ArticleEJNMMI physics2026
Generative restoration for cardiac PET attenuation correction: a two-stage 3D DDIM framework optimizing fidelity and clinical controllability.
Article in EJNMMI physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aims to develop a two-stage 3D denoising diffusion implicit model (DDIM) framework for CT-free attenuation correction in cardiac PET imaging, enabling direct generation of attenuation-corrected (AC) images from non-attenuation-corrected (NAC) PET scans. The method is comprehensively validated using both [18F]FDG PET and [13N]ammonia cardiac PET datasets to demonstrate its clinical applicability across different perfusion and metabolic imaging protocols.
methodsThe framework employs a two-stage approach: (1) a noise-to-image DDIM was first pretrained on all available AC images (i.e., no need of paired NACs) to learn a diverse AC distributions, enabling the high-fidelity generation of AC images with varying appearances; (2) the pretrained model was fine-tuned with a limited set of paired NAC-AC images to form a conditional DDIM, ensuring anatomically aligned, controllable generation. The model architecture uses a 3D U-Net, trained on 224 paired NAC-AC and 396 unpaired AC images for [18F]FDG, and 608 paired NAC-AC images and 885 unpaired AC images for [13N]ammonia. Performance was evaluated through quantitative metrics (including NMAE, NRMSE, SSIM and PSNR) and visual assessment.
resultsThe proposed two-stage DDIM framework achieved excellent agreement with clinical CT-based attenuation correction (CT-AC), demonstrating superior correlation (slope = 0.78, [Formula: see text] = 0.95 for [18F]FDG; slope = 0.99, [Formula: see text]= 0.91 for [13N]ammonia) and lower errors compared to existing approaches. Ablation studies confirmed the benefits of both the two-stage training strategy and the incorporation of unpaired AC images, as evidenced by narrower confidence intervals in Bland-Altman analysis and reduced percentage errors.
conclusionThe two-stage 3D DDIM framework achieves performance comparable to clinical CT-AC while effectively leveraging unpaired data, demonstrating significant potential for robust cardiac PET attenuation correction.
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