title: Qualitative FDG PET Image Assessment Using Automated Three-Segment MR Attenuation Correction Versus CT Attenuation Correction in a Tertiary Pediatric Hospital: A Prospective Study.
abstract: OBJECTIVE
  The purpose of this study was to systematically evaluate the diagnostic quality of (18)F-FDG PET images generated using MR attenuation correction (MRAC) compared with those images generated using CT attenuation correction (CTAC) in a pediatric population.
  
  
  METHODS
  Forty-two patients (mean age, 12.8 years; percentage who were male, 57%) who were referred for 62 indicated whole-body PET/CT studies were prospectively recruited to undergo PET/MRI examinations during the same clinic visit in which PET/CT was performed. MRAC was performed using an automatic three-segment model. Three nuclear radiologists scored the diagnostic quality of the PET images generated by MRAC and CTAC using a Likert scale (range of scores, 1-5). Images graded with a score of 1-3 were considered clinically unacceptable, whereas images with a score of 4-5 were considered clinically acceptable. A Wilcoxon signed-rank test was used to compare differences in the grading of PET/MRI and PET/CT images. The Fisher exact test was used to evaluate potential differences in clinically acceptable image quality and the presence of artifact. Fleiss kappa statistics were used to examine interobserver agreement.
  
  
  RESULTS
  There was no statistically significant difference in the proportion of PET images generated with MRAC and CTAC for which image quality was considered clinically acceptable. A total of 3.9% of PET assessments generated with MRAC were of unacceptable image quality, compared with 2.2% of PET images generated with CTAC. Two of the three radiologists who reviewed the PET images reported the presence of artifacts more often on MRAC-derived images, and they graded the mean quality of these images 0.48 and 0.29 points lower on the 5-point Likert scale than they graded the mean quality of CTAC-derived images (p < 0.0001). Interobserver agreement was fair (κ = 0.39).
  
  
  CONCLUSIONS
  The diagnostic quality of PET images obtained from a pediatric population with the use of an automatic three-segmentation MRAC method was comparable to that of PET images obtained with the use of CTAC.
authors: 1 Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St, Ste 470, Houston, TX 77030.
authors: Karen
authors: K
authors: Lyons
authors: 1 Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St, Ste 470, Houston, TX 77030.
authors: Victor
authors: V
authors: Seghers
authors: 1 Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St, Ste 470, Houston, TX 77030.|2 Present address: Department of Radiology, Florida Hospital for Children, Maitland, FL.
authors: Jennifer L
authors: JL
authors: Williams
authors: 3 Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX.
authors: James I L
authors: JI
authors: Sorensen
authors: 1 Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St, Ste 470, Houston, TX 77030.
authors: Michael J
authors: MJ
authors: Paldino
authors: 1 Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St, Ste 470, Houston, TX 77030.
authors: Rajesh
authors: R
authors: Krishnamurthy
authors: 4 Department of Nuclear Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX.
authors: Eric M
authors: EM
authors: Rohren
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: MR attenuation correction; PET/MRI; image quality; pediatric; qualitative assessment