A Quantitative Evaluation of Joint Activity and Attenuation Reconstruction in TOF PET/MR Brain Imaging

Time-of-flight (TOF) PET data provide an effective means for attenuation correction (AC) when no (or incomplete or inaccurate) attenuation information is available. Since MR scanners provide little information on photon attenuation of different tissue types, AC in hybrid PET/MR scanners has always been challenging. In this contribution, we aim at validating the activity reconstructions of the maximum-likelihood ordered-subsets activity and attenuation (OSAA) reconstruction algorithm on a patient brain data set. We present a quantitative comparison of joint reconstructions with the current clinical gold standard—ordered-subsets expectation maximization—using CT-based AC in PET/CT, as well as the current state of the art in PET/MR, that is, zero time echo (ZTE)–based AC. Methods: The TOF PET emission data were initially used in a preprocessing stage to estimate crystal maps of efficiencies, timing offsets, and timing resolutions. Applying these additional corrections during reconstructions, OSAA, ZTE-based, and the vendor-provided atlas-based AC techniques were analyzed and compared with CT-based AC. In our initial study, we used the CT-based estimate of the expected scatter and later used the ZTE-based and OSAA attenuation estimates to compute the expected scatter contribution of the data during reconstructions. In all reconstructions, a maximum-likelihood scaling of the single-scatter simulation estimate to the emission data was used for scatter correction. The reconstruction results were analyzed in the 86 segmented regions of interest of the Hammers atlas. Results: Our quantitative analysis showed that, in practice, a tracer activity difference of +0.5% (±2.1%) and +0.1% (±2.3%) could be expected for the state-of-the-art ZTE-based and OSAA AC methods, respectively, in PET/MR compared with the clinical gold standard in PET/CT. Conclusion: Joint activity and attenuation estimation methods can provide an effective solution to the challenging AC problem for brain studies in hybrid TOF PET/MR scanners. With an accurate TOF-based (timing offsets and timing resolutions) calibration, and similar to the results of the state-of-the-art method in PET/MR, regional errors of joint TOF PET reconstructions are within a few percentage points.