Accurate quantification in positron emission tomography (PET) is essential for accurate diagnostic results and effective treatment tracking. A major issue encountered in PET imaging is attenuation. Attenuation refers to the diminution of photon detected as they traverse biological tissues before reaching detectors. When such corrections are absent or inadequate, this signal degradation can introduce inaccurate quantification, making it difficult to differentiate benign from malignant conditions, and can potentially lead to misdiagnosis. Typically, this correction is done with co-computed Computed Tomography (CT) imaging to obtain structural data for calculating photon attenuation across the body. However, this methodology subjects patients to extra ionizing radiation exposure, suffers from potential spatial misregistration between PET/CT imaging sequences, and demands costly equipment infrastructure. Emerging advances in neural network architectures present an alternative approach via synthetic CT image synthesis. Our investigation reveals that Conditional Denoising Diffusion Probabilistic Models (DDPMs) can generate high quality CT images from non attenuation corrected PET images in order to correct attenuation. By utilizing all three orthogonal views from non-attenuation-corrected PET images, the DDPM approach combined with ensemble voting generates higher quality pseudo-CT images with reduced artifacts and improved slice-to-slice consistency. Results from a study of 159 head scans acquired with the Siemens Biograph Vision PET/CT scanner demonstrate both qualitative and quantitative improvements in pseudo-CT generation. The method achieved a mean absolute error of 32 $\pm$ 10.4 HU on the CT images and an average error of (1.48 $\pm$ 0.68)\% across all regions of interest when comparing PET images reconstructed using the attenuation map of the generated pseudo-CT versus the true CT.

Positron Emission Tomography (PET) imaging requires accurate attenuation correction (AC) to account for photon loss due to tissue density variations. In PET/MR systems, computed tomography (CT), which offers a straightforward estimation of AC is not available. This study presents a deep learning approach to generate synthetic CT (sCT) images directly from Time-of-Flight (TOF) non-attenuation corrected (NAC) PET images, enhancing AC for PET/MR. We first evaluated models pre-trained on large-scale natural image datasets for a CT-to-CT reconstruction task, finding that the pre-trained model outperformed those trained solely on medical datasets. The pre-trained model was then fine-tuned using an institutional dataset of 35 TOF NAC PET and CT volume pairs, achieving the lowest mean absolute error (MAE) of 74.49 HU and highest peak signal-to-noise ratio (PSNR) of 28.66 dB within the body contour region. Visual assessments demonstrated improved reconstruction of both bone and soft tissue structures from TOF NAC PET images. This work highlights the effectiveness of using pre-trained deep learning models for medical image translation tasks. Future work will assess the impact of sCT on PET attenuation correction and explore additional neural network architectures and datasets to further enhance performance and practical applications in PET imaging.

Positron Emission Tomography (PET) is an important clinical imaging tool but inevitably introduces radiation hazards to patients and healthcare providers. Reducing the tracer injection dose and eliminating the CT acquisition for attenuation correction can reduce the overall radiation dose, but often results in PET with high noise and bias. Thus, it is desirable to develop 3D methods to translate the non-attenuation-corrected low-dose PET (NAC-LDPET) into attenuation-corrected standard-dose PET (AC-SDPET). Recently, diffusion models have emerged as a new state-of-the-art deep learning method for image-to-image translation, better than traditional CNN-based methods. However, due to the high computation cost and memory burden, it is largely limited to 2D applications. To address these challenges, we developed a novel 2.5D Multi-view Averaging Diffusion Model (MADM) for 3D image-to-image translation with application on NAC-LDPET to AC-SDPET translation. Specifically, MADM employs separate diffusion models for axial, coronal, and sagittal views, whose outputs are averaged in each sampling step to ensure the 3D generation quality from multiple views. To accelerate the 3D sampling process, we also proposed a strategy to use the CNN-based 3D generation as a prior for the diffusion model. Our experimental results on human patient studies suggested that MADM can generate high-quality 3D translation images, outperforming previous CNN-based and Diffusion-based baseline methods.

Low-dose PET offers a valuable means of minimizing radiation exposure in PET imaging. However, the prevalent practice of employing additional CT scans for generating attenuation maps (u-map) for PET attenuation correction significantly elevates radiation doses. To address this concern and further mitigate radiation exposure in low-dose PET exams, we propose POUR-Net - an innovative population-prior-aided over-under-representation network that aims for high-quality attenuation map generation from low-dose PET. First, POUR-Net incorporates an over-under-representation network (OUR-Net) to facilitate efficient feature extraction, encompassing both low-resolution abstracted and fine-detail features, for assisting deep generation on the full-resolution level. Second, complementing OUR-Net, a population prior generation machine (PPGM) utilizing a comprehensive CT-derived u-map dataset, provides additional prior information to aid OUR-Net generation. The integration of OUR-Net and PPGM within a cascade framework enables iterative refinement of $\mu$-map generation, resulting in the production of high-quality $\mu$-maps. Experimental results underscore the effectiveness of POUR-Net, showing it as a promising solution for accurate CT-free low-count PET attenuation correction, which also surpasses the performance of previous baseline methods.

Attenuation correction (AC) is essential for the generation of artifact-free and quantitatively accurate positron emission tomography (PET) images. However, AC of PET faces challenges including inter-scan motion and erroneous transformation of structural voxel-intensities to PET attenuation-correction factors. Nowadays, the problem of AC for quantitative PET have been solved to a large extent after the commercial availability of devices combining PET with computed tomography (CT). Meanwhile, considering the feasibility of a deep learning approach for PET AC without anatomical imaging, this paper develops a PET AC method, which uses deep learning to generate continuously valued CT images from non-attenuation corrected PET images for AC on brain PET imaging. Specifically, an invertible network combined with the variable augmentation strategy that can achieve the bidirectional inference processes is proposed for synthetic CT generation (IVNAC). To evaluate the performance of the proposed algorithm, we conducted a comprehensive study on a total of 1440 data from 37 clinical patients using comparative algorithms (such as Cycle-GAN and Pix2pix). Perceptual analysis and quantitative evaluations illustrate that the invertible network for PET AC outperforms other existing AC models, which demonstrates the potential of the proposed method and the feasibility of achieving brain PET AC without CT.

Recent years have witnessed the trend that machine learning, especially deep learning, is being increasingly used in the application of PET imaging. Various t ypes of machine learning networks have been borrowed from computer vision field and adapted to speci fic clinical tasks for PET quantitative imaging. As reviewed in this paper, the most common applicat ions are PET AC and low-count PET reconstruction. It is also an emerging field since all of thes e reviewed studies were published within five years. With the development in both machine learning alg orithm and computing hardware, more learning-based methods are expected to facilitate the clin ical workflow of PET imaging with more potential quantification application. In addition to PET AC and low-count reconstruction, there ar e other topics in PET imaging where machine learning can be exploited. For example, high resolu tion PET has great potential in visualizing and accurately measuring the radiotracer concentrat ion in structures with dimensions of millimeter, while it is subject to the partial volume e ffect due to the limited spatial discriminating ability of scanner.[

Attenuation correction is an essential requirement of positron emission tomography (PET) image reconstruction to allow for accurate quantification. However, attenuation correction is particularly challenging for PET-MRI as neither PET nor magnetic resonance imaging (MRI) can directly image tissue attenuation properties. MRI-based computed tomography (CT) synthesis has been proposed as an alternative to physics based and segmentation-based approaches that assign a population-based tissue density value in order to generate an attenuation map. We propose a novel deep fully convolutional neural network that generates synthetic CTs in a recursive manner by gradually reducing the residuals of the previous network, increasing the overall accuracy and generalisability, while keeping the number of trainable parameters within reasonable limits. The model is trained on a database of 20 pre-acquired MRI/CT pairs and a four-fold random bootstrapped validation with a 80:20 split is performed. Quantitative results show that the proposed framework outperforms a state-of-the-art atlas-based approach decreasing the Mean Absolute Error (MAE) from 131HU to 68HU for the synthetic CTs and reducing the PET reconstruction error from 14.3% to 7.2%.

Positron Emission Tomography (PET) is a functional imaging modality widely used in neuroscience studies. To obtain meaningful quantitative results from PET images, attenuation correction is necessary during image reconstruction. For PET/MR hybrid systems, PET attenuation is challenging as Magnetic Resonance (MR) images do not reflect attenuation coefficients directly. To address this issue, we present deep neural network methods to derive the continuous attenuation coefficients for brain PET imaging from MR images. With only Dixon MR images as the network input, the existing U-net structure was adopted and analysis using forty patient data sets shows it is superior than other Dixon based methods. When both Dixon and zero echo time (ZTE) images are available, apart from stacking multiple MR images along the U-net input channels, we have proposed a new network structure to extract the features from Dixon and ZTE images independently at early layers and combine them together at later layers. Quantitative analysis based on fourteen real patient data sets demonstrates that both network approaches can perform better than the standard methods, and the proposed network structure can further reduce the PET quantification error compared to the U-net structure with multiple inputs.