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Background  Positron emission tomography/magnetic resonance imaging (PET/MRI) is a promising diagnostic imaging tool for the diagnosis of dementia, as PET can add complementary information to the routine imaging examination with MRI. The purpose of this study was to evaluate the influence of MRI-based attenuation correction (MRAC) on diagnostic assessment of dementia with [ 18 F]FDG PET. Quantitative differences in both [ 18 F]FDG uptake and z-scores were calculated for three clinically available (DixonNoBone, DixonBone, UTE) and two research MRAC methods (UCL, DeepUTE) compared to CT-based AC (CTAC). Furthermore, diagnoses based on visual evaluations were made by three nuclear medicine physicians and one neuroradiologist (PET CT , PET DeepUTE , PET DixonBone , PET UTE , PET CT  + MRI, PET DixonBone  + MRI). In addition, pons and cerebellum were compared as reference regions for normalization.    Results  The mean absolute difference in z-scores were smallest between MRAC and CTAC with cerebellum as reference region: 0.15 ± 0.11 σ (DeepUTE), 0.15 ± 0.12 σ (UCL), 0.23 ± 0.20 σ (DixonBone), 0.32 ± 0.28 σ (DixonNoBone), and 0.54 ± 0.40 σ (UTE). In the visual evaluation, the diagnoses agreed with PET CT  in 74% (PET DeepUTE ), 67% (PET DixonBone ), and 70% (PET UTE ) of the patients, while PET CT  + MRI agreed with PET DixonBone  + MRI in 89% of the patients.    Conclusion  The MRAC research methods performed close to that of CTAC in the quantitative evaluation of [ 18 F]FDG uptake and z-scores. Among the clinically implemented MRAC methods, Dixon Bone  should be preferred for diagnostic assessment of dementia with [ 18 F]FDG PET/MRI. However, as artifacts occur in Dixon Bone  attenuation maps, they must be visually inspected to assure proper quantification.    Electronic supplementary material  The online version of this article (10.1186/s13550-019-0553-2) contains supplementary material, which is available to authorized users.

Quantitative and clinical impact of MRI-based attenuation correction methods in [18F]FDG evaluation of dementia