Clinical Assessment of Emission- and Segmentation-Based MR-Guided Attenuation Correction in Whole-Body Time-of-Flight PET/MR Imaging

The joint maximum-likelihood reconstruction of activity and attenuation (MLAA) for emission-based attenuation correction has regained attention since the advent of time-of-flight PET/MR imaging. Recently, we improved the performance of the MLAA algorithm using an MR imaging–constrained gaussian mixture model (GMM). In this study, we compare the performance of our proposed algorithm with standard 4-class MR-based attenuation correction (MRAC) implemented on commercial systems. Methods: Five head and neck 18F-FDG patients were scanned on PET/MR imaging and PET/CT scanners. Dixon fat and water MR images were registered to CT images. MRAC maps were derived by segmenting the MR images into 4 tissue classes and assigning predefined attenuation coefficients. For MLAA–GMM, MR images were segmented into known tissue classes, including fat, soft tissue, lung, background air, and an unknown MR low-intensity class encompassing cortical bones, air cavities, and metal artifacts. A coregistered bone probability map was also included in the unknown tissue class. Finally, the GMM prior was constrained over known tissue classes of attenuation maps using unimodal gaussians parameterized over a patient population. Results: The results showed that the MLAA–GMM algorithm outperformed the MRAC method by differentiating bones from air gaps and providing more accurate patient-specific attenuation coefficients of soft tissue and lungs. It was found that the MRAC and MLAA–GMM methods resulted in average standardized uptake value errors of –5.4% and –3.5% in the lungs, –7.4% and –5.0% in soft tissues/lesions, and –18.4% and –10.2% in bones, respectively. Conclusion: The proposed MLAA algorithm is promising for accurate derivation of attenuation maps on time-of-flight PET/MR systems.