Development and in silico imaging trial evaluation of a deep-learning-based transmission-less attenuation compensation method for DaT SPECT

TL;DR

This paper introduces a deep learning method for attenuation correction in DaT SPECT imaging that eliminates the need for additional CT scans, showing promising results in in silico evaluations for improved quantification accuracy.

Contribution

A novel transmission-less deep learning approach for attenuation correction in DaT SPECT, reducing reliance on CT scans and improving quantification accuracy and robustness.

Findings

DaT-CTLESS outperformed traditional methods in correlation with CTAC.

It showed excellent agreement with CTAC in regional uptake quantification.

The method demonstrated robustness across different scanners and training data sizes.

Abstract

Quantitative measures of dopamine transporter (DaT) uptake in caudate, putamen, and globus pallidus derived from DaT-single-photon emission computed tomography (SPECT) images are being investigated as biomarkers to diagnose, assess disease status, and track the progression of Parkinsonism. Reliable quantification from DaT-SPECT images requires performing attenuation compensation (AC), typically with a separate X-ray CT scan. Such CT-based AC (CTAC) has multiple challenges, a key one being the non-availability of X-ray CT component on many clinical SPECT systems. Even when a CT is available, the additional CT scan leads to increased radiation dose, costs, and complexity, potential quantification errors due to SPECT-CT misalignment, and higher training and regulatory requirements. To overcome the challenges with the requirement of a CT scan for AC in DaT SPECT, we propose a deep learning (DL)-based transmission-less AC method for DaT-SPECT (DaT-CTLESS). An in silico imaging trial, titled ISIT-DaT, was designed to evaluate the performance of DaT-CTLESS on the regional uptake quantification task. We observed that DaT-CTLESS yielded a significantly higher correlation with CTAC than that between UAC and CTAC on the regional DaT uptake quantification task. Further, DaT-CLTESS had an excellent agreement with CTAC on this task, significantly outperformed UAC in distinguishing patients with normal versus reduced putamen SBR, yielded good generalizability across two scanners, was generally insensitive to intra-regional uptake heterogeneity, demonstrated good repeatability, exhibited robust performance even as the size of the training data was reduced, and generally outperformed the other considered DL methods on the task of quantifying regional uptake across different training dataset sizes. These results provide a strong motivation for further clinical evaluation of DaT-CTLESS.