Whole-body PET/MRI: The effect of bone attenuation during MR-based attenuation correction in oncology imaging

Research output: Contribution to journalJournal article – Annual report year: 2014Researchpeer-review

  • Author: Aznar, M.C.

    Copenhagen University Hospital, Denmark

  • Author: Sersar, Rachida

    Department of Applied Mathematics and Computer Science , Technical University of Denmark

  • Author: Saabye, J.

    Technical University of Denmark, Denmark

  • Author: Ladefoged, C.N.

    Copenhagen University Hospital, Denmark

  • Author: Andersen, F.L.

    Copenhagen University Hospital

  • Author: Rasmussen, J.H.

    Copenhagen University Hospital

  • Author: Löfgren, Johan

    Copenhagen University Hospital, Denmark

  • Author: Beyer, T.

    Medical University of Vienna, Austria

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Purpose: In combined PET/MRI standard PET attenuation correction (AC) is based on tissue segmentation following dedicated MR sequencing and, typically, bone tissue is not represented. We evaluate PET quantification in whole-body (WB)-PET/MRI following MR-AC without considering bone attenuation and then investigate different strategies to account for bone tissue in clinical PET/MR imaging. To this purpose, bone tissue representation was extracted from separate CT images, and different bone representations were simulated from hypothetically derived MR-based bone classifications.
Methods: Twenty oncology patients referred for a PET/CT were injected with either [18F]-FDG or [18F]-NaF and imaged on PET/CT (Biograph TruePoint/mCT, Siemens) and PET/MRI (mMR, Siemens) following a standard single-injection, dual-imaging clinical WB-protocol. Routine MR-AC was based on in-/opposed-phase MR imaging (orgMR-AC). PET(/MRI) images were reconstructed (AW-OSEM, 3 iterations, 21 subsets, 4mm Gaussian) following routine MR-AC and MR-AC based on four modified attenuation maps. These modified attenuation maps were created for each patient by non-linear co-registration of the CT images to the orgMR-AC images, and adding CT bone mask values representing cortical bone: 1200HU (cortCT), spongiosa bone: 350HU (spongCT), average CT value (meanCT) and original CT values (orgCT). Relative difference images of the PET following AC using the modified attenuation maps were compared. SUVmean was calculated in anatomical reference regions and for PET-positive lesions.
Results: The relative differences in SUVmean across patients following orgMR-AC and orgCT in soft tissue lesions and in bone lesions were similar (range: 0.0% to −22.5%), with an average underestimation of SUVmean of 7.2% and 10.0%, respectively when using orgMR-AC. In bone lesions, spongCT values were closest to orgCT (median bias of 1.3%, range: –9.0% to 13.5%) while the overestimation of SUVmean with respect to orgCT was highest for cortCT (40.8%, range: 1.5% to 110.8%). For soft tissue lesions the bias was highest using cortCT (13.4%, range: –2.3% to 17.3%) and lowest for spongCT (–2.2%, range: 0.0% to –13.7%).
Conclusions: In PET/MR imaging using standard MR-AC PET uptake values in soft lesions and bone lesions are underestimated by about 10%. In individual patients this bias can be as high as 22%, which is significant during clinical follow-up exams. If bone segmentation is available, then assigning a fixed attenuation value of spongious bone to all bone structures appears reasonable and results in only a minor bias of 5%, or less in uptake values of soft tissue and bone lesions.

Original languageEnglish
JournalEuropean Journal of Radiology
Volume83
Issue number7
Pages (from-to)1177-1183
ISSN0720-048X
DOIs
Publication statusPublished - 2014
CitationsWeb of Science® Times Cited: No match on DOI

    Research areas

  • Combined PET/MR, Attenuation correction, Bone, Quantification

ID: 93297173