmus R. Paulsen, M. Dylan Tisdall, Paul Wighton, André van der Kouwe, Lisbeth Marner, Otto M. Henriksen, Ian Law, Oline V. Olesen, Qinghui Zhang.
We demonstrate and evaluate the first markerless motion tracker compatible with PET, MRI, and simultaneous PET/MRI systems for motion correction (MC) of brain imaging.
PET and MRI compatibility is achieved by careful positioning of in-bore vision extenders and by placing all electronic components out-of-bore. The motion tracker is demonstrated in a clinical setup during a pediatric PET/MRI study including 94 pediatric patient scans. PET MC is presented for two of these scans using a customized version of the Multiple Acquisition Frame method. Prospective MC of MRI acquisition of two healthy subjects is demonstrated using a motion-aware MRI sequence. Real-time motion estimates are accompanied with a tracking validity parameter to improve tracking reliability.
For both modalities, MC shows that motion induced artifacts are noticeably reduced and that motion estimates are sufficiently accurate to capture motion ranging from small respiratory motion to large intentional motion. In the PET/MRI study, a time-activity curve analysis shows image improvements for a patient performing head movements corresponding to a tumor motion of ±5-10 mm with a 19% maximal difference in standardized uptake value before and after MC.
The first markerless motion tracker is successfully demonstrated for prospective MC in MRI and MC in PET with good tracking validity.
As simultaneous PET/MRI systems have become available for clinical use, an increasing demand for accurate motion tracking and MC in PET/MRI scans has emerged. The presented markerless motion tracker facilitate this demand.
Magnetic resonance imaging (MRI) and positron emission tomography (PET) are of great importance in the diagnosis and treatment of many neurological diseases. These modalities offer unique tissue contrasts at the expense of long image acquisition duration, making patient head motion a critical problem. The degradation of image quality resulting from patient motion can potentially lead to reduced detection of clinically relevant features, negatively influencing diagnosis and treatment. It is estimated that patient motion increases the cost of MRI examinatios by $115,000 per scanner per year . The problem is particularly acute in pediatric scans, where sedation and anesthesia are often used, which can lead to adverse reactions [2, 3]. To minimize the negative outcome of such head motion, various methods for motion correction (MC) has been proposed for MRI and PET reconstruction.
We have demonstrated the first markerless motion tracker compatible with simultaneous PET and MRI. The system has been robust for tracking motion in real patients while acquiring both MRI and PET. Only few cases, where the patients moved rapidly, lead to situations where correct tracking poses could not be estimated. These tracking poses were properly detected by the TVP algorithm. A visual inspection of the point clouds and the rejected transformations for patient(a), confirms that some of these tracking estimates would not represent a correct transformation. In addition, none of the accepted tracking estimates are notably misaligned. In just one of the 94 pediatric scans, a sub-optimal reference point cloud was created leading to additional tracking rejections. A subsequent re-alignment with an updated point cloud improved the TVP, such that 4% of the tracking estimates were rejected instead of 15%. For all other patient scans, only five cases contained rejected tracking estimates, with rejection periods of less than one second each. In total, an acceptance rate of more than 99.9% of all the motion tracking estimates is achieved, indicating the tracking robustness of the motion tracker. The clinical feasibility of the motion tracker is evidenced by the robustness of tracking when the system is operated by radiographers in the normal clinical settings.
We have presented the TCL2 motion tracker, performing real-time markerless motion tracking and monitoring compatible with both PET and MRI scanners. Design optimization makes the motion tracker feasible for the MRI environment while not compromising PET sensitivity. It is the first time that a motion tracking system has been successfully demonstrated in simultaneous PET/MRI for brain imaging including prospective MC of MRI. For both modalities, a reduction in motion-induced artifacts has been achieved after MC. The system demonstrates robust motion tracking using a TVP to avoid invalid tracking from being used in critical situation such as prospective MC. During the clinical study of 94 pediatric patients, 88 scans had no rejected tracking estimates, while five scans had only minor dropouts. The tracking capabilities of motions ranging from small respiratory motions to the largest possible motion within the MRI head coil have been demonstrated.