Impact of MR based attenuation correction on neurological PET studies

Abstract

Hybrid positron emission tomography (PET) and magnetic resonance (MR) scanners have become a reality in recent years with the benefits of reduced radiation exposure, improved image quality, reduction of imaging time, and potential advantages in quantification. Appropriate attenuation correction remains a challenge. Biases in PET activity measurements were demonstrated using the current MR based attenuation correction technique. We aim to investigate the impact of using standard MRAC technique on the clinical and research utility of PET/MR hybrid scanner for amyloid imaging. Methods: Florbetapir scans were obtained on 40 participants on a Biograph mMR hybrid scanner with simultaneous MR acquisition. PET images were reconstructed using both MR and CT derived attenuation map. Quantitative analysis was performed for both datasets to assess the impact of MR based attenuation correction to absolute PET activity measurements as well as target to reference ratio (SUVR). Clinical assessment was also performed by a nuclear medicine physician to determine amyloid status based on the criteria in the FDA prescribing information for florbetapir. Results: MR based attenuation correction led to underestimation of PET activity for most part of the brain with a small overestimation for deep brain regions. There is also an overestimation of SUVR values with cerebellar reference. SUVR measurements obtained from the two attenuation correction methods were strongly correlated. Clinical assessment of amyloid status resulted in identical classification as positive or negative regardless of the attenuation correction methods. Conclusion: MR based attenuation correction cause biases in quantitative measurements. The biases may be accounted for by a linear model, although the spatial variation cannot be easily modelled. The quantitative differences however did not affect clinical assessment as positive or negative.