ArticleEJNMMI research2026
Reconstruction matters: influence of EARL standards and BSREM in [
Article in EJNMMI research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDifferentiating progressive disease (PD) from treatment-related changes (TRC) in glioma remains challenging using magnetic resonance imaging (MRI) alone. Amino acid positron-emission tomography (PET) with O-(2-[
resultsThirty-three patients with 42 lesions were analysed. In lesion‑based comparisons, both EANM Research Ltd. harmonization standard version 2.0 (EARL2) and block-sequential regularized expectation maximization using a β-value of 150 (BSREM150) yielded significantly higher standardized uptake values (SUV), tumour‑to‑background ratios (TBR), and biological tumour volumes (BTV) than EANM Research Ltd. harmonization standard version 1.0 (EARL1), and identified a greater number of lesions as measurable disease (MD). BTV differed across reconstructions; adapting the BSREM150 segmentation threshold to SUV ≥ 1.7 x mean background activity improved BTV concordance while preserving superior MD detection. Excellent discrimination between PD and TRC was observed for TBRmax across all reconstructions (area under the curve ≥ 0.94), although optimal thresholds were reconstruction‑specific (EARL1: 1.67; EARL2: 1.84; BSREM150: 2.39). At the patient level, EARL1 failed to identify three PD cases, whereas BSREM150 misclassified one TRC case as PD.
conclusionReconstruction standards substantially influence quantitative [¹⁸F]FET PET metrics and clinical interpretation. Applying universal thresholds across reconstructions risks misclassification, with EARL1 potentially underestimating tumour extent and BSREM150 increasing false-positive findings. Reconstruction-specific thresholds and neuro-oncology-specific harmonization frameworks are therefore essential for reliable [
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