MR-based truncation correction using an advanced HUGE method to improve attenuation correction in PET/MR imaging of obese patients

Purpose Truncation artifacts in the periphery of the magnetic resonance (MR) field-of-view (FOV) and thus, in the MR-based attenuation correction (AC) map, may hamper accurate positron emission tomography (PET) quantification in whole-body PET/MR, which is especially problematic in patients with obesity with overall large body dimensions. Therefore, an advanced truncation correction (TC) method to extend the conventional MR FOV is needed. Methods The extent of MR-based AC-map truncations in obese patients was determined in a dataset including n = 10 patients that underwent whole-body PET/MR exams. Patient inclusion criteria were defined as BMI > 30 kg/m(2) and body weight > 100 kg. Truncations in PET/MR patients with obesity were quantified comparing the MR-based AC-map volume to segmented non-AC PET data, serving as the reference body volume without truncations to demonstrate the need of improved TC. The new method implemented in this study, termed "advanced HUGE," was modified and extended from the original HUGE method by Blumhagen et al. in order to provide improved TC across the entire axial MR FOV and to unlock new clinical applications of PET/MR. Advanced HUGE was then systematically tested in PET/MR NEMA phantom measurements. Relative differences between computed tomography (CT) AC PET data of the phantom setup (reference) and MR-based Dixon AC, respectively Dixon + advanced HUGE AC, were calculated. The applicability of the method for advanced TC was then demonstrated in first MR-based measurements in healthy volunteers. Results It was found that the MR-based AC maps of obese patients often reveal truncations in the anterior-posterior direction. Especially, the abdominal region could benefit from improved TC, where maximal relative differences in the AC-map volume up to -17% were calculated. Applying advanced HUGE to improve the MR-based AC in PET/MR, PET quantification errors in the large-volume phantom setup could be considerably reduced from average -18.6% (Dixon AC) to 4.6% compared to the CT AC reference. Volunteer measurements demonstrate that formerly missing AC-map volume in the Dixon-VIBE AC-map could be added due to advanced HUGE in the anterior-posterior direction and thus, potentially improves AC in PET/MR. Conclusions The advanced HUGE method for truncation correction considerably reduces truncations in the anterior-posterior direction demonstrated in phantom measurements and healthy volunteers and thus, further improves MR-based AC in PET/MR imaging.