Quantitative differences in [(18)F] NaF PET/CT: TOF versus non-TOF measurements

[(18)F] sodium fluoride (NaF) PET/CT is a current, clinically relevant method to assess bone metastases. Time-of-flight (TOF) PET provides better statistical data quality, which can improve either lower image noise or improve resolution, or both, depending on the image reconstruction. Improved resolution can improve quantitative measurements of standardized uptake value (SUV) in small structures. These quantitative differences may be important in both clinical interpretation and multicenter clinical trials where quantification is integral to assessing response to therapy. The purpose of this study is to determine if and by how much SUV quantitatively differs between TOF and conventional non-TOF reconstructions in [(18)F] NaF PET/CT. SUV measurements (mean and maximum) were compared in TOF and non-TOF [(18)F] NaF PET-CT reconstructions for 47 prostate cancer patients in normal regions including: soft tissue (n=282 total regions; liver, aorta, posterior abdominal fat, bladder, brain, and paraspinal muscles), and osseous structures (n=188; T12 vertebral body, femoral diaphyseal cortex, femoral head, and lateral rib). Comparisons were also made for benign degenerative changes (n=281) and metastases (n=159). TOF and non-TOF SUVs were assessed with paired t-test and linear correlations. Normal soft tissue showed lower SUVmean for TOF compared to non-TOF in liver, brain, and adipose. All osseous structures showed higher SUVmean for TOF compared to non-TOF including normal regions, degenerative joint disease, and metastases. For all metastatic lesions, the average SUVmean increased by 2.5%, and in degenerative joint disease it increased by 3.5% on TOF reconstructions. Smaller lesion size was a significant factor influencing this increase in SUVmean. TOF SUVmean values are higher in osseous structures and lower in background soft tissue structures. While these differences are statistically significant, the magnitudes of these changes are relatively modest. Smaller osseous lesions may have higher contrast and higher SUVmean values with TOF reconstruction compared to non-TOF reconstructions. The differences in TOF vs. non-TOF images should be considered when evaluating response to therapy and in the design of multi-center clinical trials.