Iterative reconstruction incorporating background correction improves quantification of [(18)F]-NaF PET/CT images of patients with abdominal aortic aneurysm

BACKGROUND: A confounding issue in [(18)F]-NaF PET/CT imaging of abdominal aortic aneurysms (AAA) is the spill in contamination from the bone into the aneurysm. This study investigates and corrects for this spill in contamination using the background correction (BC) technique without the need to manually exclude the part of the AAA region close to the bone. METHODS: Seventy-two (72) datasets of patients with AAA were reconstructed with the standard ordered subset expectation maximization (OSEM) algorithm incorporating point spread function (PSF) modelling. The spill in effect in the aneurysm was investigated using two target regions of interest (ROIs): one covering the entire aneurysm (AAA), and the other covering the aneurysm but excluding the part close to the bone (AAA(exc)). ROI analysis was performed by comparing the maximum SUV in the target ROI (SUV(max)(T)), the corrected cSUV(max) (SUV(max)(T) − SUV(mean)(B)) and the target-to-blood ratio (TBR = SUV(max)(T)/SUV(mean)(B)) with respect to the mean SUV in the right atrium region. RESULTS: There is a statistically significant higher [(18)F]-NaF uptake in the aneurysm than normal aorta and this is not correlated with the aneurysm size. There is also a significant difference in aneurysm uptake for OSEM and OSEM + PSF (but not OSEM + PSF + BC) when quantifying with AAA and AAA(exc) due to the spill in from the bone. This spill in effect depends on proximity of the aneurysms to the bone as close aneurysms suffer more from spill in than farther ones. CONCLUSION: The background correction (OSEM + PSF + BC) technique provided more robust AAA quantitative assessments regardless of the AAA ROI delineation method, and thus it can be considered as an effective spill in correction method for [(18)F]-NaF AAA studies. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-019-01940-4) contains supplementary material, which is available to authorized users.