Coronary CT imaging was conducted using a 128-multislice scanner (Optima CT660; GE Healthcare Japan Corp., Tokyo, Japan) or dual source CT system (SOMATOM Definition Flash; Siemens Healthcare, Forchheim, Germany) with administration of 90 to 100 mL of iodinated contrast medium (Ultravist® 370; Bayer Healthcare, Berlin, Germany). Images were reconstructed at a 3-mm slice thickness. CACS was calculated as described by Agatston et al.14 (link) using the AW server 4.6 (GE Healthcare). In brief, calcium deposits with an attenuation of more than 130 Hounsfield units (HU) are multiplied by a density weighting factor derived from the maximal CT attenuation within a given calcified lesion. The score for all lesions in all coronary arteries is then summed.
Aw server 4
Manufactured by GE Healthcare
Sourced in United States
The AW Server 4.7 is a medical imaging software platform developed by GE Healthcare. It is designed to manage and process medical images from various imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The AW Server 4.7 provides a centralized solution for image storage, retrieval, and analysis, enabling healthcare professionals to access and review patient imaging data efficiently.
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6 protocols using aw server 4
1
Coronary Calcium Scoring Protocol
2
Standardized Contrast-Enhanced CT Imaging
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All the patients underwent contrast-enhanced CT scans using the standardized protocol of our institution. CT acquisition was performed on two 16-rows and a 64-rows scanner (LightSpeed and Optima, Ge Healthcare, Chicago, IL, USA) after contrast media injection (80–120 mL, Iopamiro 370, Bracco) during the venous phase. The acquisition parameters were the following: tube voltage 120 kV, slice thickness 1.25 mm, FOV 35–50 cm, matrix 512 × 512. Tube current automatic modulation was employed. DICOM images were transferred on a dedicated workstation (AW Server 4.6, GE Healthcare, Chicago, IL, USA) and reformatted on the axial plane at 3.0 mm of slice thickness.
3
Multitracer PET/CT Imaging Protocol
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All PET/CT scans included in the study were performed according to our institute’s clinical scanning protocols. Acquisitions were performed on a Discovery 710 PET/CT scanner (GE, General Electrics, Milwaukee, WI, USA). The field of view and pixel size of the PET images reconstructed for fusion were 70 cm and 2.73 mm, respectively, with a matrix size of 256 × 256. The technical parameters used for CT imaging were: pitch 0.98, gantry rotation speed of 0.5 s/rot, 120 kVp, and modulated tube current of 140 mA. After 6 h of fasting, patients received an intravenous injection of 3 MBq/kg [18F]FDG or [18F]FCH and 370 MBq [18F]Fluciclovine. About 60 min after [18F]FDG/FCH administration or 4 min after [18F] Fluciclovine injection, CT images were obtained from the skull base to the midthigh. A 3D acquisition mode PET scan for the same longitudinal coverage, 2.5 min per bed position was performed. CT images were used for attenuation correction, anatomical information and images interpretation. Image analysis was carried out using a dedicate console (AW Server 4.7, General Electrics, Milwaukee, WI, USA).
4
PET/CT Evaluation of 18F-FCH Uptake
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Image analysis was performed using a dedicated workstation (AW Server 4.7, General Electrics, Milwaukee, WI, USA). 18F-FCH PET/CT scans were independently evaluated by two nuclear medicine physicians with at least 5 years of experience in image reading and who were aware of clinical data. In the event of disagreement, a third nuclear medicine physician’s opinion was reached.
Maximum intensity projection, PET, CT, and PET/CT fused images in different planes (axial, sagittal, and coronal) were visualized simultaneously to correctly interpret the scans. Examinations were considered positive in the presence of focal areas of detectable increased tracer uptake, visually more intense than the background, not correlating with physiological tracer uptake and inflammatory articular processes, with or without any underlying lesion identified on the co-registered CT (5 (link)).The semiquantitative parameter maximum standardized uptake value (SUVmax) was collected in all visualized lesions.
Maximum intensity projection, PET, CT, and PET/CT fused images in different planes (axial, sagittal, and coronal) were visualized simultaneously to correctly interpret the scans. Examinations were considered positive in the presence of focal areas of detectable increased tracer uptake, visually more intense than the background, not correlating with physiological tracer uptake and inflammatory articular processes, with or without any underlying lesion identified on the co-registered CT (5 (link)).The semiquantitative parameter maximum standardized uptake value (SUVmax) was collected in all visualized lesions.
5
PET/CT Imaging Protocol for 18F-FDG Oncology Studies
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PET/CT imaging was performed on a Discovery IQ (GE, Healthcare Technologies, Milwaukee, WI, USA). The field of view and pixel size of the PET images reconstructed for fusion was 70 cm and 2.73 mm, respectively, with a matrix size of 256 × 256. The technical parameters used for CT imaging were: pitch 0.98, gantry rotation speed of 0.5 s/rot, 120 kVp, and modulated tube current of 140 mA. After 6 h of fasting, patients received an intravenous injection of 2.5 MBq/kg 18F-FDG. About 60 min after 18F-FDG administration, CT images were obtained from the skull base to the midthigh. A 3D acquisition mode PET scan for the same longitudinal coverage, 2.5 min per bed position, was performed. CT images were used for attenuation correction, anatomical information, and image interpretation. Image analysis was carried out using a dedicated console (AW Server 4.7, General Electrics, Milwaukee, WI, USA).
Baseline-PET and EoT-PET of each patient were performed with the same PET/CT scanner.
Baseline-PET and EoT-PET of each patient were performed with the same PET/CT scanner.
6
PET/CT Interpretation for Cancer Imaging
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Image analysis was carried out using a dedicated console (AW Server 4.7, General Electrics, Milwaukee, WI, USA). PET/CT scans were independently evaluated by two nuclear medicine physicians with at least 3 years of experience in [18F]fluciclovine and [18F]fluorocholine PET/CT reading and aware of clinical data. In the event of disagreement, a final consensus was reached.
Maximum intensity projection (MIP), PET, CT, and PET/CT fused images in different planes (axial, sagittal, and coronal) were visualized simultaneously to correctly interpret scans. Examinations were considered positive in the presence of focal areas of detectable increased tracer uptake, visually more intense than the background, not correlating with physiological tracer uptake and inflammatory articular processes, with or without any underlying lesion identified on the co-registered CT [15 (link),16 (link)]. The semiquantitative evaluation by the maximum standardized uptake value (SUV) and, for [18F]fluciclovine PET/CT image, also by the SUV ratio (SUVmax in the lesion/SUVmean in the surrounding background) was used to aid visual analysis. In particular, bone marrow uptake of vertebra L3 was used as a reference for lesions larger than a 1 cm longest dimension, and abdominal aortic blood pool for lesions smaller than a 1 cm longest dimension [14 (link)].
Maximum intensity projection (MIP), PET, CT, and PET/CT fused images in different planes (axial, sagittal, and coronal) were visualized simultaneously to correctly interpret scans. Examinations were considered positive in the presence of focal areas of detectable increased tracer uptake, visually more intense than the background, not correlating with physiological tracer uptake and inflammatory articular processes, with or without any underlying lesion identified on the co-registered CT [15 (link),16 (link)]. The semiquantitative evaluation by the maximum standardized uptake value (SUV) and, for [18F]fluciclovine PET/CT image, also by the SUV ratio (SUVmax in the lesion/SUVmean in the surrounding background) was used to aid visual analysis. In particular, bone marrow uptake of vertebra L3 was used as a reference for lesions larger than a 1 cm longest dimension, and abdominal aortic blood pool for lesions smaller than a 1 cm longest dimension [14 (link)].
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