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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2022 Feb 04

DOI: 10.23736/S1824-4785.22.03389-1


lingua: Inglese

(11) C-Methionine Positron Emission Tomography/Magnetic Resonance Imaging in postoperative patients after craniotomy: Zero echo time and Head Atlas versus Computed Tomography based attenuation correction

Francesca DE LUCA 1, 2 , Martin BOLIN 1, 3, Lennart BLOMQVIST 3, 4, Cecilia WASSBERG 3, Heather MARTIN 2, Anna FALK DELGADO 1, 2

1 Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; 2 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; 3 Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; 4 Department of Molecular Medicine and Surgery Karolinska Institutet, Solna, Sweden

BACKGROUND: Attenuation correction (AC) is an important topic in PET/MRI and particularly challenging after brain tumour surgery, near metal implants, adjacent bone and burr holes. In this study, we evaluated the performance of two MR-driven AC methods, ZTE- and atlas-AC, in comparison to reference standard CT-AC in patients with surgically treated brain tumors at 11C-Methionine PET/MRI.
METHODS: This retrospective study investigated seven postoperative patients with neuropathologically confirmed brain tumour at 11C-Methionine PET/MRI. Three AC maps - ZTE-AC, atlas-AC and reference standard CT-AC - were generated for each patient. Standardised uptake values (SUV) were obtained at the metal implant, adjacent bone and burr hole. Standard uptake ratio (SUR) SURmetal/mirror, SURbone/mirror and SURburrhole/mirror were then calculated and analyzed with Bland-Altman, Pearson correlation and intraclass correlation reliability.
RESULTS: Smaller mean bias range % (Bland-Altman) was found for ZTE- than atlas-AC in all analyses (Metal ZTE -0.46 - -0.02, Metal atlas -3.57 - -3.26; Bone ZTE -4.60- -2.16, Bone atlas -5.25- -3.81; Burr hole ZTE -0.95- -0.52, Burr hole atlas 7.86-8.87). SD range % (Bland-Altman) was large for both methods in all analyses, with lower absolute values for ZTE-AC (ZTE 7.02-8.49; Atlas 11.47-14.83). A very strong correlation (Pearson correlation) was demonstrated for both methods compared to CT-AC (ZTE ρ 0.97-0.99, p <0.001; atlas ρ 0.88-0.91, p ≤0.009) with higher absolute values for ZTE. An excellent intraclass correlation
coefficient was found across all analyses for ZTE, atlas and CT maps (ICC ≥0.88).
CONCLUSIONS: ZTE for MR-driven PET attenuation correction presented a more comparable performance to reference standard CT-AC at the postoperative site. ZTE-AC may serve as a useful diagnostic tool for MR-driven AC in patients with surgically treated brain tumors.

KEY WORDS: Attenuation correction; PET/MRI; ZTE-AC; atlas-AC; CT-AC

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