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This study aimed to perform a quantitative evaluation and clinical validation of the MLAA method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A uniform cylinder phantom filled with<jats:sup>18<\/jats:sup>F-FDG solution was scanned to optimize the reconstruction parameters for the implemented MLAA algorithm. 67 patients who underwent whole-body<jats:sup>18<\/jats:sup>F-FDG PET\/CT scan were retrospectively recruited. PET images were reconstructed using MLAA and clinical standard OSEM algorithm with CT-AC (CT-OSEM). The mean and maximum standardized uptake values (SUVmean and SUVmax) in regions of interest (ROIs) of organs, high uptake lesions and areas affected by metal implants and respiration motion artifacts were quantitatively analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In quantitative analysis, SUVs in patient\u2019s organ ROIs between two methods showed<jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>ranging from 0.91 to 0.98 and<jats:italic>k<\/jats:italic>ranging from 0.90 to 1.06, and the average SUVmax and SUVmean differences between two methods were within 10% range, except for the lung ROI, which was 10.5% and 16.73% respectively. The average SUVmax and SUVmean differences of a total of 117 high uptake lesions were 7.25% and 7.10% respectively. 20 patients were identified to have apparent respiration motion artifacts in the liver in CT-OSEM images, and the SUVs differences between two methods measured at dome of the liver were significantly larger than measured at middle part of the liver. 10 regions with obvious metal artifacts were identified in CT-OSEM images and the average SUVmean and SUVmax differences in metal implants affected regions were reported to be 52.90% and 56.20% respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PET images reconstructed using MLAA are clinically acceptable in terms of image quality as well as quantification and it is a useful tool in clinical practice, especially when CT-AC may cause respiration motion and metal artifacts. Moreover, this study also provides technical reference and data support for the future iteration and development of PET reconstruction technology of SUV accurate quantification.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12880-023-00987-7","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T17:02:35Z","timestamp":1677517355000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A quantitative clinical evaluation of simultaneous reconstruction of attenuation and activity in time-of-flight PET"],"prefix":"10.1186","volume":"23","author":[{"given":"Haiqiong","family":"Zhang","sequence":"first","affiliation":[]},{"given":"Jingnan","family":"Wang","sequence":"additional","affiliation":[]},{"given":"Nan","family":"Li","sequence":"additional","affiliation":[]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[]},{"given":"Jie","family":"Cui","sequence":"additional","affiliation":[]},{"given":"Li","family":"Huo","sequence":"additional","affiliation":[]},{"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,2,27]]},"reference":[{"key":"987_CR1","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1088\/0031-9155\/54\/7\/005","volume":"54","author":"PJ Schleyer","year":"2009","unstructured":"Schleyer PJ, O\u2019Doherty MJ, Barrington SF, Marsden PK. 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The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and all the experimental protocols were approved by the institutional review board of Peking Union Medical College Hospital as well as the requirement for informed consent was waived by the institutional review board of Peking Union Medical College Hospital since this was a retrospective study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Nan Li, Yue Zhang and Jie Cui are employees of SinoUnion Healthcare, which owns the property of the presented MLAA reconstruction program. Hui Zhang serves as a member of the Board of Directors of SinoUnion Healthcare. No other potential conflicts of interest relevant to this article are reported.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"35"}}