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The effect of patient positioning aids on PET quantification in PET/MR imaging

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http://pubman.mpdl.mpg.de/cone/persons/resource/persons84075

Mantlik,  F
Department Empirical Inference, Max Planck Institute for Biological Cybernetics, Max Planck Society;

http://pubman.mpdl.mpg.de/cone/persons/resource/persons83974

Hofmann,  M
Department Empirical Inference, Max Planck Institute for Biological Cybernetics, Max Planck Society;

http://pubman.mpdl.mpg.de/cone/persons/resource/persons84193

Werner MK, Sauter A, Kupferschläger J, Schölkopf,  B
Department Empirical Inference, Max Planck Institute for Biological Cybernetics, Max Planck Society;

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Mantlik, F., Hofmann, M., Werner MK, Sauter A, Kupferschläger J, Schölkopf, B., Pichler, B., & Beyer, T. (2011). The effect of patient positioning aids on PET quantification in PET/MR imaging. European Journal of Nuclear Medicine and Molecular Imaging, 38(5), 920-929. doi:10.1007/s00259-010-1721-9.


Cite as: http://hdl.handle.net/11858/00-001M-0000-0013-BBBA-A
Abstract
Objectives Clinical PET/MR requires the use of patient positioning aids to immobilize and support patients for the duration of the combined examination. Ancillary immobilization devices contribute to overall attenuation of the PET signal, but are not detected with conventional MR sequences and, hence, are ignored in standard MR-based attenuation correction (MR-AC). We report on the quantitative effect of not accounting for the attenuation of patient positioning aids in combined PET/MR imaging. Methods We used phantom and patient data acquired with positioning aids on a PET/CT scanner (Biograph 16, HI-REZ) to mimic PET/MR imaging conditions. Reference CT-based attenuation maps were generated from measured (original) CT transmission images (origCT-AC). We also created MR-like attenuation maps by following the same conversion procedure of the attenuation values except for the prior delineation and subtraction of the positioning aids from the CT images (modCT-AC). First, a uniform 68Ge cylinder was positioned centrally in the PET/CT scanner and fixed with a vacuum mattress (10 cm thick) and, in a repeat examination, with MR positioning foam pads. Second, 16 patient datasets were selected for subsequent processing. All patients were regionally immobilized with positioning aids: a vacuum mattress for head/neck imaging (nine patients) and a foam mattress for imaging of the lower extremities (seven patients). PET images were reconstructed following CT-based attenuation and scatter correction using the original and modified (MR-like) CT images: PETorigCT-AC and PETmodCT-AC, respectively. PET images following origCT-AC and modCT-AC were compared visually and in terms of mean differences of voxels with a standardized uptake value of at least 1.0. In addition, we report maximum activity concentration in lesions for selected patients. Results In the phantom study employing the vacuum mattress the average voxel activity in PETmodCT-AC was underestimated by 6.4 compared to PETorigCT-AC, with 3.4 of the PET voxels being underestimated by 10 or more. When the MR foam pads were not accounted for during AC, PETmodCT-AC was underestimated by 1.1 on average, with none of the PET voxels being underestimated by 10 or more. Evaluation of the head/neck patient data showed a decrease of 8.4 ([68Ga]DOTATOC) and 7.4 ([18F]FDG) when patient positioning aids were not accounted for during AC, while the corresponding decrease was insignificant for the lower extremities. Conclusion Depending on the size and density of the positioning aids used, a regionally variable underestimation of PET activity following AC is observed when positioning aids are not accounted for. This underestimation may become relevant in combined PET/MR imaging of patients with neuropsychiatric indications, but appears to be of no clinical relevance in imaging the extremities.