Maintaining SUV accuracy in low-count PET with PETfectior: a deep learning denoising solution

Area of Science:

• Nuclear Medicine
• Medical Imaging
• Artificial Intelligence

Background:

• Positron emission tomography (PET) image quality is limited by radiotracer activity and acquisition time, impacting radiation exposure and costs.
• Reducing these parameters is crucial for patient safety and economic viability in PET examinations.
• Current standards, like EARL, guide quantitative PET imaging, but achieving them often requires higher activity and longer scans.

Purpose of the Study:

• To clinically validate PETfectior, an AI software designed to improve signal-to-noise ratio in low-count PET scans.
• To assess PETfectior's performance in lesion detection, quantitative accuracy, and image quality using reduced counting statistics.
• To evaluate the potential of PETfectior in enabling high-quality PET imaging with halved radiation dose and cost.

Main Methods:

• Prospective inclusion of 258 patients undergoing 18F-FDG PET/CT scans.
• Acquisition and reconstruction of standard-of-care scans (100% statistics) following EARL standards.
• Generation of half-counting-statistics (50%) PET images processed by PETfectior.
• Evaluation of lesion detectability, SUVmax quantification, and subjective image quality by experienced physicians.

Main Results:

• PETfectior processed 50% counting statistics images demonstrated high lesion detection sensitivity (99.9%) with minimal false positives.
• Quantitative analysis showed good concordance for SUVmax between 100% and 50% + PETfectior images (±12.5% 95% LOA, -1.01% bias).
• Subjective assessment revealed no significant difference in image quality between standard and PETfectior-processed reduced-statistics images.

Conclusions:

• PETfectior can be safely implemented in clinical practice for 18F-FDG PET imaging at half counting statistics.
• The AI software maintains high sensitivity and specificity, with acceptable quantitative accuracy and excellent subjective image quality.
• PETfectior offers a promising solution for reducing radiation dose and costs in PET examinations without compromising diagnostic performance.