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Clinical issues regarding misclassification by Dixon based PET/MR attenuation correction.

Eunjung Kong1, Ihnho Cho

  • 1317-1 Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea. ihcho@med.yu.ac.kr.

Hellenic Journal of Nuclear Medicine
|April 5, 2015
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Summary

Fluid volume is key to accurate PET/MR imaging. Insufficient hydration can lead to Dixon sequence misclassifications, impacting quantitative analysis. Always check Dixon images before interpreting PET/MR scans.

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Area of Science:

  • Medical Imaging
  • Radiology
  • Nuclear Medicine

Background:

  • The Dixon sequence is crucial for attenuation correction (AC) in integrated PET/MR imaging.
  • Misclassification of soft tissue and fat in the μ-map can occur, affecting image accuracy.

Purpose of the Study:

  • To investigate factors contributing to Dixon sequence misclassifications in PET/MR.
  • To analyze the clinical impact of these misclassifications on PET quantification.

Main Methods:

  • 48 oncological patients underwent PET/CT and PET/MR scans with fluorine-18 fluorodeoxyglucose ((18)F-FDG).
  • Patients were grouped based on μ-map classification accuracy (Group A: misclassified, Group B: correctly classified).
  • Factors compared included BMI, hydration volume, and age; PET quantification was assessed using Standard Uptake Ratio (SUR).

Main Results:

  • Misclassification occurred in 21% of patients.
  • Lower hydration volume was significantly associated with misclassification (Group A: 245mL vs. Group B: 452.6mL, P=0.027).
  • Dixon-AC SUR/CT-AC SUR ratios differed significantly between misclassified (0.80) and correctly classified (0.93) regions (P=0.046).

Conclusions:

  • Hydration status is a critical factor influencing Dixon sequence accuracy in PET/MR.
  • Pre-examination checks of Dixon images and μ-maps are recommended.
  • While misclassifications don't alter (18)F-FDG uptake presence, they can significantly impact PET quantification.