Correction of oral contrast artifacts in CT-based attenuation correction of PET images using an automated segmentation algorithm

Purpose Oral contrast is usually administered in most X-ray computed tomography (CT) examinations of the abdomen and the pelvis as it allows more accurate identification of the bowel and facilitates the interpretation of abdominal and pelvic CT studies. However, the misclassification of contrast medium with high-density bone in CT-based attenuation correction (CTAC) is known to generate artifacts in the attenuation map (mu map), thus resulting in overcorrection for attenuation of positron emission tomography (PET) images. In this study, we developed an automated algorithm for segmentation and classification of regions containing oral contrast medium to correct for artifacts in CT-attenuation-corrected PET images using the segmented contrast correction (SCC) algorithm. Methods The proposed algorithm consists of two steps: first, high CT number object segmentation using combined region- and boundary-based segmentation and second, object classification to bone and contrast agent using a knowledge-based nonlinear fuzzy classifier. Thereafter, the CT numbers of pixels belonging to the region classified as contrast medium are substituted with their equivalent effective bone CT numbers using the SCC algorithm. The generated CT images are then down-sampled followed by Gaussian smoothing to match the resolution of PET images. A piecewise calibration curve was then used to convert CT pixel values to linear attenuation coefficients at 511 keV. Results The visual assessment of segmented regions performed by an experienced radiologist confirmed the accuracy of the segmentation and classification algorithms for delineation of contrast-enhanced regions in clinical CT images. The quantitative analysis of generated mu maps of 21 clinical CT colonoscopy datasets showed an overestimation ranging between 24.4% and 37.3% in the 3D-classified regions depending on their volume and the concentration of contrast medium. Two PET/CT studies known to be problematic demonstrated the applicability of the technique in clinical setting. More importantly, correction of oral contrast artifacts improved the readability and interpretation of the PET scan and showed substantial decrease of the SUV (104.3%) after correction. Conclusions An automated segmentation algorithm for classification of irregular shapes of regions containing contrast medium was developed for wider applicability of the SCC algorithm for correction of oral contrast artifacts during the CTAC procedure. The algorithm is being refined and further validated in clinical setting.