Reduced count pediatric whole-body 18F-FDG PET imaging reconstruction with a Bayesian penalized likelihood algorithm

Background Advanced positron emission tomography (PET) image reconstruction methods promise to allow optimized PET/CT protocols with improved image quality, decreased administered activity and/or acquisition times. Objective To evaluate the impact of reducing counts (simulating reduced acquisition time) in block sequential regularized expectation maximization (BSREM) reconstructed pediatric whole-body 18 F-fluorodeoxyglucose (FDG) PET images, and to compare BSERM with ordered-subset expectation maximization (OSEM) reconstructed reduced-count images. Materials and methods Twenty children (16 male) underwent clinical whole-body 18 F-FDG PET/CT examinations using a 25-cm axial field-of-view (FOV) digital PET/CT system at 90 s per bed (s/bed) with BSREM reconstruction ( β =700). Reduced count simulations with varied BSREM β levels were generated from list-mode data: 60 s/bed, β =800; 50 s/bed, β =900; 40 s/bed, β =1000; and 30 s/bed, β =1300. In addition, a single OSEM reconstruction was created at 60 s/bed based on prior literature. Qualitative (Likert scores) and quantitative (standardized uptake value [SUV]) analyses were performed to evaluate image quality and quantitation across simulated reconstructions. Results The mean patient age was 9.0 ± 5.5 (SD) years, mean weight was 38.5 ± 24.5 kg, and mean administered 18 F-FDG activity was 4.5 ± 0.7 (SD) MBq/kg. Between BSREM reconstructions, no qualitative measure showed a significant difference versus the 90 s/bed β =700 standard (all P >0.05). SUV max values for lesions were significantly lower from 90 s/bed, β =700 only at a simulated acquisition time of 30 s/bed, β =1300 ( P =0.001). In a side-by-side comparison of BSREM versus OSEM reconstructions, 40 s/bed, β =1000 images were generally preferred over 60 s/bed TOF OSEM images. Conclusion In children who undergo whole-body 18 F-FDG PET/CT on a 25-cm FOV digital PET/CT scanner, reductions in acquisition time or, by corollary, administered radiopharmaceutical activity of >50% from a clinical standard of 90 s/bed may be possible while maintaining diagnostic quality when a BSREM reconstruction algorithm is used. Graphical Abstract