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This may cause limited access to examination slots because of the growing demand for PSMA-PET. Ultra-fast PSMA-PET may enhance throughput but comes at the cost of poor image quality. The aim of this manuscript is to evaluate the accuracy of AI-enhanced ultra-fast PSMA-PET for staging of patients with prostate cancer.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A total number of 357 whole-body [<jats:sup>68<\/jats:sup>Ga]Ga-PSMA-11 PET datasets were included. Patients underwent two digital PET scans, one at standard and one at ultra-fast speed (table speed: 0.6\u20131.2\u00a0mm\/s vs. 50\u00a0mm\/s). A modified pix2pixHD generative adversarial network to enhance the ultra-fast images was trained with 286 datasets and evaluated with the remaining 71 datasets. The staging accuracy of ultra-fast PSMA-PET and AI-enhanced ultra-fast PET was compared with the reference standard PET separately for miTNM regions proposed by PROMISE V2.0.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The AI-network significantly improved the visual image quality and detection rate in most miTNM regions compared with the non-enhanced image data (T: 69.6% vs. 43.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05; N: 46.3% vs. 27.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01; M1a 64.4% vs. 47.5%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01; M1b: 85.7% vs. 72.1%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). However, improvement was not significant for the M1c category (42.9 vs. 28.6%, <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Missed lesions had a smaller SUVmax and lesion size compared with detected lesions (exemplary for N: 9.5 vs. 26.5 SUVmax; 4 vs. 10\u00a0mm). SUVmax values of lesions were significantly different in all miTNM regions between the ultra-fast and reference standard PET, but only in the T-region between the AI-enhanced and reference standard PET.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The AI-based image enhancement improved image quality and region detection rates by a mean of 17.9%. As the sensitivity of synthetic PET for small and low-uptake lesions was limited, a potential clinical use case could be disease monitoring in patients with high tumor volume and PSMA uptake undergoing PSMA radioligand therapy. The improvement in detection rate of distant metastases was not significant. This indicates that more training data is needed to ensure robust results also for lesions that have lower appearance frequency. Future studies on accelerated PSMA-PET seem warranted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00259-024-07060-7","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T02:50:34Z","timestamp":1736563834000},"page":"1658-1670","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Staging of prostate Cancer with ultra-fast PSMA-PET scans enhanced by AI"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-1830","authenticated-orcid":false,"given":"David","family":"Kersting","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Borys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"K\u00fcper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Haubold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsepo","family":"Goerttler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lale","family":"Umutlu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Fragoso","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Kleesiek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Rischpler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Nensa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Herrmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang P.","family":"Fendler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9","family":"Hosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Seifert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"7060_CR1","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1001\/jamaoncol.2021.3771","volume":"7","author":"TA Hope","year":"2021","unstructured":"Hope TA, Eiber M, Armstrong WR, Juarez R, Murthy V, Lawhn-Heath C, et al. 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Written informed consent was requested.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"DK reports a research grant from Pfizer, funding by the German Research Foundation (DFG, KE2933\/1\u20131), funding by the Universit\u00e4tsmedizin Essen Clinician Scientist Academy (UMEA)\/DFG (FU356\/12\u20132), and speaker honoraria from Pfizer and Novartis outside of the submitted work. JH reports funding by the Universit\u00e4tsmedizin Essen Clinician Scientist Academy (UMEA)\/DFG (FU356\/12\u20132) outside of the submitted work. TG reports funding by the Universit\u00e4tsmedizin Essen Clinician Scientist Academy (UMEA)\/DFG (FU356\/12\u20132) outside of the submitted work. LU is a Speaker\/Advisory Board Member for Bayer Healthcare and Siemens Healthcare and received research grants from Siemens Healthcare outside of the submitted work. CR is an editor in this journal and reports a research grant from Pfizer, consultancy for Adacap and Pfizer, and speaker honoraria from Adacap, Alnylam, BTG, Curium, GE Healthcare, Pfizer, and Siemens Healthineers outside of the submitted work. KH reports personal fees from Bayer, personal fees and other from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, personal fees from Novartis, personal fees from ymabs, personal fees from Aktis Oncology, personal fees from Theragnostics, personal fees from Pharma15, personal fees from Debiopharm, personal fees from AstraZeneca, and personal fees from Janssen outside of the submitted work. WPF reports fees from SOFIE Bioscience (research funding), Janssen (consultant, speaker), Calyx (consultant, image review), Bayer (consultant, speaker, research funding), Novartis (speaker, consultant), Telix (speaker), GE Healthcare (speaker), Eczac\u0131ba\u015f\u0131 Monrol (speaker), Abx (speaker), Amgen (speaker), Urotrials (speaker) outside of the submitted work. MW reports fees from Boston Scientific, Terumo, Eli Lilly, and Advanced Accelerator Applications. RS has received research\/travel funding from Else Kr\u00f6ner-Fresenius-Stiftung and Boehringer Ingelheim Fonds as well as speaker honoraria and travel support from Novartis and Boston Scientific outside of the submitted work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}