The effect of positioning aids on PET quantification following MR-based attenuation correction (AC) in PET/MR imaging

Objectives: We study the quantitative effect of not accounting for the attenuation of patient positioning aids in combined PET/MR imaging. Methods: Positioning aids cannot be detected with conventional MR sequences. We mimic this effect using PET/CT data (Biograph HiRez16) with the foams removed from CT images prior to using them for CT-AC. PET/CT data were acquired using standard parameters (phantoms/patients): 120/140 kVp, 30/250 mAs, 5 mm slices, OSEM (4i, 8s, 5 mm filter) following CT-AC. First, a uniform 68Ge-cylinder was positioned centrally in the PET/CT and fixed with a vacuum mattress (10 cm thick). Second, the same cylinder was placed in 3 positioning aids from the PET/MR (BrainPET-3T). Third, 5 head/neck patients who were fixed in a vacuum mattress were selected. In all 3 studies PET recon post CT-AC based on measured CT images was used as the reference (mCT-AC). The PET/MR set-up was mimicked by segmenting the foam inserts from the measured CT images and setting their voxel values to -1000 HU (air). PET images were reconstructed using CT-AC with the segmented CT images (sCT-AC). PET images with mCT- and sCT-AC were compared. Results: sCT-AC underestimated PET voxel values in the phantom by 6.7% on average compared to mCT-AC with the vacuum mattress in place. 5% of the PET voxels were underestimated by >=10%. Not accounting for MR positioning aids during AC led to an underestimation of 2.8% following sCT-AC, with 5% of the PET voxels being underestimated by >=7% wrt mCT-AC. Preliminary evaluation of the patient data indicates a slightly higher bias from not accounting for patient positioning aids (mean: -9.1%, 5% percentile: -11.2%). Conclusions: A considerable and regionally variable underestimation of the PET activity following AC is observed when positioning aids are not accounted for. This bias may become relevant in neurological activation or dementia studies with PET/M

Non-transmissive attenuation and scatter correction of Tc-99m cardiac SPECT in patients with and without perfusion defects

Eur J Nucl Med 1996; 23(9): 1049

Non-transmissive attenuation correction and scatter correction of Tc-99m cardiac SPECT in patients with and without perfusion defects

Eur J Nucl Med 1996; 23(9): 1049. (available on demand

Effect of MR Contrast Agents on Quantitative Accuracy of PET in Combined Whole-Body PET/MR Imaging

Combined whole-body PET/MR systems are being tested in clinical practice today. Integrated imaging protocols entail the use of MR contrast agents (MRCA) that could bias PET attenuation correction. In this work, we assess the effect of MRCA in PET/MR imaging. We analyze the effect of oral and intravenous MRCA on PET activity after attenuation correction. We conclude that in clinical scenarios, MRCA are not expected to lead to significant attenuation of PET signals, and that attenuation maps are not biased after the ingestion of adequate oral contrasts

The effect of patient positioning aids on PET quantification in PET/MR imaging

Objectives Clinical PET/MR requires the use of patient positioning aids to immobilize and support patients for the duration of the combined examination. Ancillary immobilization devices contribute to overall attenuation of the PET signal, but are not detected with conventional MR sequences and, hence, are ignored in standard MR-based attenuation correction (MR-AC). We report on the quantitative effect of not accounting for the attenuation of patient positioning aids in combined PET/MR imaging. Methods We used phantom and patient data acquired with positioning aids on a PET/CT scanner (Biograph 16, HI-REZ) to mimic PET/MR imaging conditions. Reference CT-based attenuation maps were generated from measured (original) CT transmission images (origCT-AC). We also created MR-like attenuation maps by following the same conversion procedure of the attenuation values except for the prior delineation and subtraction of the positioning aids from the CT images (modCT-AC). First, a uniform 68Ge cylinder was positioned centrally in the PET/CT scanner and fixed with a vacuum mattress (10 cm thick) and, in a repeat examination, with MR positioning foam pads. Second, 16 patient datasets were selected for subsequent processing. All patients were regionally immobilized with positioning aids: a vacuum mattress for head/neck imaging (nine patients) and a foam mattress for imaging of the lower extremities (seven patients). PET images were reconstructed following CT-based attenuation and scatter correction using the original and modified (MR-like) CT images: PETorigCT-AC and PETmodCT-AC, respectively. PET images following origCT-AC and modCT-AC were compared visually and in terms of mean differences of voxels with a standardized uptake value of at least 1.0. In addition, we report maximum activity concentration in lesions for selected patients. Results In the phantom study employing the vacuum mattress the average voxel activity in PETmodCT-AC was underestimated by 6.4% compared to PETorigCT-AC, with 3.4% of the PET voxels being underestimated by 10% or more. When the MR foam pads were not accounted for during AC, PETmodCT-AC was underestimated by 1.1% on average, with none of the PET voxels being underestimated by 10% or more. Evaluation of the head/neck patient data showed a decrease of 8.4% ([68Ga]DOTATOC) and 7.4% ([18F]FDG) when patient positioning aids were not accounted for during AC, while the corresponding decrease was insignificant for the lower extremities. Conclusion Depending on the size and density of the positioning aids used, a regionally variable underestimation of PET activity following AC is observed when positioning aids are not accounted for. This underestimation may become relevant in combined PET/MR imaging of patients with neuropsychiatric indications, but appears to be of no clinical relevance in imaging the extremities