Quantitative and Visual Benefits of Data-Driven Motion Correction on Oncologic PET/CT: AProspective Cross-sectional Study.

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Conventional positron emission tomography (PET) respiratory gating utilizes a fraction of acquired PET counts (i.e., optimal gate [OG]), whereas elastic motion correction with deblurring (EMCD) utilizes all PET counts to reconstruct motion-corrected images without increasing image noise. Our aim was to assess the quantitative and visual impacts of EMCD-based motion correction on FDG-PET and DOTATATE-PET images relative to OG and ungated (UG) images. This prospective, single-center study enrolled adults undergoing FDG or DOTATATE oncologic PET/CT between June 2020 and October 2022. Subjects underwent a standard-of-care (SOC) PET acquisition while wearing a respiratory gating belt. UG, belt-gating-derived optimal gate (BG-OG), EMCD utilizing belt gating (BG-EMCD), and EMCD utilizing data-driven gating (DDG-EMCD) images were reconstructed. Tracer-avid lesions in the lower chest or upper abdomen were segmented. Quantitative metrics were extracted. Two independent, blinded readers assessed image quality via a 4-point scale and counted lesions on each reconstruction. Differences between reconstructions were assessed via the Wilcoxon signed-rank test (alpha, 0.05). This study enrolled 78 subjects; 36 subjects (mean age, 64.8 years; 20 males) with 136 tracer-avid lesions were analyzed. Data provided are medians across all tracers. Lesion SUV-max was significantly higher (P<0.001) on motion-corrected images (BG-OG: 10.77, BG-EMCD: 10.75, DDG-EMCD: 10.74) than UG images (9.00). Lesion contrast-to-noise ratios (CNRs) were significantly lower (P<0.001) for BG-OG (6.31) and UG images (7.89) than BG-EMCD (9.14) and DDG-EMCD (8.89) images. FDG and DOTATATE subgroup analyses produced similar results. Among motion-corrected images, both readers preferred EMCD-based images to BG-OG images for all tracers (P<0.001) and both subgroups. EMCD-based images occasionally demonstrated more tracer-avid lesions than BG-OG or UG images. EMCD-based motion correction beneficially impacts lesion quantitation (including higher SUVs and CNRs) and overall image quality. When employed on capable scanners, EMCD can improve the quality of oncologic PET imaging.