Accurate attenuation correction (AC) on PET/MR is still challenging. The purpose of this study was to evaluate the clinical feasibility of AC based on fast zero-echo-time (ZTE) MRI by comparing it with the default atlas-based AC on a clinical PET/MR scanner. Methods: We recruited 10 patients with malignant diseases not located on the brain. In all patients, a clinically indicated whole-body 18 F-FDG PET/CT scan was acquired. In addition, a head PET/MR scan was obtained voluntarily. For each patient, 2 AC maps were generated from the MR images. One was atlas-AC, derived from T1-weighted liver acquisition with volume acceleration flex images (clinical standard). The other was ZTE-AC, derived from proton-density-weighted ZTE images by applying tissue segmentation and assigning continuous attenuation values to the bone. The AC map generated by PET/CT was used as a silver standard. On the basis of each AC map, PET images were reconstructed from identical raw data on the PET/MR scanner. All PET images were normalized to the SPM5 PET template. After that, these images were qualified visually and quantified in 67 volumes of interest (VOIs; automated anatomic labeling, atlas). Relative differences and absolute relative differences between PET images based on each AC were calculated. 18 F-FDG uptake in all 670 VOIs and generalized merged VOIs were compared using a paired t test. Results: Qualitative analysis shows that ZTE-AC was robust to patient variability. Nevertheless, misclassification of air and bone in mastoid and nasal areas led to the overestimation of PET in the temporal lobe and cerebellum (%diff of ZTE-AC, 2.46% ± 1.19% and 3.31% ± 1.70%, respectively). The j%diffj of all 670 VOIs on ZTE was improved by approximately 25% compared with atlas-AC (ZTE-AC vs. atlas-AC, 1.77% ± 1.41% vs. 2.44% ± 1.63%, P , 0.01). In 2 of 7 generalized VOIs, j%diffj on ZTE-AC was significantly smaller than atlas-AC (ZTE-AC vs. atlas-AC: insula and cingulate, 1.06% ± 0.67% vs. 2.22% ± 1.10%, P , 0.01; central structure, 1.03% ± 0.99% vs. 2.54% ± 1.20%, P , 0.05). Conclusion: The ZTE-AC could provide more accurate AC than clinical atlas-AC by improving the estimation of head-skull attenuation. The misclassification in mastoid and nasal areas must be addressed to prevent the overestimation of PET in regions near the skull base.

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Purpose To determine the level of clinically acceptable reduction in injected fluorine 18 ((18)F) fluorodeoxyglucose (FDG) dose in time-of-flight (TOF)-positron emission tomography(PET)/magnetic resonance (MR) imaging by using silicon photomultiplier (SiPM) detectors compared with TOF-PET/computed tomography (CT) using Lu1.8Y0.2SiO5(Ce), or LYSO, detectors in patients with different body mass indexes (BMIs). Materials and Methods Patients were enrolled in this study as part of a larger prospective study with a different purpose than evaluated in this study (NCT02316431). All patients gave written informed consent prior to inclusion into the study. In this study, 74 patients with different malignant diseases underwent sequential whole-body TOF-PET/CT and TOF-PET/MR imaging. PET images with simulated reduction of injected (18)F-FDG doses were generated by unlisting the list-mode data from PET/MR imaging. Two readers rated the image quality of whole-body data sets, as well as the image quality in each body compartment, and evaluated the conspicuity of malignant lesions. Results The image quality with 70% or 60% of the injected dose of (18)F-FDG at PET/MR imaging was comparable to that at PET/CT. With 50% of the injected dose, comparable image quality was maintained among patients with a BMI of less than 25 kg/m(2). PET images without TOF reconstruction showed higher artifact scores and deteriorated sharpness than those with TOF reconstruction. Conclusion Sixty percent of the usually injected (18)F-FDG dose (reduction of up to 40%) in patients with a BMI of more than 25 kg/m(2) results in clinically adequate PET image quality in TOF-PET/MR imaging performed by using SiPM detectors. Additionally, in patients with a BMI of less than 25 kg/m(2), 50% of the injected dose may safely be used. (©) RSNA, 2017 Online supplemental material is available for this article. Purpose:To determine the level of clinically acceptable reduction in injected fluorine 18 ( Materials andMethods:Patients were enrolled in this study as part of a larger prospective study with a different purpose than evaluated in this study (NCT02316431). All patients gave written informed consent prior to inclusion into the study. In this study, 74 patients with different malignant diseases underwent sequential whole-body TOF-PET/CT and TOF-PET/MR imaging. PET images with simulated reduction of injected 18 F-FDG doses were generated by unlisting the list-mode data from PET/MR imaging. Two readers rated the image quality of whole-body data sets, as well as the image quality in each body compartment, and evaluated the conspicuity of malignant lesions. Results:The image quality with 70% or 60% of the injected dose of 18 F-FDG at PET/MR imaging was comparable to that at PET/CT. With 50% of the injected dose, comparable image quality was maintained among patients with a BMI of less than 25 kg/m 2 . PET images without TOF reconstruction showed higher artifact scores and deteriorated sharpness than those with TOF reconstruction. Conclusion:Sixty percent...

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In this work, we assessed the feasibility of attenuation correction (AC) based on a multi-atlas-based method (m-Atlas) by comparing it with a clinical AC method (single-atlas-based method [s-Atlas]), on a timeof-flight (TOF) PET/MRI scanner. Methods: We enrolled 15 patients. The median patient age was 59 y (age range, 31-80). All patients underwent clinically indicated whole-body 18 F-FDG PET/CT for staging, restaging, or follow-up of malignant disease. All patients volunteered for an additional PET/MRI scan of the head (no additional tracer being injected). For each patient, 3 AC maps were generated. Both s-Atlas and m-Atlas AC maps were generated from the same patient-specific LAVA-Flex T1-weighted images being acquired by default on the PET/MRI scanner during the first 18 s of the PET scan. An s-Atlas AC map was extracted by the PET/MRI scanner, and an m-Atlas AC map was created using a Web service tool that automatically generates m-Atlas pseudo-CT images. For comparison, the AC map generated by PET/CT was registered and used as a gold standard. PET images were reconstructed from raw data on the TOF PET/MRI scanner using each AC map. All PET images were normalized to the SPM5 PET template, and 18 F-FDG accumulation was quantified in 67 volumes of interest (VOIs; automated anatomic labeling atlas). Relative (%diff) and absolute differences (j%diffj) between images based on each atlas AC and CT-AC were calculated. 18 F-FDG uptake in all VOIs and generalized merged VOIs were compared using the paired t test and Bland-Altman test. Results: The range of error on m-Atlas in all 1,005 VOIs was −4.99% to 4.09%. The j%diffj on the m-Atlas was improved by about 20% compared with s-Atlas (s-Atlas vs. m-Atlas: 1.49% ± 1.06% vs. 1.21% ± 0.89%, P , 0.01). In generalized VOIs, %diff on m-Atlas in the temporal lobe and cerebellum was significantly smaller (s-Atlas vs. m-Atlas: temporal lobe, 1.49% ± 1.37% vs. −0.37% ± 1.41%, P , 0.01; cerebellum, 1.55% ± 1.97% vs. −1.15% ± 1.72%, P , 0.01). Conclusion: The errors introduced using either s-Atlas or m-Atlas did not exceed 5% in any brain region investigated.When compared with the clinical s-Atlas, m-Atlas is more accurate, especially in regions close to the skull base.

Purpose: A drawback of time-resolved 3-dimensional phase contrast magnetic resonance (4D Flow MR) imaging is its lengthy scan time for clinical application in the brain. We assessed the feasibility for flow measurement and visualization of 4D Flow MR imaging using Cartesian y-z radial sampling and that using k-t sensitivity encoding (k-t SENSE) by comparison with the standard scan using SENSE.Materials and Methods: Sixteen volunteers underwent 3 types of 4D Flow MR imaging of the brain using a 3.0-tesla scanner. As the standard scan, 4D Flow MR imaging with SENSE was performed first and then followed by 2 types of acceleration scan-with Cartesian y-z radial sampling and with k-t SENSE. We measured peak systolic velocity (PSV) and blood flow volume (BFV) in 9 arteries, and the percentage of particles arriving from the emitter plane at the target plane in 3 arteries, visually graded image quality in 9 arteries, and compared these quantitative and visual data between the standard scan and each acceleration scan.Results: 4D Flow MR imaging examinations were completed in all but one volunteer, who did not undergo the last examination because of headache. Each acceleration scan reduced scan time by 50% compared with the standard scan. The k-t SENSE imaging underestimated PSV and BFV (P < 0.05). There were significant correlations for PSV and BFV between the standard scan and each acceleration scan (P < 0.01). The percentage of particles reaching the target plane did not differ between the standard scan and each acceleration scan. For visual assessment, y-z radial sampling deteriorated the image quality of the 3 arteries.Conclusion: Cartesian y-z radial sampling is feasible for measuring flow, and k-t SENSE offers sufficient flow visualization; both allow acquisition of 4D Flow MR imaging with shorter scan time.

Both contrast-enhanced PET/MRI and contrast-enhanced PET/CT can serve as reliable examinations for defining local resectability of head and neck cancer.

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