PET-enabled dual-energy CT: image reconstruction and a proof-of-concept computer simulation study

Standard dual-energy computed tomography (CT) uses two different x-ray energies to obtain energy-dependent tissue attenuation information to allow quantitative material decomposition. The combined use of dual-energy CT and positron emission tomography (PET) may provide a more comprehensive characterization of disease states in cancer and other diseases. However, the integration of dual-energy CT with PET is not trivial, either requiring costly hardware upgrades or increasing radiation exposure. This paper proposes a different dual-energy CT imaging method that is enabled by PET. Instead of using a second x-ray CT scan with a different energy, this method exploits time-of-flight PET image reconstruction via the maximum likelihood attenuation and activity (MLAA) algorithm to obtain a 511 keV gamma-ray attenuation image from PET emission data. The high-energy gamma-ray attenuation image is then combined with the low-energy x-ray CT of PET/CT to provide a pair of dual-energy CT images. A major challenge with the standard MLAA reconstruction is the high noise present in the reconstructed 511 keV attenuation map, which would not compromise the PET activity reconstruction too much but may significantly affect the performance of the gamma-ray attenuation image for material decomposition. To overcome the problem, we further propose a kernel MLAA algorithm to exploit the prior information from the available x-ray CT image. We conducted a computer simulation to test the concept and algorithm for the task of material decomposition. The simulation results demonstrate that this PET-enabled dual-energy CT method is promising for quantitative material decomposition. The proposed method can be readily implemented on time-of-flight PET/CT scanners to enable simultaneous PET and dual-energy CT imaging.