Phantom and clinical evaluation of Block Sequential Regularized Expectation Maximization (BSREM) Reconstruction Algorithm in 68Ga-PSMA PET/CT Studies

Abstract Purpose we aimed to investigate the effect of various β-value in BSREM algorithm under different lesion sizes, in order to determine an optimal penalty factor for clinical use. Methods The NEMA IQ phantom and 15 patients with prostate cancer were injected with 68Ga-PSMA and scanned by GE Discovery IQ PET/CT scanner. Images were reconstructed using OSEM and BSREM with different β-values and then background variability (BV), contrast recovery (CR), signal-to-noise ratio (SNR), and lung residual error (LE) from phantom data, and Signal-to-Background Ratio (SBR), contrast from clinical data were measured. Results The increment of BV using β-value of 100 was 120% and the decrement of BV using β-value 1000 were 40.5% compared to OSEM. As the β decreased from 1000 to 100, the SUVmax increased by 59% and 26.4% for sphere with diameter of 10 mm and 37 mm, respectively.Δ SNR(100-1000) % increased by 140.5 and 29.0 in the smallest and the largest sphere, respectively. The Δ LE OSEM-100 and Δ LE OSEM-1000 was − 41.1% and − 36.7% respectively. In the clinical study, the lowest SBR and contrast was related to the OSEM. The SBR and contrast, respectively increased by 69.7% and 71.8% in small lesions and 35.6% and 33% in large lesions, respectively, when β-value was decreased from 500 to 100. Conclusions As the lesion size decreased, the optimum β-value decreased. In both studies, a β value of 400 would be optimal for reconstruction of small lesions, whereas for large lesions in phantom and clinical studies respectively, β-value of 600 and 500 is recommended.