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Comparison of Positron Emission Tomography Quantification Using Magnetic Resonance– and Computed Tomography–Based Attenuation Correction in Physiological Tissues and Lesions: A Whole-Body Positron Emission Tomography/Magnetic Resonance Study in 66 Patients

Seith, Ferdinand MD*; Gatidis, Sergios MD*; Schmidt, Holger PhD*; Bezrukov, Ilja Dipl-Inform†‡; la Fougère, Christian MD§; Nikolaou, Konstantin MD*; Pfannenberg, Christina MD*; Schwenzer, Nina MD*

doi: 10.1097/RLI.0000000000000208
Original Articles

Objective Attenuation correction (AC) in fully integrated positron emission tomography (PET)/magnetic resonance (MR) systems plays a key role for the quantification of tracer uptake. The aim of this prospective study was to assess the accuracy of standardized uptake value (SUV) quantification using MR-based AC in direct comparison with computed tomography (CT)–based AC of the same PET data set on a large patient population.

Materials and Methods Sixty-six patients (22 female; mean [SD], 61 [11] years) were examined by means of combined PET/CT and PET/MR (11C-choline, 18F-FDG, or 68Ga-DOTATATE) subsequently. Positron emission tomography images from PET/MR examinations were corrected with MR-derived AC based on tissue segmentation (PETMR). The same PET data were corrected using CT-based attenuation maps (μ-maps) derived from PET/CT after nonrigid registration of the CT to the MR-based μ-map (PETMRCT). Positron emission tomography SUVs were quantified placing regions of interest or volumes of interest in 6 different body regions as well as PET-avid lesions, respectively.

Results The relative differences of quantitative PET values when using MR-based AC versus CT-based AC were varying depending on the organs and body regions assessed. In detail, the mean (SD) relative differences of PET SUVs were as follows: −7.8% (11.5%), blood pool; −3.6% (5.8%), spleen; −4.4% (5.6%)/−4.1% (6.2%), liver; −0.6% (5.0%), muscle; −1.3% (6.3%), fat; −40.0% (18.7%), bone; 1.6% (4.4%), liver lesions; −6.2% (6.8%), bone lesions; and −1.9% (6.2%), soft tissue lesions. In 10 liver lesions, distinct overestimations greater than 5% were found (up to 10%). In addition, overestimations were found in 2 bone lesions and 1 soft tissue lesion adjacent to the lung (up to 28.0%).

Conclusions Results obtained using different PET tracers show that MR-based AC is accurate in most tissue types, with SUV deviations generally of less than 10%. In bone, however, underestimations can be pronounced, potentially leading to inaccurate SUV quantifications. In addition, SUV overestimations were found for some lesions close to lung borders. This has to be taken into account when comparing PET/CT- and PET/MR-derived SUVs.

From the *Diagnostic and Interventional Radiology, and †Preclinical Imaging and Radiopharmacy, Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens Foundation, Department of Radiology, Eberhard Karls University; ‡Max Planck Institute for Intelligent Systems; and §Nuclear Medicine, Department of Radiology, Eberhard Karls University, Tübingen, Germany.

Received for publication June 16, 2015; and accepted for publication, after revision, July 23, 2015.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Holger Schmidt, PhD, Diagnostic and Interventional Radiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany. E-mail:

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