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

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. 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. 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.