Sources of attenuation-correction artefacts in cardiac PET/CT and SPECT/CT

  • Sarah J. McQuaid
  • Brian F. Hutton
Original Article



Respiratory motion during myocardial perfusion imaging can cause artefacts in both positron emission tomography (PET) and single-photon emission computed tomography (SPECT) images when mismatches between emission and transmission datasets arise. In this study, artefacts from different breathing motions were quantified in both modalities to assess key factors in attenuation-correction accuracy.


Activity maps were generated using the NURBS-based cardiac-torso phantom for different respiratory cycles, which were projected, attenuation-corrected and reconstructed to form PET and SPECT images. Attenuation-correction was performed with maps at mismatched respiratory phases to observe the effect on the left-ventricular myocardium. Myocardial non-uniformity was assessed in terms of the standard deviation in scores obtained from the 17-segment model and changes in uniformity were compared for each mismatch and modality.


Certain types of mismatch led to artefacts and corresponding increases in the myocardial non-uniformity. For each mismatch in PET, the increases in non-uniformity relative to an artefact-free image were as follows: (a) cardiac translation mismatch, 84% ± 11%; (b) liver mismatch, 59% ± 10%, (c) lung mismatch from diaphragm contraction, 28% ± 8%; and (d) lung mismatch from chest-wall motion, 6% ± 7%. The corresponding factors for SPECT were (a) 61% ± 8%, (b) 34% ± 8%, (c) −2% ± 7)% and (d) −4% ± 6%.


Attenuation-correction artefacts were seen in PET and SPECT images, with PET being more severely affected. The most severe artefacts were produced from mismatches in cardiac and liver position, whereas lung mismatches were less critical. Both cardiac and liver positions must, therefore, be correctly matched during attenuation correction.


Attenuation correction Artefacts Respiratory motion Hybrid imaging Myocardial perfusion imaging 



This work was supported by the Biotechnology and Biological Sciences Research Council and GlaxoSmithKline. This work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme.


  1. 1.
    Chin BB, Nakamoto Y, Kraitchman DL, Marshall L, Wahl R. PET-CT evaluation of 2-deoxy-2-[18F]fluoro-d-glucose myocardial uptake: effect of respiratory motion. Mol Imaging Biol. 2003;5:57–64.PubMedCrossRefGoogle Scholar
  2. 2.
    Osman MM, Cohade C, Nakamoto Y, Wahl RL. Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT. Eur J Nucl Med Mol Imaging. 2003;30:603–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Goerres GW, Burger C, Kamel E, Seifert B, Kaim AH, Buck A, et al. Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology. 2003;226:906–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Folks RD, Hainer J, Di Carli MF, Garcia EV. Development of normal limits for rubidium-82 PET myocardial perfusion using CT-based attenuation correction. J Nucl Cardiol 2006;13:S5.CrossRefGoogle Scholar
  5. 5.
    McCord ME, Bacharach SL, Bonow RO, Dilsizian V, Cuocolo A, Freedman N. Misalignment between PET transmission and emission scans: its effect on myocardial imaging. J Nucl Med. 1992;33:1209–14.PubMedGoogle Scholar
  6. 6.
    Fitzpatrick GM, Wells RG. Simulation study of respiratory-induced errors in cardiac positron emission tomography/computed tomography. Med Phys. 2006;33:2888–95.PubMedCrossRefGoogle Scholar
  7. 7.
    Gould KL, Pan T, Loghin C, Johnson NP, Guha A, Sdringola S. Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: a definitive analysis of causes, consequences, and corrections. J Nucl Med. 2007;48:1112–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Loghin C, Sdringola S, Gould KL. Common artifacts in PET myocardial perfusion images due to attenuation-emission misregistration: clinical significance, causes, and solutions. J Nucl Med. 2004;45:1029–39.PubMedGoogle Scholar
  9. 9.
    Le Meunier L, Maass-Moreno R, Carrasquillo JA, Dieckmann W, Bacharach SL. PET/CT imaging: effect of respiratory motion on apparent myocardial uptake J Nucl Cardiol. 2006;13:821–30.PubMedCrossRefGoogle Scholar
  10. 10.
    Martinez-Moller A, Souvatzoglou M, Navab N, Schwaiger M, Nekolla SG. Artifacts from misaligned CT in cardiac perfusion PET/CT studies: frequency, effects, and potential solutions. J Nucl Med. 2007;48:188–93.PubMedGoogle Scholar
  11. 11.
    Cook R, Carnes G, Ting-Yim L, Wells RG. 4D CT for respiratory gated attenuation corrections in canine cardiac PET imaging. In: IEEE Nuclear Science Symposium Conference Record, NSS-MIC 2005, pp 2408–12.Google Scholar
  12. 12.
    Matsunari I, Boning G, Ziegler SI, Kosa I, Nekolla SG, Ficaro EP, et al. Effects of misalignment between transmission and emission scans on attenuation-corrected cardiac SPECT. J Nucl Med. 1998;39:411–6.PubMedGoogle Scholar
  13. 13.
    King MA, Tsui BMW, Pan TS. Attenuation compensation for cardiac single-photon emission computed tomographic imaging: part 1. Impact of attenuation and methods of estimating attenuation maps. J Nucl Cardiol. 1995;2:513–24.PubMedCrossRefGoogle Scholar
  14. 14.
    Hendel RC, Corbett JR, Cullom SJ, DePuey EG, Garcia EV, Bateman TM. The value and practice of attenuation correction for myocardial perfusion SPECT imaging: a joint position statement from the American Society of Nuclear Cardiology and the Society of Nuclear Medicine. J Nucl Cardiol. 2002;9:135–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Singh B, Bateman TM, Case JA, Heller G. Attenuation artifact, attenuation correction, and the future of myocardial perfusion SPECT. J Nucl Cardiol. 2007;14:153–64.PubMedCrossRefGoogle Scholar
  16. 16.
    Pitman AG, Kalff V, Van Every B, Risa B, Barnden LR, Kelly MJ. Effect of mechanically simulated diaphragmatic respiratory motion on myocardial SPECT processed with and without attenuation correction. J Nucl Med. 2002;43:1259–67.PubMedGoogle Scholar
  17. 17.
    Goetze S, Wahl RL. Prevalence of misregistration between SPECT and CT for attenuation-corrected myocardial perfusion SPECT. J Nucl Cardiol. 2007;14:200–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Wang Y, Riederer SJ, Ehman RL. Respiratory motion of the heart: kinematics and the implications for the spatial resolution in coronary imaging. Magn Reson Med. 1995;33:713–9.PubMedCrossRefGoogle Scholar
  19. 19.
    McLeish K, Hill DLG, Atkinson D, Blackall JM, Razavi R. A study of the motion and deformation of the heart due to respiration. IEEE Trans Med Imag 2002;21:1142–50.CrossRefGoogle Scholar
  20. 20.
    Danias PG, Stuber M, Botnar RM, Kissinger KV, Edelman RR, Manning WJ. Relationship between motion of coronary arteries and diaphragm during free breathing: lessons from real-time MR imaging. Am J Roentgenol. 1999;172:1061–5.Google Scholar
  21. 21.
    Martin SJ, Dey J, King MA, Hutton BF. Segmenting and tracking diaphragm and heart regions in gated-CT datasets as an aid to developing a predictive model for respiratory motion-correction. In: IEEE Nuclear Science Symposium Conference Record, NSS-MIC 2007, pp 2680-5.Google Scholar
  22. 22.
    Segars WP, Lalush DS, Tsui BMW. Modeling respiratory mechanics in the MCAT and spline-based MCAT phantoms. IEEE Trans Nucl Sci. 2001;48:89–97.CrossRefGoogle Scholar
  23. 23.
    Ackerman MJ. The Visible Human Project. Proceedings of the IEEE 1998;86:504–11.CrossRefGoogle Scholar
  24. 24.
    Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imag. 1994;13:601–9.CrossRefGoogle Scholar
  25. 25.
    Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42.PubMedCrossRefGoogle Scholar
  26. 26.
    Meikle SR, Dahlbom M, Cherry SR. Attenuation correction using count-limited transmission data in positron emission tomography. J Nucl Med. 1993;34:143–50.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Institute of Nuclear MedicineUniversity College LondonLondonUK

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