The Effect of Including Bone in Dixon-Based Attenuation Correction for 18F-Fluciclovine PET/MRI of Prostate Cancer

J Nucl Med. 2018 Dec;59(12):1913-1917. doi: 10.2967/jnumed.118.208868. Epub 2018 May 4.

Abstract

The objective of this study was to evaluate the effect of including bone in Dixon-based attenuation correction for 18F-fluciclovine PET/MRI of primary and recurrent prostate cancer. Methods:18F-fluciclovine PET data from 2 PET/MRI studies-one for staging of high-risk prostate cancer (28 patients) and one for diagnosis of recurrent prostate cancer (81 patients)-were reconstructed with a 4-compartment (reference) and 5-compartment attenuation map. In the latter, continuous linear attenuation coefficients for bone were included by coregistration with an atlas. The SUVmax and mean 50% isocontour SUV (SUViso) of primary, locally recurrent, and metastatic lesions were compared between the 2 reconstruction methods using linear mixed-effects models. In addition, mean SUVs were obtained from bone marrow in the third lumbar vertebra (L3) to investigate the effect of including bone attenuation on lesion-to-bone marrow SUV ratios (SUVRmax and SUVRiso; recurrence study only). The 5-compartment attenuation maps were visually compared with the in-phase Dixon MR images for evaluation of bone registration errors near the lesions. P values of less than 0.05 were considered significant. Results: Sixty-two lesions from 39 patients were evaluated. Bone registration errors were found near 19 (31%) of these lesions. In the remaining 8 primary prostate tumors, 7 locally recurrent lesions, and 28 lymph node metastases without bone registration errors, use of the 5-compartment attenuation map was associated with small but significant increases in SUVmax (2.5%; 95% confidence interval [CI], 2.0%-3.0%; P < 0.001) and SUViso (2.5%; 95% CI, 1.9%-3.0%; P < 0.001), but not SUVRmax (0.2%; 95% CI, -0.5%-0.9%; P = 0.604) and SUVRiso (0.2%; 95% CI -0.6%-1.0%; P = 0.581), in comparison to the 4-compartment attenuation map. Conclusion: The investigated method for atlas-based inclusion of bone in 18F-fluciclovine PET/MRI attenuation correction has only a small effect on the SUVs of soft-tissue prostate cancer lesions, and no effect on their lesion-to-bone marrow SUVRs when using signal from L3 as a reference. The attenuation maps should always be checked for registration artifacts for lesions in or close to the bones.

Keywords: FACBC; PET/MRI; attenuation correction; fluciclovine; prostate cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Bone and Bones / diagnostic imaging*
  • Carboxylic Acids*
  • Cohort Studies
  • Cyclobutanes*
  • Fluorine Radioisotopes
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Imaging / statistics & numerical data
  • Male
  • Multimodal Imaging / methods
  • Multimodal Imaging / statistics & numerical data
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasm Staging
  • Positron-Emission Tomography / methods*
  • Positron-Emission Tomography / statistics & numerical data
  • Prostatic Neoplasms / diagnostic imaging*
  • Radiopharmaceuticals
  • Retrospective Studies

Substances

  • Carboxylic Acids
  • Cyclobutanes
  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • fluciclovine F-18
  • Fluorine-18