Abstract

PurposeTendency is to moderate the injected activity and/or reduce acquisition time in PET examinations to minimize potential radiation hazards and increase patient comfort. This work aims to assess the performance of regular full-dose (FD) synthesis from fast/low-dose (LD) whole-body (WB) PET images using deep learning techniques.MethodsInstead of using synthetic LD scans, two separate clinical WB 18F-Fluorodeoxyglucose (18F-FDG) PET/CT studies of 100 patients were acquired: one regular FD (~ 27 min) and one fast or LD (~ 3 min) consisting of 1/8th of the standard acquisition time. A modified cycle-consistent generative adversarial network (CycleGAN) and residual neural network (ResNET) models, denoted as CGAN and RNET, respectively, were implemented to predict FD PET images. The quality of the predicted PET images was assessed by two nuclear medicine physicians. Moreover, the diagnostic quality of the predicted PET images was evaluated using a pass/fail scheme for lesion detectability task. Quantitative analysis using established metrics including standardized uptake value (SUV) bias was performed for the liver, left/right lung, brain, and 400 malignant lesions from the test and evaluation datasets.ResultsCGAN scored 4.92 and 3.88 (out of 5) (adequate to good) for brain and neck + trunk, respectively. The average SUV bias calculated over normal tissues was 3.39 ± 0.71% and − 3.83 ± 1.25% for CGAN and RNET, respectively. Bland-Altman analysis reported the lowest SUV bias (0.01%) and 95% confidence interval of − 0.36, + 0.47 for CGAN compared with the reference FD images for malignant lesions.ConclusionCycleGAN is able to synthesize clinical FD WB PET images from LD images with 1/8th of standard injected activity or acquisition time. The predicted FD images present almost similar performance in terms of lesion detectability, qualitative scores, and quantification bias and variance.

Highlights

  • Good image quality and high quantitative accuracy in 18FFluorodeoxyglucose (18F-FDG) PET imaging are crucial for reliable visual interpretation and image analysis in clinical oncology [1, 2]

  • PET images predicted by both deep learning models (RNET and CGAN) exhibited notable enhancement in image quality compared to LD by providing almost similar visual appearance with respect to reference FD PET images

  • It was shown that CGAN had a superior image quality and lower regional standardized uptake value (SUV) bias and variance compared to RNET

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Summary

Introduction

Good image quality and high quantitative accuracy in 18FFluorodeoxyglucose (18F-FDG) PET imaging are crucial for reliable visual interpretation and image analysis in clinical oncology [1, 2]. Apart from the technical aspects, PET image quality depends on the amount of the injected radiotracer and/ or acquisition time, which are proportional to the statistics of the detected events and the noise characteristics of PET images. The main argument in favor of reducing the injected radiotracer’s activity is the potential hazards of ionizing radiation [3]. Albeit low, this risk motivates precaution, in pediatric patients, healthy volunteers or in case of multiple scanning for follow-up or treatment response monitoring using different molecular imaging probes. Dose/ time reduction adversely affects image quality, potentially reducing signal-to-noise ratio (SNR) and hampering the diagnostic and quantitative performance of PET imaging

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