Phantom test procedures for a new neuro-oncological amino acid PET tracer: [18F]fluciclovine

Objective: Amino acid positron emission tomography (PET) examinations using anti-1-amino-3-[F-18]-fluorocyclobutane-1-carboxylic acid ([F-18]FACBC) were allowed for routine clinical use in July 2024. However, phantom test procedures for [F-18]FACBC reconstruction parameters have not yet been established. The present study aimed to establish new phantom test procedures for [F-18]FACBC brain PET imaging to determine optimal reconstruction parameters. Methods: Background (BG) activity as well as hot sphere and target-to-background ratios (TBRs) of [F-18]FACBC were estimated based on brain activity and tumor-to-normal tissue ratios (TNR) in a Japanese clinical trial of [F-18]FACBC. Phantom experiments proceeded under [F-18]FACBC or L-[methyl-C-11]-methionine ([C-11]MET) conditions. The number of iterations and the Gaussian filter parameters were determined from the reconstruction parameters %contrast(mean) and coefficients of variation (CVs) in ordered subset expectation maximization (OSEM) and time-of-flight (TOF) with or without point-spread-function (PSF) correction. Results: The amounts of activity in the hot spheres and BG were 1.1 and 5.5 kBq/mL, respectively, and the TBR was 5.0 at the start of acquisition. The %contrast(mean) of all hot spheres was higher with [F-18]FACBC than [C-11]MET, and %contrast(mean) converged between 4 and 6 iterations in hot spheres with diameters < 10 mm. We used four iterations for OSEM + TOF and five for OSEM + TOF + PSF correction for [F-18]FACBC and [C-11]MET images. The CV was higher for [F-18]FACBC than [C-11]MET. The optimal sizes of Gaussian filters for OSEM + TOF and OSEM + TOF + PSF correction of image reconstruction were 5 mm for [F-18]FACBC, and 4 and 3 mm, respectively, for [C-11]MET images. Conclusions: We estimated phantom activity and TBR based on brain activity in a Japanese clinical trial and established new phantom test procedures for [F-18]FACBC. We recommend that the optimal reconstruction parameters for [F-18]FACBC should be set to the same number of iterations as [C-11]MET and that the FWHM of Gaussian filter should have a few mm higher than [C-11]MET to reduce image noise from brain normal tissue.