Enhancing the Diagnostic Accuracy of Amyloid PET: The Impact of MR-Guided PET Reconstruction.

F-Florbetaben (FBB) uptake in the supratentorial cortex is indicative of amyloid positivity. Due to PET's low spatial resolution, image noise, and spill-over of signal from adjacent white-matter into gray-matter, there are inconsistencies in ratings among trained readers. A set of 264 F-Florbetaben (amyloid) PET/MRI exams were reconstructed using conventional ordered subset expectation maximization (OSEM) method and MR-guided block sequential regularized expectation maximization (MRgBSREM) method. Images from 264 patients reconstructed by OSEM method and rated by 3 trained readers. Fifty-three exams were rated inconsistently and were mixed with another 53 exams which were rated consistently. These 106 subjects were then rated by our readers using the MRgBSREM PET reconstruction method. Centiloids (CL) were measured using both reconstruction methods. Signal to noise ratio (SNR) was calculated in frontal, anterior/posterior cingulate, lateral parietal, and lateral temporal regions for both reconstruction methods. There is significant correlation between CL measured by OSEM and MRgBSREM methods with R2=0.99. MRgBSREM enhanced the SNR in all regions by average of 21%. The number of inconsistent exams dropped by 64% using MRgBSREM method as compared with OSEM method. Using Fleiss-Kappa statistical test, the agreement between readers was raised from "Fair" to "Significant" in the 106-subjects subset. PET reconstruction with MR priors can significantly improve the consistency of ratings among trained readers. Given the prevalence of inconsistent ratings in amyloid PET, methods that enhance the ability to distinguish intermediate amyloid levels could be valuable for the widespread adoption of this modality.