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The effect of metal artefact reduction on CT-based attenuation correction for PET imaging in the vicinity of metallic hip implants: a phantom study

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Abstract

Background

To determine if metal artefact reduction (MAR) combined with a priori knowledge of prosthesis material composition can be applied to obtain CT-based attenuation maps with sufficient accuracy for quantitative assessment of 18F-fluorodeoxyglucose uptake in lesions near metallic prostheses.

Methods

A custom hip prosthesis phantom with a lesion-sized cavity filled with 0.2 ml 18F-FDG solution having an activity of 3.367 MBq adjacent to a prosthesis bore was imaged twice with a chrome–cobalt steel hip prosthesis and a plastic replica, respectively. Scanning was performed on a clinical hybrid PET/CT system equipped with an additional external 137Cs transmission source. PET emission images were reconstructed from both phantom configurations with CT-based attenuation correction (CTAC) and with CT-based attenuation correction using MAR (MARCTAC). To compare results with the attenuation-correction method extant prior to the advent of PET/CT, we also carried out attenuation correction with 137Cs transmission-based attenuation correction (TXAC). CTAC and MARCTAC images were scaled to attenuation coefficients at 511 keV using a trilinear function that mapped the highest CT values to the prosthesis alloy attenuation coefficient. Accuracy and spatial distribution of the lesion activity was compared between the three reconstruction schemes.

Results

Compared to the reference activity of 3.37 MBq, the estimated activity quantified from the PET image corrected by TXAC was 3.41 MBq. The activity estimated from PET images corrected by MARCTAC was similar in accuracy at 3.32 MBq. CTAC corrected PET images resulted in nearly 40 % overestimation of lesion activity at 4.70 MBq. Comparison of PET images obtained with the plastic and metal prostheses in place showed that CTAC resulted in a marked distortion of the 18F-FDG distribution within the lesion, whereas application of MARCTAC and TXAC resulted in lesion distributions similar to those observed with the plastic replica.

Conclusions

MAR combined with a trilinear CT number mapping for PET attenuation correction resulted in estimates of lesion activity comparable in accuracy to that obtained with 137Cs transmission-based attenuation correction, and far superior to estimates made without attenuation correction or with a standard CT attenuation map. The ability to use CT images for attenuation correction is a potentially important development because it obviates the need for a 137Cs transmission source, which entails extra scan time, logistical complexity and expense.

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Acknowledgments

This study was supported by grants R21-AR055253 and R01-AR048241, National Institute of Arthritis, Musculoskeletal and Skin Diseases.

Conflict of interest

None to declare.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, Box 0946, San Francisco, CA, 94143-0946, USA

    Roy Harnish & Thomas F. Lang

  2. Phillips Medical Systems, Hamburg, Germany

    Sven Prevrhal

  3. Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA

    Abass Alavi

  4. Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, 1211, Geneva, Switzerland

    Habib Zaidi

  5. Geneva Neuroscience Center, Geneva University, 1205, Geneva, Switzerland

    Habib Zaidi

  6. Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, The Netherlands

    Habib Zaidi

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  1. Roy Harnish
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Correspondence to Thomas F. Lang.

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Harnish, R., Prevrhal, S., Alavi, A. et al. The effect of metal artefact reduction on CT-based attenuation correction for PET imaging in the vicinity of metallic hip implants: a phantom study. Ann Nucl Med 28, 540–550 (2014). https://doi.org/10.1007/s12149-014-0844-7

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  • DOI: https://doi.org/10.1007/s12149-014-0844-7

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