Optimization of Image Reconstruction for 90Y Selective Internal Radiotherapy on a Lutetium Yttrium Orthosilicate PET/CT System Using a Bayesian Penalized Likelihood Reconstruction Algorithm

Imaging on a γ-camera with ⁹⁰Y after selective internal radiotherapy (SIRT) may allow for verification of treatment delivery but suffers relatively poor spatial resolution and imprecise dosimetry calculation. ⁹⁰Y PET/CT imaging is possible on 3-dimensional, time-of-flight machines; however, images are usually poor because of low count statistics and noise. A new PET reconstruction software using a Bayesian penalized likelihood (BPL) reconstruction algorithm (termed Q.Clear) was investigated using phantom and patient scans to optimize the reconstruction for post-SIRT imaging and clarify whether BPL leads to an improvement in clinical image quality using ⁹⁰Y. Methods: Phantom studies over an activity range of 0.5–4.2 GBq were performed to assess the contrast recovery, background variability, and contrast-to-noise ratio for a range of BPL and ordered-subset expectation maximization (OSEM) reconstructions on a PET/CT scanner. Patient images after SIRT were reconstructed using the same parameters and were scored and ranked on the basis of image quality, as assessed by visual evaluation, with the corresponding SPECT/CT Bremsstrahlung images by 2 experienced radiologists. Results: Contrast-to-noise ratio was significantly better in BPL reconstructions when compared with OSEM in phantom studies. The patient-derived BPL and matching Bremsstrahlung images scored higher than OSEM reconstructions when scored by radiologists. BPL with a β value of 4,000 was ranked the highest of all images. Deadtime was apparent in the system above a total phantom activity of 3.3 GBq. Conclusion: BPL with a β value of 4,000 is the optimal image reconstruction in PET/CT for confident radiologic reading when compared with other reconstruction parameters for ⁹⁰Y imaging after SIRT imaging. Activity in the field of view should be below 3.3 GBq at the time of PET imaging to avoid deadtime losses for this scanner.