MR-Based Attenuation Correction Methods for Improved PET Quantification in Lesions Within Bone and Susceptibility Artifact Regions

Hybrid PET/MR systems have recently entered clinical practice. Thus, the accuracy of MR-based attenuation correction in simultaneously acquired data can now be investigated. We assessed the accuracy of 4 methods of MR-based attenuation correction in lesions within soft tissue, bone, and MR susceptibility artifacts: 2 segmentation-based methods (SEG1, provided by the manufacturer, and SEG2, a method with atlas-based susceptibility artifact correction); an atlas-and pattern recognition-based method (AT&PR), which also used artifact correction; and a new method combining AT&PR and SEG2 (SEG2wBONE). Methods: Attenuation maps were calculated for the PET/MR datasets of 10 patients acquired on a whole-body PET/MR system, allowing for simultaneous acquisition of PET and MR data. Eighty percent iso-contour volumes of interest were placed on lesions in soft tissue (n = 21), in bone (n = 20), near bone (n = 19), and within or near MR susceptibility artifacts (n = 9). Relative mean volume-of-interest differences were calculated with CT-based attenuation correction as a reference. Results: For soft-tissue lesions, none of the methods revealed a significant difference in PET standardized uptake value relative to CT-based attenuation correction (SEG1, -2.6% +/- 5.8%; SEG2, -1.6% +/- 4.9%; AT&PR, -4.7% +/- 6.5%; SEG2wBONE, 0.2% +/- 5.3%). For bone lesions, underestimation of PET standardized uptake values was found for all methods, with minimized error for the atlas-based approaches (SEG1, -16.1% +/- 9.7%; SEG2, -11.0% +/- 6.7%; AT&PR, -6.6% +/- 5.0%; SEG2wBONE, -4.7% +/- 4.4%). For lesions near bone, underestimations of lower magnitude were observed (SEG1, -12.0% +/- 7.4%; SEG2, -9.2% +/- 6.5%; AT&PR, -4.6% +/- 7.8%; SEG2wBONE, -4.2% +/- 6.2%). For lesions affected by MR susceptibility artifacts, quantification errors could be reduced using the atlas-based artifact correction (SEG1, -54.0% +/- 38.4%; SEG2, -15.0% +/- 12.2%; AT&PR, -4.1% +/- 11.2%; SEG2wBONE, 0.6% +/- 11.1%). Conclusion: For soft-tissue lesions, none of the evaluated methods showed statistically significant errors. For bone lesions, significant underestimations of -16% and -11% occurred for methods in which bone tissue was ignored (SEG1 and SEG2). In the present attenuation correction schemes, uncorrected MR susceptibility artifacts typically result in reduced attenuation values, potentially leading to highly reduced PET standardized uptake values, rendering lesions indistinguishable from background. While AT&PR and SEG2wBONE show accurate results in both soft tissue and bone, SEG2wBONE uses a two-step approach for tissue classification, which increases the robustness of prediction and can be applied retrospectively if more precision in bone areas is needed.