Clinical evaluation of ⁶⁸Ga-PSMA-11 and ⁶⁸Ga-RM2 PET images reconstructed with an improved scatter correction algorithm

OBJECTIVE. Gallium-68-labeled radiopharmaceuticals pose a challenge for scatter estimation because their targeted nature can produce high contrast in these regions of the kidneys and bladder. Even small errors in the scatter estimate can result in washout artifacts. Administration of diuretics can reduce these artifacts, but they may result in adverse events. Here, we investigated the ability of algorithmic modifications to mitigate washout artifacts and eliminate the need for diuretics or other interventions. MATERIALS AND METHODS. The model-based scatter algorithm was modified to account for PET/MRI scanner geometry and challenges of non-FDG tracers. Fifty-three clinical ⁶⁸Ga-RM2 and ⁶⁸Ga-PSMA-11 whole-body images were reconstructed using the baseline scatter algorithm. For comparison, reconstruction was also processed with modified sampling in the single-scatter estimation and with an offset in the scatter tail-scaling process. None of the patients received furosemide to attempt to decrease the accumulation of radiopharmaceuticals in the bladder. The images were scored independently by three blinded reviewers using the 5-point Likert scale. RESULTS. The scatter algorithm improvements significantly decreased or completely eliminated the washout artifacts. When comparing the baseline and most improved algorithm, the image quality increased and image artifacts were reduced for both ⁶⁸Ga-RM2 and for ⁶⁸Ga-PSMA-11 in the kidneys and bladder regions. CONCLUSION. Image reconstruction with the improved scatter correction algorithm mitigated washout artifacts and recovered diagnostic image quality in ⁶⁸Ga PET, indicating that the use of diuretics may be avoided.