A clinical evaluation of the impact of the Bayesian penalized likelihood reconstruction algorithm on PET FDG metrics

Purpose The aim of this study was to evaluate the impact of using the Bayesian penalized likelihood (BPL) algorithm on a bismuth germanium oxide positron emission tomography (PET)/computed tomography (CT) system for F-18-FDG PET/CT exams in case of low injected activity and scan duration. Materials and methods F-18-FDG respiratory gated PET/CT performed on 102 cancer patients, injected with similar to 2 M Bq/kg of F-18-FDG, were reconstructed using two algorithms: ordered subset expectation maximization (OSEM) and BPL. The signal-to-noise ratio (SNR) was calculated as the ratio of mean standard uptake value (SUV) over the standard deviation in a reference volume defined automatically in the liver. The peak SUV and volumes were also measured in lesions larger than 2 cm(3) thanks to the automated segmentation method. Results On 85 respiratory gated patients, the median SNR was significantly higher with BPL (P<0.0001) and it is even better when the BMI of the patient increases (odds ratio = 1.26). For the 55 lesions, BPL significantly increased the SUVpeak [difference: (-0.5; 1.4), median = 0.4, P<0.0001] compared with OSEM in 83.6% of the cases. With BPL, the volume was lower in 61.8% of the cases compared with OSEM, but this was not statistically significant. Conclusion The BPL algorithm improves the image quality and lesion contrast and appears to be particularly appropriate for patients with a high BMI as it improves the SNR. However, it will be important for patient follow-up or multicenter studies to use the same algorithm and preferably BPL. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.