CT-less Direct Correction of Attenuation and Scatter in the Image Space Using Deep Learning for Whole-Body FDG PET: Potential Benefits and Pitfalls.

PURPOSE: To demonstrate the feasibility of CT-less attenuation and scatter correction (ASC) in the image space using deep learning for whole-body PET, with a focus on the potential benefits and pitfalls.
MATERIALS AND METHODS: In this retrospective study, 110 whole-body fluorodeoxyglucose (FDG) PET/CT studies acquired in 107 patients (mean age ± standard deviation, 58 years ± 18; age range, 11-92 years; 72 females) from February 2016 through January 2018 were randomly collected. A total of 37.3% (41 of 110) of the studies showed metastases, with diverse FDG PET findings throughout the whole body. A U-Net-based network was developed for directly transforming noncorrected PET (PETNC) into attenuation- and scatter-corrected PET (PETASC). Deep learning-corrected PET (PETDL) images were quantitatively evaluated by using the standardized uptake value (SUV) of the normalized root mean square error, the peak signal-to-noise ratio, and the structural similarity index, in addition to a joint histogram for statistical analysis. Qualitative reviews by radiologists revealed the potential benefits and pitfalls of this correction method.
RESULTS: The normalized root mean square error (0.21 ± 0.05 [mean SUV ± standard deviation]), mean peak signal-to-noise ratio (36.3 ± 3.0), mean structural similarity index (0.98 ± 0.01), and voxelwise correlation (97.62%) of PETDL demonstrated quantitatively high similarity with PETASC. Radiologist reviews revealed the overall quality of PETDL. The potential benefits of PETDL include a radiation dose reduction on follow-up scans and artifact removal in the regions with attenuation correction- and scatter correction-based artifacts. The pitfalls involve potential false-negative results due to blurring or missing lesions or false-positive results due to pseudo-low-uptake patterns.
CONCLUSION: Deep learning-based direct ASC at whole-body PET is feasible and potentially can be used to overcome the current limitations of CT-based approaches, benefiting patients who are sensitive to radiation from CT.Supplemental material is available for this article.© RSNA, 2020. 2021 by the Radiological Society of North America, Inc.