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An Analytic Study of the Effects of Attenuation on Tumor Detection in Whole-Body PET Oncology Imaging

¹ Philips Medical Systems, ADAC Laboratories, Milpitas, California
² Department of Radiology, University of Washington, Seattle, Washington
³ Institut de Recherches Subatomiques, Institut National de Physique Nucléaire et de Physique des Particules, Centre National de la Recherche Scientifique/Université Louis Pasteur, Strasbourg, France
⁴ Department of Medical Research, Service Hospitalier Frédéric Joliot, Commissariat à l’Energie Atomique, Orsay, France
⁵ Cancer Imaging and Tracer Development, University of Tennessee Medical Center, Knoxville, Tennessee
⁶ Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
⁷ Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
⁸ Division of Nuclear Medicine, Vrije Universiteit Brussel, Brussels, Belgium

There has been considerable debate about the desirability of attenuation correction in whole-body PET oncology imaging. The advantages of attenuation correction are quantitative accuracy, whereas the perceived disadvantages are loss of contrast, noise amplification, and increased scanning time. In this work, we explain contrast changes between images reconstructed with and without attenuation correction. Methods: To analytically explain both well-known and surprising phenomena in images reconstructed without attenuation correction, we performed a series of simulation studies, a phantom experiment, and a patient experiment. Results: We showed that it is possible to calculate a priori the appearance of images reconstructed without attenuation correction. Compared with attenuation-corrected images, images without attenuation correction may have locally enhanced contrast in the abdomen or other regions of uniform attenuation, although the amount of enhancement varies with position in a complex manner. In regions of nonuniform attenuation, such as the thorax, it is possible that foci of increased tracer uptake disappear in images reconstructed without attenuation correction. The critical tracer concentration for this zero-contrast effect depends on the size, location, and density of the foci. Above the critical value, foci are visible in images with and without attenuation correction, whereas below the critical value, foci are visible in attenuation-corrected images but appear as photopenic regions in images without attenuation correction. Conclusion: Even though images without attenuation correction may be desired, these results suggest that all studies should at least be reconstructed with attenuation correction to avoid missing regions of elevated tracer uptake.

Key Words: whole-body PET • attenuation correction • image reconstruction

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				M. Hofmann, F. Steinke, V. Scheel, G. Charpiat, J. Farquhar, P. Aschoff, M. Brady, B. Scholkopf, and B. J. Pichler MRI-Based Attenuation Correction for PET/MRI: A Novel Approach Combining Pattern Recognition and Atlas Registration J. Nucl. Med., November 1, 2008; 49(11): 1875 - 1883. [Abstract] [Full Text] [PDF]