Computed tomography based attenuation correction in PET/CT: Principles, instrumentation, protocols, artifacts and future trends

  The advent of dual-modality PET/CT imaging has revolutionized the practice of clinical oncology, cardiology and neurology by improving lesions localization and the possibility of accurate quantitative analysis. In addition, the use of CT images for CT-based attenuation correction (CTAC) allows to decrease the overall scanning time and to create a noise-free attenuation map (μmap). The near simultaneous data acquisition in a fixed combination of a PET and a CT scanner in a hybrid PET/CT imaging system with a common patent table minimizes spatial and temporal mismatches between the modalities by elimination the need to move the patient in between exams. As PET/CT technology becomes more widely available, studies are beginning to appear in the literature that document the use of PET/CT in a variety of different cancers, including lung, thyroid, ovarian, lymphoma, and unknown primary cancers, and for general oncology, cardiology and neurology applications. Specific applications of PET/CT, such as those for radiation therapy planning, are also being explored. The purpose of this review paper is to introduce the principles of PET/CT imaging systems and describe the sources of error and artifact in CT-based attenuation correction algorithm. This paper also focuses on recent developments and future trends in hybrid imaging and their areas of application. It should be noted that due to limited space, the references contained herein are for illustrative purposes and are not inclusive; no implication that those chosen are better than others not mentioned is intended.