Crossover evaluation of time-of-flight-based attenuation correction in brain ¹⁸F-FDG and ¹⁸F-flutemetamol PET

Brain-dedicated positron emission tomography (PET) systems offer high spatial resolution and sensitivity for accurate clinical assessments. Attenuation correction (AC) is important in PET imaging, particularly in brain studies. This study assessed the reproducibility of attenuation maps (µ-maps) generated by a specialized time-of-flight (TOF) brain-dedicated PET system for imaging using different PET tracers.

Twelve subjects underwent both ¹⁸F-fluorodeoxyglucose (FDG)-PET and ¹⁸F-flutemetamol (FMM) amyloid-PET scans. Images were reconstructed with µ-maps obtained by a maximum likelihood-based AC method. Voxel-based and region-based analyses were used to compare µ-maps obtained with FDG-PET versus FMM-PET; FDG-PET images reconstructed using an FDG-PET µ-map (FDG × FDG) versus those reconstructed with an FMM-PET µ-map (FDG × FMM); and FMM-PET images reconstructed using an FDG-PET µ-map (FMM × FDG) versus those reconstructed with an FMM-PET µ-map (FMM × FMM).

Small but significant differences in µ-maps were observed between tracers, primarily in bone regions. In the comparison between the µ-maps obtained with FDG-PET and FMM-PET, the µ-maps obtained with FDG-PET had higher µ-values than those obtained with FMM-PET in the parietal regions of the head and skull, in a portion of the cerebellar dentate nucleus and on the surface of the frontal lobe. The comparison between FDG and FDG × FMM values in different regions yielded findings similar to those of the µ-maps comparison. FDG × FMM values were significantly higher than FDG values in the bilateral temporal bones and a small part of the temporal lobe. Similarly, FMM values were significantly higher than FMM × FDG values in the bilateral temporal bones. FMM × FDG values were significantly higher than FMM values in a small area of the right cerebellar hemisphere. However, the relative errors in these µ-maps were within ± 4%, suggesting that they are clinically insignificant. In PET images reconstructed with the original and swapped µ-maps, the relative errors were within ± 7% and the quality was nearly equivalent.

These findings suggest the clinical reliability of the AC method without an external radiation source in TOF brain-dedicated PET systems.