ArticleAnnals of nuclear medicine2026
Reconstruction robustness of liver-referenced adaptive thresholding for
Article in Annals of nuclear medicine, 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
objectivePSMA tumor volume (PSMA-TV) is increasingly investigated as a quantitative biomarker for treatment assessment and prognostic stratification in metastatic castration-resistant prostate cancer (mCRPC). However, PSMA-TV depends on segmentation methodology and may be affected by reconstruction-related changes in PET image characteristics. This study evaluated the robustness of different PSMA-TV segmentation approaches across two reconstruction presets and investigated systematic bias, individual-patient disagreement, and equivalence between reconstruction settings.
methodsForty patients with mCRPC undergoing
resultsPSMA-TV measurements demonstrated threshold-dependent reconstruction sensitivity. T3 showed the largest reconstruction-related variability, with a median signed relative difference of - 53.9% and markedly increased median absolute percentage difference (53.9%). In contrast, T1 and T2 showed substantially lower proportional disagreement (12.7% and 12.1%, respectively). T2 demonstrated the smallest systematic bias between reconstructions (median signed difference 0.4 mL; relative difference 1.1%) compared with T1 (16.9 mL; 9.0%). ICC values indicated high consistency for T1 (0.96; 95% CI, 0.93-0.98) and T2 (0.97; 95% CI, 0.94-0.98), whereas T3 showed lower precision (0.82; 95% CI, 0.29-0.93). Log-ratio Bland-Altman analysis demonstrated no evidence of proportional bias for any threshold. T2 was the only approach demonstrating equivalence within the strictest exploratory ± 10% margin.
conclusionsReconstruction-dependent effects on PSMA-TV are strongly influenced by segmentation methodology. Liver-referenced adaptive thresholding minimized systematic reconstruction-related bias and demonstrated the highest robustness among evaluated approaches, although individual variability was not completely eliminated. Relative SUV
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