Validation of postinjection transmission measurements for attenuation correction in neurological FDG-PET studies

Accurate estimation of local cerebral metabolic rate of glucose utilization (LCMRGlu) with PET requires a separate measurement of photon attenuation using a transmission source that extends study duration. The feasibility of postinjection transmission, (PIT) scanning has been demonstrated but not previously validated in humans.

Preinjection and postinjection transmission scans were performed in 26 patients undergoing routine [18F]fluorodeoxyglucose (FDG) neurological PET. The PIT data were processed with two methods: One estimated emission contamination using an independent emission scan (PITind); the other estimated the contamination directly from the PIT scan, using simultaneously acquired emission data for subtraction (PITsim). These methods were compared with measured attenuation correction (AC) using preinjection transmission data (ACpre) and calculated AC (ACcalc). After reconstruction, image data were reformatted to fit a standard brain atlas to facilitate analysis of the region of interest and to allow subtraction of datasets averaged over all subjects.

The ratios of LCMRGlu values with respect to those obtained by the ACpre method ranged from 0.98 to 1.06 (mean +/- s.d., 1.01 +/- 0.02) for PITind, from 0.96 to 1.04 (mean 0.99 +/- 0.02) for PITsim and from 0.77 to 1.12 (mean 0.96 +/- 0.07) for ACcalc. Both PIT methods agreed well with the ACpre method, whereas ACcalc gave rise to appreciable bias in structures near thick bone or sinuses.

Accurate quantitative estimates of LCMRGlu can be obtained using PIT measurements. The PIT methods shorten study duration and increase patient throughput. The PITsim method has the further advantage that it is not affected by tracer redistribution and can therefore be applied to tracers with relatively rapid kinetics in vivo.