PADM: A Physics-aware Diffusion Model for Attenuation Correction

Abstract: Attenuation artifacts remain a significant challenge in cardiac Myocardial Perfusion Imaging (MPI) using Single-Photon Emission Computed Tomography (SPECT), often compromising diagnostic accuracy and reducing clinical interpretability. While hybrid SPECT/CT systems mitigate these artifacts through CT-derived attenuation maps, their high cost, limited accessibility, and added radiation exposure hinder widespread clinical adoption. In this study, we propose a novel CT-free solution to attenuation correction in cardiac SPECT. Specifically, we introduce Physics-aware Attenuation Correction Diffusion Model (PADM), a diffusion-based generative method that incorporates explicit physics priors via a teacher--student distillation mechanism. This approach enables attenuation artifact correction using only Non-Attenuation-Corrected (NAC) input, while still benefiting from physics-informed supervision during training. To support this work, we also introduce CardiAC, a comprehensive dataset comprising 424 patient studies with paired NAC and Attenuation-Corrected (AC) reconstructions, alongside high-resolution CT-based attenuation maps. Extensive experiments demonstrate that PADM outperforms state-of-the-art generative models, delivering superior reconstruction fidelity across both quantitative metrics and visual assessment.