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Abstract:
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/MR
