Advanced kinetic modelling strategies: Towards adoption in clinical PET imaging

Positron emission tomography (PET) is a highly quantitative imaging modality that can probe a number of functional and biological processes, depending on the radio-labelled tracer used. Static imaging, followed by analysis using semi-quantitative indices, such as the standardised uptake value, is used in the majority of clinical assessments in which PET has a role. However, considerably more information can be extracted from dynamic image acquisition protocols, followed by application of appropriate image reconstruction and tracer kinetic modelling techniques, but the latter approaches have mainly been restricted to drug development and clinical research applications due to their complexity in terms of both protocol design and parameter estimation methodology. To make dynamic imaging more feasible and valuable in routine clinical imaging, novel research outcomes are needed. Research areas include non-invasive input function extraction, protocol design for whole-body imaging application, and kinetic parameter estimation methods using spatiotemporal (4D) image reconstruction algorithms. Furthermore, with the advent of sequential and simultaneous PET/magnetic resonance (MR) data acquisition, strategies for obtaining synergistic benefits in kinetic modelling are emerging and potentially enhancing the role and clinical importance of PET/MR imaging. In this article, we review and discuss various advances in kinetic modelling both from a protocol design and a methodological development perspective. Moreover, we discuss future trends and potential outcomes, which could facilitate more routine use of tracer kinetic modelling techniques in clinical practice.