Evaluation of improved attenuation correction in whole-body PET/MR on patients with bone metastasis using various radiotracers

Purpose This study evaluates the quantitative effect of improved MR-based attenuation correction (AC), including bone segmentation and the HUGE method for truncation correction in PET/MR whole-body hybrid imaging specifically of oncologic patients with bone metastasis and using various radiotracers. Methods Twenty-three patients that underwent altogether 28 whole-body PET/MR examinations with findings of bone metastasis were included in this study. Different radiotracers (F-18-FDG, Ga-68-PSMA, Ga-68-DOTATOC, I-124-MIBG) were injected according to appropriate clinical indications. Each of the 28 whole-body PET datasets was reconstructed three times using AC with (1) standard four-compartment mu-maps (background air, lung, muscle, and soft tissue), (2) five-compartment mu-maps (adding bone), and (3) six-compartment mu-maps (adding bone and HUGE truncation correction). The SUVmax of each detected bone lesion was measured in each reconstruction to evaluate the quantitative impact of improved MR-based AC. Relative difference images between four- and six-compartment mu-maps were calculated. MR-based HUGE truncation correction was compared with the PET-based MLAA truncation correction method in all patients. Results Overall, 69 bone lesions were detected and evaluated. The mean increase in relative difference over all 69 lesions in SUVmax was 5.4 +/- 6.4% when comparing the improved six-compartment AC with the standard four-compartment AC. Maximal relative difference of 28.4% was measured in one lesion. Truncation correction with HUGE worked robust and resulted in realistic body contouring in all 28 exams and for all 4 different radiotracers. Truncation correction with MLAA revealed overestimations of arm tissue volume in all PET/MR exams with F-18-FDG radiotracer and failed in all other exams with radiotracers Ga-68-PSMA, Ga-68-DOTATOC, and I-124- MIBG due to limitations in body contour detection. Conclusion Improved MR-based AC, including bone segmentation and HUGE truncation correction in whole-body PET/MR on patients with bone lesions and using various radiotracers, is important to ensure best possible diagnostic image quality and accurate PET quantification. The HUGE method for truncation correction based on MR worked robust and results in realistic body contouring, independent of the radiotracers used.