PET image quality improvement for simultaneous PET/MRI with a lightweight MRI surface coil

Background: During simultaneous PET/MRI, flexible MRI surface coils that lay on the patient are often omitted from PET attenuation correction processing, leading to quantification bias in PET images. Purpose: To identify potential PET image quality improvement by using a recently developed lightweight MRI coil technology for the anterior array (AA) surface coil in both a phantom and in vivo study. Materials and Methods: A phantom study and a prospective in vivo study were performed with a PET/CT scanner under three conditions: (a) no MRI surface coil (standard of reference), (b) traditional AA coil, and (c) lightweight AA coil. AA coils were not used in attenuation correction processing to emulate clinical PET/MRI. For the phantom study, PET images were reconstructed with and without time of flight (TOF) to assess quantification accuracy and uniformity. The in vivo study consisted of 10 participants (mean age, 66 years 6 10 [standard deviation]; six men) referred for a PET/CT oncologic examination who had undergone imaging between October 2019 and February 2020. Assessment of image quantification bias (defined as the standard error of the mean values) was conducted by comparing mean liver region of interest standardized uptake values with the no-coil standard of reference. A Wilcoxon signed-rank test was used to establish significance. Results: For TOF and non-TOF, respectively, the phantom study revealed a mean PET quantification bias of 29.0% and 28.6% with the traditional AA coil and a mean PET quantification bias of 24.3% and 24.0% with the lightweight AA coil. The coefficients of variation reduced from 4.3% and 6.2% with the traditional AA coil to 2.1% and 2.7% with the lightweight AA coil, which demonstrated a homogeneity benefit from the lightweight coil that was greater with, versus without, TOF reconstruction. For the in vivo study, the mean liver standardized uptake value error was 25.9% with the traditional AA coil (P = .002 vs no coil) and 22.4% with the lightweight AA coil (P = .004 vs no coil). Conclusion: The lightweight anterior array coil reduced PET image quantification bias by more than 50% compared with the traditional coil. Using the lightweight coil and performing time of flight–based reconstruction each reduced the variation of error.