PurposeRespiratory motion causes mismatches between PET images of the myocardium and the corresponding cardiac MR images in cardiac integrated PET/MR. The mismatch may affect the attenuation correction and the diagnosis of non-ischemic cardiomyopathies. In this study, we present a two-stage cardiac PET and MR Late Gadolinium Enhancement (LGE) co-registration method, which seeks to improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration using an integrated wholebody PET/MR system. MethodsThe proposed PET and LGE two-stage co-registration method was evaluated through comparison with one-stage direct co-registration and no-registration. One hundred and ninety-one slices of LGE and forty lesions were studied. Two trained nuclear medicine physicians independently assessed the displacement between LGE and PET to qualitatively evaluate the co-registration quality. The changes of the mean SUV in the normal myocardium and the LGE-enhanced lesions before and after image co-registration were measured to quantitatively evaluate the accuracy and value of image co-registration. ResultsThe two-stage method had an improved image registration score (4.93±0.89) compared with the noregistration method (3.49±0.84, p value <0.001) and the single-stage method (4.23±0.81, p value <0.001).Furthermore, the two-stage method led to increased SUV value in the myocardium (3.87±2.56) compared with the no-registration method (3.14±1.92, p value <0.001) and the single-stage method (3.32±2.16, p value <0.001). The mean SUV in the LGE lesion signi cantly increased from 2.51±2.09 to 2.85±2.35 (p value<0.001) after the two-stage co-registration. ConclusionThe proposed two-stage registration method signi cantly improved the co-registration between PET andLGE in integrated PET/MR imaging. The technique may improve diagnostic accuracy of non-ischemic cardiomyopathies via better image co-registration.Registered No.
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