The value of Bayesian penalized likelihood reconstruction for improving lesion conspicuity of malignant lung tumors on 18F-FDG PET/CT: comparison with ordered subset expectation maximization reconstruction incorporating time-of-flight model and point spread function correction

Objective To evaluate the value of Bayesian penalized likelihood (BPL) reconstruction for improving lesion conspicuity of malignant lung tumors on F-18-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography computed tomography (PET/CT) as compared with the ordered subset expectation maximization (OSEM) reconstruction incorporating time-of-flight (TOF) model and point-spread-function (PSF) correction. Methods Twenty-nine patients with primary or metastatic lung cancers who underwent F-18-FDG PET/CT were retrospectively studied. PET images were reconstructed with OSEM + TOF, OSEM + TOF + PSF, and BPL with noise penalty strength beta-value of 200, 400, 600, and 800. The signal-to-noise ratio (SNR) was determined in normal liver parenchyma. Lung lesion conspicuity was evaluated in 50 lung lesions by using a 4-point scale (0, no visible; 1, poor; 2, good; 3, excellent conspicuity). Two observers were independently asked to choose the most preferred reconstruction for detecting the lung lesions on a per-patient level. The maximum standardized uptake value (SUVmax) was measured in each of the 50 lung lesions. Results Liver SNR on the images reconstructed by BPL with beta-value of 600 and 800 (17.8 +/- 3.7 and 22.5 +/- 4.6, respectively) was significantly higher than that by OSEM + TOF + PSF (15.0 +/- 3.4, p < 0.0001). BPL with beta-value of 600 was chosen most frequently as the preferred reconstruction algorithm for lung lesion assessment by both observers. The conspicuity score of the lung lesions < 10 mm in diameter on images reconstructed by BPL with beta-value of 600 was significantly greater than that with OSEM + TOF + PSF (2.2 +/- 0.8 vs 1.6 +/- 0.9, p < 0.0001), while the conspicuity score of the lesions >= 10 mm in diameter was not significantly different between BPL with beta-value of 600 and OSEM + TOF + PSF. The mean SUVmax was increased by BPL with beta-value of 600 for the lung lesions with < 10 mm in diameter, compared to OSEM + TOF + PSF (3.4 +/- 3.1 to 4.2 +/- 3.5, p = 0.001). In contrast, BPL with beta-value of 600 did not provide increased SUVmax for the lesions >= 10 mm in diameter. Conclusion BPL reconstruction significantly improves the detection of small inconspicuous malignant tumors in the lung, improving the diagnostic performance of PET/CT.