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Open Access 01-08-2019 | Original Article

Assessment of attenuation correction for myocardial PET imaging using combined PET/MRI

Authors: Martin Lyngby Lassen, MSc, Sazan Rasul, MD, PhD, Dietrich Beitzke, MD, Marie-Elisabeth Stelzmüller, MD, Jacobo Cal-Gonzalez, PhD, Marcus Hacker, MD, Thomas Beyer, PhD

Published in: Journal of Nuclear Cardiology | Issue 4/2019

Abstract

Objective

To evaluate the frequency of artifacts in MR-based attenuation correction (AC) maps and their impact on the quantitative accuracy of PET-based flow and metabolism measurements in a cohort of consecutive heart failure patients undergoing combined PET/MR imaging.

Methods

Myocardial viability studies were performed in 20 patients following a dual-tracer protocol involving the assessment of myocardial perfusion (¹³N-NH₃: 813 ± 86 MBq) and metabolism (¹⁸F-FDG: 335 ± 38 MBq). All acquisitions were performed using a fully-integrated PET/MR system, with standard DIXON-attenuation correction (DIXON-AC) mapping for each PET scan. All AC maps were examined for spatial misalignment with the emission data, total lung volume, susceptibility artifacts, and tissue inversion (TI). Misalignment and susceptibility artifacts were corrected using rigid co-registration and retrospective filling of the susceptibility-induced gaps, respectively. The effects of the AC artifacts were evaluated by relative difference measures and perceived changes in clinical interpretations.

Results

Average respiratory misalignment of (7 ± 4) mm of the PET-emission data and the AC maps was observed in 18 (90%) patients. Substantial changes in the lung volumes of the AC maps were observed in the test–retest analysis (ratio: 1.0 ± 0.2, range: 0.8-1.4). Susceptibility artifacts were observed in 10 (50%) patients, while six (30%) patients had TI artifacts. Average differences of 14 ± 10% were observed for PET images reconstructed with the artifactual AC maps. The combined artifact effects caused false-positive findings in three (15%) patients.

Conclusion

Standard DIXON-AC maps must be examined carefully for artifacts and misalignment effects prior to AC correction of cardiac PET/MRI studies in order to avoid misinterpretation of biased perfusion and metabolism readings from the PET data.

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Title: Assessment of attenuation correction for myocardial PET imaging using combined PET/MRI
Authors: Martin Lyngby Lassen, MSc
Sazan Rasul, MD, PhD
Dietrich Beitzke, MD
Marie-Elisabeth Stelzmüller, MD
Jacobo Cal-Gonzalez, PhD
Marcus Hacker, MD
Thomas Beyer, PhD
Publication date: 01-08-2019
Publisher: Springer International Publishing
Published in: Journal of Nuclear Cardiology / Issue 4/2019
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-017-1118-2

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Springer Medicine

Assessment of attenuation correction for myocardial PET imaging using combined PET/MRI

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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