ArticleThe Lancet medical imaging & theranostics2026
Low-dose CT for MRI-free quantification of tau PET in Alzheimer's disease: a multicentre, cross-sectional, comparison study.
Article in The Lancet medical imaging & theranostics, 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
Background: Tau PET quantification typically requires structural MRI for reference-region definition, normalisation, and segmentation. We evaluated whether low-dose CT can serve as a reliable MRI alternative for tau PET quantification when MRI is unavailable. Methods: In this multicentre cross-sectional methods comparison study, we developed a PET-CT pipeline using low-dose CT as the sole anatomical reference for tau PET quantification. Participants were recruited from six sites in the multicentre Head-to-head Harmonisation of tau PET tracers (HEAD) study. The cohort comprised cognitively unimpaired (CU) young adults (<28 years), CU middle-aged adults (50-65 years), CU elderly (>65 years), and participants with mild cognitive impairment (MCI) or dementia. Participants underwent [ Findings: A total of 387 participants were included, with recruitment spanning from November 11, 2022 and July 7, 2025 (205 [53%] female, 182 [47%] male; 6 [2%] aged 19-25 years, 130 [34%] aged 50-65 years and 251 [65%] aged 66-89 years). Against the template-based PET-MR pipeline, CT-derived SUVRs showed near-perfect linear correspondence with the template-based PET-MR pipeline for MK6240 (R Interpretation: CT-only processing enables robust tau PET quantification comparable to standard MRI-based pipelines, including computationally intensive FreeSurfer-based approaches. This method was validated across different radiotracers and represents a reliable alternative when MRI is unavailable or contraindicated. Because low-dose CT is routinely acquired during PET-CT sessions, this approach enables quantification of legacy datasets lacking MRI, broadens participant inclusion in clinical trials, and may reduce imaging costs in settings where MRI is not clinically indicated.
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