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Am J Nucl Med Mol Imaging 2013;3(3):291-299
Original Article
Image quality assessment of automatic three-segment MR attenua-tion correction
vs. CT attenuation correction
Sasan Partovi, Andres Kohan, Chiara Gaeta, Christian Rubbert, Jose L Vercher-Conejero, Robert S Jones, James K O’Donnell,
Patrick Wojtylak, Peter Faulhaber
University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, 11100 Euclid Avenue,
Cleveland, OH 44106
Received January 19, 2013; Accepted March 11, 2013; Epub April 9, 2013; Published April 15, 2013
Abstract: The purpose of this study is to systematically evaluate the usefulness of Positron emission tomography/Magnetic
resonance imaging (PET/MRI) images in a clinical setting by assessing the image quality of Positron emission tomography (PET)
images using a three-segment MR attenuation correction (MRAC) versus the standard CT attenuation correction (CTAC). We
prospectively studied 48 patients who had their clinically scheduled FDG-PET/CT followed by an FDG-PET/MRI. Three nuclear
radiologists evaluated the image quality of CTAC vs. MRAC using a Likert scale (five-point scale). A two-sided, paired t-test was
performed for comparison purposes. The image quality was further assessed by categorizing it as acceptable (equal to 4 and 5 on
the five-point Likert scale) or unacceptable (equal to 1, 2, and 3 on the five-point Likert scale) quality using the McNemar test. When
assessing the image quality using the Likert scale, one reader observed a significant difference between CTAC and MRAC (p=0.
0015), whereas the other readers did not observe a difference (p=0.8924 and p=0.1880, respectively). When performing the grouping
analysis, no significant difference was found between CTAC vs. MRAC for any of the readers (p=0.6137 for reader 1, p=1 for reader 2,
and p=0.8137 for reader 3). All three readers more often reported artifacts on the MRAC images than on the CTAC images. There
was no clinically significant difference in quality between PET images generated on a PET/MRI system and those from a Positron
emission tomography/Computed tomography (PET/CT) system. PET images using the automatic three-segmented MR attenuation
method provided diagnostic image quality. However, future research regarding the image quality obtained using different MR
attenuation based methods is warranted before PET/MRI can be used clinically. (ajnmmi1301005).
Keywords: PET/CT, PET/MRI, FDG, attenuation correction, image quality, hybrid imaging
Address correspondence to: Peter Faulhaber, Department of Radiology, University Hospitals Case Medical Center, Case Western
Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106. Phone: 216-844-8140; Fax: 216-844-3106; E-mail: Peter.
Faulhaber@uhhospitals.org
Original Article
Image quality assessment of automatic three-segment MR attenua-tion correction
vs. CT attenuation correction
Sasan Partovi, Andres Kohan, Chiara Gaeta, Christian Rubbert, Jose L Vercher-Conejero, Robert S Jones, James K O’Donnell,
Patrick Wojtylak, Peter Faulhaber
University Hospitals Case Medical Center, Case Western Reserve University, Department of Radiology, 11100 Euclid Avenue,
Cleveland, OH 44106
Received January 19, 2013; Accepted March 11, 2013; Epub April 9, 2013; Published April 15, 2013
Abstract: The purpose of this study is to systematically evaluate the usefulness of Positron emission tomography/Magnetic
resonance imaging (PET/MRI) images in a clinical setting by assessing the image quality of Positron emission tomography (PET)
images using a three-segment MR attenuation correction (MRAC) versus the standard CT attenuation correction (CTAC). We
prospectively studied 48 patients who had their clinically scheduled FDG-PET/CT followed by an FDG-PET/MRI. Three nuclear
radiologists evaluated the image quality of CTAC vs. MRAC using a Likert scale (five-point scale). A two-sided, paired t-test was
performed for comparison purposes. The image quality was further assessed by categorizing it as acceptable (equal to 4 and 5 on
the five-point Likert scale) or unacceptable (equal to 1, 2, and 3 on the five-point Likert scale) quality using the McNemar test. When
assessing the image quality using the Likert scale, one reader observed a significant difference between CTAC and MRAC (p=0.
0015), whereas the other readers did not observe a difference (p=0.8924 and p=0.1880, respectively). When performing the grouping
analysis, no significant difference was found between CTAC vs. MRAC for any of the readers (p=0.6137 for reader 1, p=1 for reader 2,
and p=0.8137 for reader 3). All three readers more often reported artifacts on the MRAC images than on the CTAC images. There
was no clinically significant difference in quality between PET images generated on a PET/MRI system and those from a Positron
emission tomography/Computed tomography (PET/CT) system. PET images using the automatic three-segmented MR attenuation
method provided diagnostic image quality. However, future research regarding the image quality obtained using different MR
attenuation based methods is warranted before PET/MRI can be used clinically. (ajnmmi1301005).
Keywords: PET/CT, PET/MRI, FDG, attenuation correction, image quality, hybrid imaging
Address correspondence to: Peter Faulhaber, Department of Radiology, University Hospitals Case Medical Center, Case Western
Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106. Phone: 216-844-8140; Fax: 216-844-3106; E-mail: Peter.
Faulhaber@uhhospitals.org
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