Dual energy CT attenuation correction methods for quantitative assessment of response to cancer therapy with PET/CT imaging.

We hypothesize that improved quantification for PET imaging of high atomic number materials can be achieved by combining low-dose x-ray imaging with dual energy CT for PET attenuation correction. Improved quantification of tracer uptake will lead to improved patient outcomes by providing more accurate information for therapeutic choices. Accurate PET/CT measurements of early response will be critical in determining the best cancer therapy option for each patient in a timely manner and in sparing patients the morbidity and cost of ineffective treatments. We first evaluate the potential errors in PET images arising from CT-based attenuation correction when iodine-based contrast is incorrectly classified as bone when forming the linear attenuation coefficient image. We then investigate two methods of reducing errors in the linear attenuation image: an approximate, but fast, hybrid classification/scaling algorithm and a model-based dual-energy CT method that incorporates the polyenergetic spectrum and a noise model in an iterative reconstruction method. Both methods are shown to reduce errors in the estimated linear attenuation coefficient image, but require further study to determine the effects of noise propagation if low-dose CT scans are used for the estimation of the linear attenuation image.