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Research ArticlePhysics and Instrumentation

Reproducibility of MR-Based Attenuation Maps in PET/MRI and the Impact on PET Quantification in Lung Cancer

Anders Olin, Claes N. Ladefoged, Natasha H. Langer, Sune H. Keller, Johan Löfgren, Adam E. Hansen, Andreas Kjær, Seppo W. Langer, Barbara M. Fischer and Flemming L. Andersen
Journal of Nuclear Medicine June 2018, 59 (6) 999-1004; DOI: https://doi.org/10.2967/jnumed.117.198853
Anders Olin
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Claes N. Ladefoged
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Natasha H. Langer
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Sune H. Keller
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Johan Löfgren
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Adam E. Hansen
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Andreas Kjær
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Seppo W. Langer
2Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Barbara M. Fischer
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Flemming L. Andersen
1Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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  • FIGURE 1.
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    FIGURE 1.

    Overview of categorization of all 90 MR-AC maps, including color coding of type of artifact causing categorization. Empty fields indicate no examination performed, and gray squares indicate MR-AC maps categorized as noncritical. All other colored squares indicate MR-AC maps categorized as critical.

  • FIGURE 2.
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    FIGURE 2.

    Overview of Embedded Image (A) and Embedded Image (B) for each tumor of each examination of each patient. Each patient has up to 3 tumors (T1, T2, T3). For each tumor, Embedded Image is displayed on y-axis for each examination (up to 5 examinations). This information can be compared with that of Figure 1.

  • FIGURE 3.
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    FIGURE 3.

    Patient 9, examination 1. Intrasubject repeated MR-AC maps fused with PETA and PETB are shown along with their respective Dixon water images. Tumor delineated in red has Embedded Image of 12%; tumor delineated in blue, 36%. Arrows indicate noteworthy differences in paired MR-AC maps and Dixon water images.

  • FIGURE 4.
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    FIGURE 4.

    Patient 9, examination 4. Intrasubject repeated MR-AC maps fused with PETA and PETB are shown along with their respective Dixon water images. Respiratory motion causes incorrect tissue classification in μ-mapA. Trachea is completely missed (blue arrows), and lung tissue is incorrectly classified as soft tissue (red arrows). As a result, PETB is lower than PETA for tumor delineated in blue (Embedded Image of −21%), because PETA is locally overcorrected for attenuation (SUVs too high). Tumor delineated in red is incorrectly classified as lung tissue in μ-mapA, causing undercorrection for attenuation in PETA and causing PETB to be slightly higher than PETA (Embedded Image of 5%).

  • FIGURE 5.
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    FIGURE 5.

    Patient 7, examination 1. Intrasubject repeated MR-AC maps fused with PETA and PETB are shown along with their respective Dixon water images. Embedded Image of −29% is found in tumor delineated in red. Respiratory motion artifacts cause erroneous tissue classification in μ-mapA.

  • FIGURE 6.
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    FIGURE 6.

    Patient 3, examination 2. Intrasubject repeated MR-AC maps fused with PETA and PETB are shown along with their respective Dixon water images. Initially, no artifacts were thought to affect tumor SUV based on visual evaluation of MR-AC maps alone. However, from corresponding Dixon water image of μ-mapB, respiration artifacts are apparent. A comparison of μ-mapA and μ-mapB shows partially elevated diaphragm in μ-mapB (red line), causing Embedded Image of 27%.

  • FIGURE 7.
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    FIGURE 7.

    Bland–Altman plots showing Embedded Image vs. average SUV. Upper and lower LOA were calculated for log-transformed SUVmean (A) and log-transformed SUVmax (B), in which multiple observations for each patient were accounted for.

Tables

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    TABLE 1

    Intraclass Correlation and Coefficient of Variation for SUVmean and SUVmax

    LOA (%)
    VariableIntraclass correlationCoefficient of variation (%)LowerUpper
    SUVmean0.9825.6−14.0817.48
    SUVmax0.9756.6−16.2121.18
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    TABLE 2

    Correlation Matrix for Embedded Image, Embedded Image, and Selected Variables Measured Within 10-Centimeter-Diameter Sphere Encapsulating Center of Mass of Tumor

    VariableEmbedded ImageEmbedded ImageEmbedded ImageEmbedded ImageEmbedded Image
    Embedded Image10.9*−0.71*0.030.70*
    Embedded Image—1−0.72*0.120.70*
    Embedded Image——1−0.17−0.96*
    Embedded Image———10.07
    Embedded Image————1
    • ↵* Significant correlation with P < 0.01.

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Journal of Nuclear Medicine: 59 (6)
Journal of Nuclear Medicine
Vol. 59, Issue 6
June 1, 2018
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Reproducibility of MR-Based Attenuation Maps in PET/MRI and the Impact on PET Quantification in Lung Cancer
Anders Olin, Claes N. Ladefoged, Natasha H. Langer, Sune H. Keller, Johan Löfgren, Adam E. Hansen, Andreas Kjær, Seppo W. Langer, Barbara M. Fischer, Flemming L. Andersen
Journal of Nuclear Medicine Jun 2018, 59 (6) 999-1004; DOI: 10.2967/jnumed.117.198853

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Reproducibility of MR-Based Attenuation Maps in PET/MRI and the Impact on PET Quantification in Lung Cancer
Anders Olin, Claes N. Ladefoged, Natasha H. Langer, Sune H. Keller, Johan Löfgren, Adam E. Hansen, Andreas Kjær, Seppo W. Langer, Barbara M. Fischer, Flemming L. Andersen
Journal of Nuclear Medicine Jun 2018, 59 (6) 999-1004; DOI: 10.2967/jnumed.117.198853
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Keywords

  • PET/MR
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  • non-small cell lung cancer
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