Qualitative FDG PET Image Assessment Using Automated Three-Segment MR Attenuation Correction Versus CT Attenuation Correction in a Tertiary Pediatric Hospital: A Prospective Study

OBJECTIVE. The purpose of this study was to systematically evaluate the diagnostic quality of F-18-FDG PET images generated using MR attenuation correction (MRAC) compared with those images generated using CT attenuation correction (CTAC) in a pediatric population. SUBJECTS AND METHODS. Forty-two patients (mean age, 12.8 years; percentage who were male, 57%) who were referred for 62 indicated whole-body PET/CT studies were prospectively recruited to undergo PET/MRI examinations during the same clinic visit in which PET/CT was performed. MRAC was performed using an automatic three-segment model. Three nuclear radiologists scored the diagnostic quality of the PET images generated by MRAC and CTAC using a Likert scale (range of scores, 1-5). Images graded with a score of 1-3 were considered clinically unacceptable, whereas images with a score of 4-5 were considered clinically acceptable. A Wilcoxon signed-rank test was used to compare differences in the grading of PET/MRI and PET/CT images. The Fisher exact test was used to evaluate potential differences in clinically acceptable image quality and the presence of artifact. Fleiss kappa statistics were used to examine interobserver agreement. RESULTS. There was no statistically significant difference in the proportion of PET images generated with MRAC and CTAC for which image quality was considered clinically acceptable. A total of 3.9% of PET assessments generated with MRAC were of unacceptable image quality, compared with 2.2% of PET images generated with CTAC. Two of the three radiologists who reviewed the PET images reported the presence of artifacts more often on MRAC-derived images, and they graded the mean quality of these images 0.48 and 0.29 points lower on the 5-point Likert scale than they graded the mean quality of CTAC-derived images (p < 0.0001). Interobserver agreement was fair (kappa = 0.39). CONCLUSION. The diagnostic quality of PET images obtained from a pediatric population with the use of an automatic three-segmentation MRAC method was comparable to that of PET images obtained with the use of CTAC.