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Improving 68-Ga-PSMA PET/MR hybrid imaging of the prostate with un-renormalized absolute scatter correction.

Purpose: A limitation of using 68-gallium-labelled prostate-specific membrane antigen (68-Ga-PSMA) for detection and staging of prostate cancer is a frequently observed halo artifact around the urinary bladder caused by inaccurate scatter correction (SC) of positron emission tomography (PET) data. The aim of this study is to investigate the impact of un-renormalized absolute SC on 68-Ga-PSMA PET quantification in PET/magnetic resonance (MR) hybrid imaging of the prostate in 100 patients. Methods: The PET data of 100 patients were reconstructed twice using standard SC and improved un-renormalized SC. The visual presence of halo artifacts was rated in each PET data reconstruction using five grades (0 = no halo artifact, 4 = severe halo artifact). The number of visible lesions in the pelvis was recorded. Standardized-uptake-values (SUVmean and SUVmax ) were measured in the lesions, the bladder, in the gluteus maximus, and within the halo margin. Furthermore, the signal-to-noise-ratio (SNR) and image noise were measured in all PET data. Relative differences between standard and un-renormalized SC were calculated. Results: With standard SC the average grade in halo presence was 2 (moderate halo-artifact), whereas for un-renormalized SC the average grade was 0.9 (slight halo-artifact). The same number of congruent lesions ( n = 74) was detected for both PET data reconstructions. Relative changes in PET signal-to-noise-ratio and image noise were statistically not significant ( P > 0.05). The mean ± standard deviation (SD) increase in SUVmean in the gluteus maximus using un-renormalized SC was 23.0 ± 9.2 %, in the bladder 7.1 ± 4.5 %, in the halo-margin 325.4 ± 748.5 % and in all n = 74 detected lesions 12.4 ± 16.8 %. The mean increase using un-renormalized SC in SUVmean for lesions inside (38 lesions) the halo-margin was 17.5 % and outside (36 lesions) the halo-margin is 6.9 %. Conclusion: For PET/MR hybrid imaging of prostate cancer using 68-Ga-PSMA a proper SC is important to ensure best possible diagnostic quality and PET quantification. The un-renormalized absolute SC significantly reduces the halo artifact around the bladder and improves PET/MR hybrid imaging of the prostate.

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