Med Phys. 2021 Aug 9. doi: 10.1002/mp.15149. Online ahead of print.
ABSTRACT
PURPOSE: PET attenuation correction (AC) in PET/MR scanners constitutes a critical and barely explored issue in spinal cord investigation, mainly due to the limitations in accounting for highly attenuating bone structures which surround the spinal canal. Our study aims at evaluating the clinical suitability of MR-driven AC (MRAC) for 18 F-FDG-PET in spinal cord.
METHODS: Thirty-six patients, undergoing PET/CT and PET/MR in the same session for oncological examination, were retrospectively analyzed. For each patient, raw PET data from PET/MR scanner were reconstructed with 4- and 5-class MRAC maps, generated by hybrid PET/MR system (PET_MRAC4 and PET_MRAC5, respectively), and an AC map derived from CT data after a custom co-registration pipeline (PET_rCTAC), which served as reference. Mean PET standardized uptake values (SUVm ) were extracted from the three reconstructed PET images by regions of interest (ROIs) identified on T2-weighted MRI, in the spinal cord, lumbar cerebrospinal fluid (CSF), and vertebral marrow at 5 levels (C2, C5, T6, T12, and L3). SUVm values from PET_MRAC4 and PET_MRAC5 were compared with each other and with the reference by means of paired t-test, and correlated using Pearson’s correlation (r) to assess their consistency. Cohen’s d was calculated to assess the magnitude of differences between PET images.
RESULTS: SUVm values from PET_MRAC4 were lower than those from PET_MRAC5 in almost all analyzed ROIs, with a mean difference ranging from 0.03 to 0.26 (statistically significant in the vertebral marrow at C2 and C5, spinal cord at T6 and T2, and CSF at L3). This was also confirmed by the effect size, with highest values at low spinal levels (d = 0.45 at T12 in spinal cord, d = 0.95 at L3 in CSF). SUVm values from PET_MRAC4 and PET_MRAC5 showed a very good correlation (0.81 < r < 0.97, p < 0.05) in all spinal ROIs. Underestimation of SUVm between PET_MRAC4 and PET_rCTAC was observed at each level, with a mean difference ranging from 0.02 to 0.32 (statistically significant in the vertebral marrow at C2 and T6, and CSF at L3). Although also PET_MRAC5 underestimates PET_rCTAC (mean difference ranging from 0.02 to 0.3), an overall decrease in effect size could be observed for PET_MRAC5, mainly at lower spinal levels (T12, L3). SUVm from both PET_MRAC4 and PET_MRAC5 methods showed r value from good to very good with respect to PET_rCTAC (0.67 < r < 0.9 and 0.73 < r < 0.94, p < 0.05, respectively).
CONCLUSIONS: Our results showed that neglecting bones in AC can underestimate the FDG uptake measurement of the spinal cord. The inclusion of bones in MRAC is far from negligible and improves the AC in spinal cord, mainly at low spinal levels. Therefore, care must be taken in the spinal canal region and the use of AC map reconstruction methods accounting for bone structures could be beneficial. This article is protected by copyright. All rights reserved.
PMID:34369590 | DOI:10.1002/mp.15149