Deep learning enhanced ultra-fast SPECT/CT bone scan in patients with suspected malignancy: quantitative assessment and clinical performance.

Objectives To evaluate the clinical performance of deep learning-enhanced ultrafast single photon emission computed tomography/computed tomography (SPECT/CT) bone scans in patients with suspected malignancy. Approach In this prospective study, 102 patients with potential malignancy were enrolled and underwent a 20 min SPECT/CT and a 3 min SPECT scan. A deep learning model was applied to generate algorithm-enhanced images (3 min-DL SPECT), and the reference modality was the 20 min SPECT/CT scan. Two reviewers independently evaluated general image quality, Tc-99m MDP distribution, artifacts, and diagnostic confidence of 20 min SPECT/CT, 3 min SPECT/CT, and 3 min-DL SPECT/CT images. The sensitivity, specificity, accuracy, and interobserver agreement were calculated. The lesion maximum standard uptake value (SUVmax) of the 3 min-DL and 20 min SPECT/CT images was analyzed. The peak signal-to-noise ratio (PSNR) and structure similarity index measure (SSIM) were evaluated. Main results The 3 min-DL SPECT/CT images showed significantly superior general image quality, Tc-99m MDP distribution, artifacts, and diagnostic confidence than the 20 min SPECT/CT images (P < 0.0001). The diagnostic performance of the 20 min and 3 min-DL SPECT/CT images was similar for reviewer 1 (paired X2 = 0.333, P = 0.564) and reviewer 2 (paired X2 = 0.05, P = 0.823). The diagnosis results for the 20 min (kappa = 0.822) and 3 min-DL (kappa = 0.732) SPECT/CT images showed high interobserver agreement. The 3 min-DL SPECT/CT images had significantly higher PSNR and SSIM than the 3 min SPECT/CT images (51.44 vs. 38.44, P<0.0001; 0.863 vs. 0.752, P < 0.0001). The SUVmax of the 3 min-DL and 20 min SPECT/CT images showed a strong linear relationship (r = 0.991; P < 0.0001). Significance Ultrafast SPECT/CT with a 1/7 scan time can be enhanced by deep learning to achieve comparable image quality and diagnostic value to standard acquisition.