Deep learning-based T1-enhanced selection of linear attenuation coefficients (DL-TESLA) for PET/MR attenuation correction in dementia neuroimaging

Purpose: The accuracy of existing PET/MR attenuation correction (AC) has been limited by a lack of correlation between MR signal and tissue electron density. Based on our finding that longitudinal relaxation rate, or R-1, is associated with CT Hounsfield unit in bone and soft tissues in the brain, we propose a deep learning T-1-enhanced selection of linear attenuation coefficients (DL-TESLA) method to incorporate quantitative R-1 for PET/MR AC and evaluate its accuracy and longitudinal test-retest repeatability in brain PET/MR imaging. Methods: DL-TESLA uses a 3D residual UNet (ResUNet) for pseudo-CT (pCT) estimation. With a total of 174 participants, we compared PET AC accuracy of DL-TESLA to 3 other methods adopting similar 3D ResUNet structures but using UTE R-2*, or Dixon, or T-1-MPRAGE as input. With images from 23 additional participants repeatedly scanned, the test-retest differences and within-subject coefficient of variation of standardized uptake value ratios (SUVR) were compared between PET images reconstructed using either DL-TESLA or CT for AC. Results: DL-TESLA had (1) significantly lower mean absolute error in pCT, (2) the highest Dice coefficients in both bone and air, (3) significantly lower PET relative absolute error in whole brain and various brain regions, (4) the highest percentage of voxels with a PET relative error within both +/- 3% and +/- 5%, (5) similar to CT test-retest differences in SUVRs from the cerebrum and mean cortical (MC) region, and (6) similar to CT within-subject coefficient of variation in cerebrum and MC. Conclusion: DL-TESLA demonstrates excellent PET/MR AC accuracy and test-retest repeatability.

Automated summary

The study proposed a deep learning T-1-enhanced selection of linear attenuation coefficients (DL-TESLA) method based on the correlation between R-1 relaxation rate and CT Hounsfield unit, demonstrating excellent accuracy and longitudinal test-retest repeatability in brain PET/MR imaging.