PET/MR attenuation correction: where have we come from and where are we going?

Excerpt

The advent of clinical multimodality imaging with the development of PET/CT scanners [1] has presented us with ample opportunities to harvest the benefits of combining functional and anatomical imaging. These benefits concern improved PET quantitative accuracy and overall patient management (improved diagnostic accuracy and therapy response assessment), but also increased patient throughput. It is indeed the last of these points that has substantially contributed to the rapid acceptance of PET/CT imaging in clinical practice eclipsing PET-only systems. Indeed, one of the major reasons behind the improved patient throughput achieved with PET/CT has been the use of CT images for attenuation correction (AC) of the acquired PET emission datasets. In this context, CT images possess two desirable properties. Firstly, CT acquisitions are very fast, removing the need for long radionuclide-based transmission imaging that was traditionally used in PET (about 50 % of the overall acquisition times). Secondly, CT intensity values represent the attenuation properties of the tissues in the imaging field of view, albeit at X-ray photon energies. The necessary transformation of CT images into attenuation maps at 511 keV can be achieved by bilinear transformation [2]. Although such a transformation represents a certain approximation, CT-based AC of PET datasets using such attenuation maps has been shown to lead to the same level of quantitative accuracy and superior contrast in the reconstructed PET images compared to radionuclide-based transmission scanning [3]. …