Abstract
BACKGROUND: [(18)F]FDG PET/CT scan combined with [(18)F]PSMA-1007 PET/CT scan is commonly conducted for detecting bone metastases in prostate cancer (PCa). However, it is expensive and may expose patients to more radiation hazards. This study explores deep learning (DL) techniques to synthesize [(18)F]PSMA-1007 PET bone images from CT bone images for the early detection of bone metastases in PCa, which may reduce additional PET/CT scans and relieve the burden on patients. METHODS: We retrospectively collected paired whole-body (WB) [(18)F]PSMA-1007 PET/CT images from 152 patients with clinical and pathological diagnosis results, including 123 PCa and 29 cases of benign lesions. The average age of the patients was 67.48 ± 10.87 years, and the average lesion size was 8.76 ± 15.5 mm. The paired low-dose CT and PET images were preprocessed and segmented to construct the WB bone structure images. 152 subjects were randomly stratified into training, validation, and test groups in the number of 92:41:19. Two generative adversarial network (GAN) models-Pix2pix and Cycle GAN-were trained to synthesize [(18)F]PSMA-1007 PET bone images from paired CT bone images. The performance of two synthesis models was evaluated using quantitative metrics of mean absolute error (MAE), mean squared error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity index metrics (SSIM), as well as the target-to-background ratio (TBR). RESULTS: The results of DL-based image synthesis indicated that the synthesis of [(18)F]PSMA-1007 PET bone images from low-dose CT bone images was highly feasible. The Pix2pix model performed better with an SSIM of 0.97, PSNR of 44.96, MSE of 0.80, and MAE of 0.10, respectively. The TBRs of bone metastasis lesions calculated on DL-synthesized PET bone images were highly correlated with those of real PET bone images (Pearson's r > 0.90) and had no significant differences (p < 0.05). CONCLUSIONS: It is feasible to generate synthetic [(18)F]PSMA-1007 PET bone images from CT bone images by using DL techniques with reasonable accuracy, which can provide information for early detection of PCa bone metastases.