Background
Block-sequential regularized expectation maximization (BSREM), commercially Q. Clear (GE Healthcare, Milwaukee, WI, USA), is a reconstruction algorithm that allows for a fully convergent iterative reconstruction leading to higher image contrast compared to conventional reconstruction algorithms, while also limiting noise. The noise penalization factor
β
controls the trade-off between noise level and resolution and can be adjusted by the user. The aim was to evaluate the influence of different
β
values for different activity time products (ATs = administered activity × acquisition time) in whole-body
18
F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET-CT) regarding quantitative data, interpretation, and quality assessment of the images.
Twenty-five patients with known or suspected malignancies, referred for clinical
18
F-FDG PET-CT examinations acquired on a silicon photomultiplier PET-CT scanner, were included. The data were reconstructed using BSREM with
β
values of 100–700 and ATs of 4–16 MBq/kg × min/bed (acquisition times of 1, 1.5, 2, 3, and 4 min/bed). Noise level, lesion SUV
max
, and lesion SUV
peak
were calculated. Image quality and lesion detectability were assessed by four nuclear medicine physicians for acquisition times of 1.0 and 1.5 min/bed position.
Results
The noise level decreased with increasing
β
values and ATs. Lesion SUV
max
varied considerably between different
β
values and ATs, whereas SUV
peak
was more stable. For an AT of 6 (in our case 1.5 min/bed), the best image quality was obtained with a
β
of 600 and the best lesion detectability with a
β
of 500. AT of 4 generated poor-quality images and false positive uptakes due to noise.
Conclusions
For oncologic whole-body
18
F-FDG examinations on a SiPM-based PET-CT, we propose using an AT of 6 (i.e., 4 MBq/kg and 1.5 min/bed) reconstructed with BSREM using a
β
value of 500–600 in order to ensure image quality and lesion detection rate as well as a high patient throughput. We do not recommend using AT < 6 since the risk of false positive uptakes due to noise increases.
Viscoelasticity influences P(el,dyn)/V curves. Hysteresis caused by surface tension merits re-evaluation. Lung collapse and re-expansion may be indicated by hysteresis of P(el)/V loops.
All methods (visual inspection, SUVmax and the Likert scale) identified responders and nonresponders and predicted RC. A Likert scale is a promising tool to reduce to a minimum the problem of PET scans judged as equivocal. Consensus regarding qualitative assessment would facilitate PET reporting in clinical practice.
Here, we aimed to develop and validate a fully automated artificial intelligence (AI)-based method for the detection and quantification of suspected prostate tumour/local recurrence, lymph node metastases, and bone metastases from [18F]PSMA-1007 positron emission tomography-computed tomography (PET-CT) images. Images from 660 patients were included. Segmentations by one expert reader were ground truth. A convolutional neural network (CNN) was developed and trained on a training set, and the performance was tested on a separate test set of 120 patients. The AI method was compared with manual segmentations performed by several nuclear medicine physicians. Assessment of tumour burden (total lesion volume (TLV) and total lesion uptake (TLU)) was performed. The sensitivity of the AI method was, on average, 79% for detecting prostate tumour/recurrence, 79% for lymph node metastases, and 62% for bone metastases. On average, nuclear medicine physicians’ corresponding sensitivities were 78%, 78%, and 59%, respectively. The correlations of TLV and TLU between AI and nuclear medicine physicians were all statistically significant and ranged from R = 0.53 to R = 0.83. In conclusion, the development of an AI-based method for prostate cancer detection with sensitivity on par with nuclear medicine physicians was possible. The developed AI tool is freely available for researchers.
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