MRI-guided attenuation correction in torso PET/MRI: Assessment of segmentation-, atlas-, and deep learning-based approaches in the presence of outliers

Purpose We compare the performance of three commonly used MRI-guided attenuation correction approaches in torso PET/MRI, namely segmentation-, atlas-, and deep learning-based algorithms. Methods Twenty-five co-registered torso F-18-FDG PET/CT and PET/MR images were enrolled. PET attenuation maps were generated from in-phase Dixon MRI using a three-tissue class segmentation-based approach (soft-tissue, lung, and background air), voxel-wise weighting atlas-based approach, and a residual convolutional neural network. The bias in standardized uptake value (SUV) was calculated for each approach considering CT-based attenuation corrected PET images as reference. In addition to the overall performance assessment of these approaches, the primary focus of this work was on recognizing the origins of potential outliers, notably body truncation, metal-artifacts, abnormal anatomy, and small malignant lesions in the lungs. Results The deep learning approach outperformed both atlas- and segmentation-based methods resulting in less than 4% SUV bias across 25 patients compared to the segmentation-based method with up to 20% SUV bias in bony structures and the atlas-based method with 9% bias in the lung. The deep learning-based method exhibited superior performance. Yet, in case of sever truncation and metallic-artifacts in the input MRI, this approach was outperformed by the atlas-based method, exhibiting suboptimal performance in the affected regions. Conversely, for abnormal anatomies, such as a patient presenting with one lung or small malignant lesion in the lung, the deep learning algorithm exhibited promising performance compared to other methods. Conclusion The deep learning-based method provides promising outcome for synthetic CT generation from MRI. However, metal-artifact and body truncation should be specifically addressed.