Maintaining SUV Accuracy in Low-Count PET with PETfectior: A Deep Learning Denoising Solution

TL;DR

PETfectior, an AI-based software, enhances low-count PET images to match standard quality, enabling reduced radiation exposure without compromising lesion detection or quantitative accuracy.

Contribution

This study is the first clinical validation demonstrating that PETfectior maintains diagnostic accuracy in low-count PET scans, allowing for reduced radiotracer doses.

Findings

High lesion detection sensitivity (99.9%) with PETfectior

Quantitative SUVmax agreement within 12.5%

Subjective image quality rated equal or better

Abstract

Background: Diagnostic PET image quality depends on the administered activity and acquisition time. However, minimizing these variables is desirable to reduce patient radiation exposure and radiopharmaceutical costs. PETfectior is an artificial intelligence-based software that processes PET scans and increases signal-to-noise ratio, obtaining high-quality images from low-count-rate images. We perform an initial clinical validation of PETfectior on images acquired with half of the counting statistics required to meet the most recent EANM quantitative standards for 18F-FDG PET, evaluating lesions detectability, quantitative performance and image quality. Materials and methods: 258 patients referred for 18F-FDG PET/CT were prospectively included. The standard-of-care scans (100% scans) were acquired and reconstructed according to EARL standards 2. Half-counting-statistics versions were generated from list-mode data and processed with PETfecftior (50%+PETfectior scans). All oncologic lesions were segmented on both PET/CT versions, manually or automatically, and lesions detectability was evaluated. The SUVmax of the lesions was measured and the quantitative concordance of 50%+PETfectior and 100% images was evaluated. Subjective image quality was visually assessed by two experienced physicians. Results: 1649 lesions were detected in a total of 198 studies. The 50%+PETfectior images showed high sensitivity for lesion detection (99.9%) and only 1 false positive was detected. The SUVmax measured in 100% and 50%+PETfectior images agreed within 12.5% (95% limits of agreement), with a bias of -1.01%. Image quality of the 50%+PETfectior images was rated equal to or better than the standard-of-care images. Conclusion: PETfectior can safely be used in clinical practice at half counting statistics, with high sensitivity and specificity, low quantitative bias and high subjective image quality.