Accuracy and precision of zero-echo-time, single- and multi-atlas attenuation correction for dynamic [(11)C]PE2I PET-MR brain imaging

BACKGROUND: A valid photon attenuation correction (AC) method is instrumental for obtaining quantitatively correct PET images. Integrated PET/MR systems provide no direct information on attenuation, and novel methods for MR-based AC (MRAC) are still under investigation. Evaluations of various AC methods have mainly focused on static brain PET acquisitions. In this study, we determined the validity of three MRAC methods in a dynamic PET/MR study of the brain. METHODS: Nine participants underwent dynamic brain PET/MR scanning using the dopamine transporter radioligand [(11)C]PE2I. Three MRAC methods were evaluated: single-atlas (Atlas), multi-atlas (MaxProb) and zero-echo-time (ZTE). The (68)Ge-transmission data from a previous stand-alone PET scan was used as reference method. Parametric relative delivery (R(1)) images and binding potential (BP(ND)) maps were generated using cerebellar grey matter as reference region. Evaluation was based on bias in MRAC maps, accuracy and precision of [(11)C]PE2I BP(ND) and R(1) estimates, and [(11)C]PE2I time-activity curves. BP(ND) was examined for striatal regions and R(1) in clusters of regions across the brain. RESULTS: For BP(ND), ZTE-MRAC showed the highest accuracy (bias < 2%) in striatal regions. Atlas-MRAC exhibited a significant bias in caudate nucleus (− 12%) while MaxProb-MRAC revealed a substantial, non-significant bias in the putamen (9%). R(1) estimates had a marginal bias for all MRAC methods (− 1.0–3.2%). MaxProb-MRAC showed the largest intersubject variability for both R(1) and BP(ND). Standardized uptake values (SUV) of striatal regions displayed the strongest average bias for ZTE-MRAC (~ 10%), although constant over time and with the smallest intersubject variability. Atlas-MRAC had highest variation in bias over time (+10 to − 10%), followed by MaxProb-MRAC (+5 to − 5%), but MaxProb showed the lowest mean bias. For the cerebellum, MaxProb-MRAC showed the highest variability while bias was constant over time for Atlas- and ZTE-MRAC. CONCLUSIONS: Both Maxprob- and ZTE-MRAC performed better than Atlas-MRAC when using a (68)Ge transmission scan as reference method. Overall, ZTE-MRAC showed the highest precision and accuracy in outcome parameters of dynamic [(11)C]PE2I PET analysis with use of kinetic modelling.