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Objective  To explore the impact of the time-of-flight (TOF) reconstruction on brain PET with short-lived  11 C-labeled tracers in PET magnetic resonance (PET/MR) brain images among suspected patients with Alzheimer's and Parkinson's disease (AD/PD).    Methods  Patients who underwent  11 C-2-ß-carbomethoxy-3-b-(4-fluorophenyl) tropane ( 11 C-CFT) and 2-(4-N-[ 11 C] methylaminophenyl)-6-hydroxybenzothiazole ( 11 C-PiB) PET/MRI were retrospectively included in the study. Each PET LIST mode data were reconstructed with and without the TOF reconstruction algorithm. Standard uptake values (SUVs) of Caudate Nucleus (CN), Putamen (PU), and Whole-brain (WB) were measured. TOF and non-TOF SUVs were assessed by using paired  t -test. Standard formulas were applied to measure contrast, signal-to-noise ratio (SNR), and percentage relative average difference of SUVs (%RAD-SUVs).    Results  Total 75 patients were included with the median age (years) and body mass index (BMI-kg/m 2 ) of 60.2 ± 10.9 years and 23.9 ± 3.7 kg/m 2  in  11 C-CFT ( n  = 41) and 62.2 ± 6.8 years and 24.7 ± 2.9 kg/m 2  in  11 C-PiB ( n  = 34), respectively. Higher average SUVs and positive %RAD-SUVs were observed in CN and PU in TOF compared with non-TOF reconstructions for the two  11 C-labeled radiotracers. Differences of SUV mean  were significant ( p  &amp;lt; 0.05) in CN and PU for both  11 C-labeled radiotracers. SUV max  was enhanced significantly in CN and PU for  11 C-CFT and CN for  11 C-PiB, but not in PU. Significant contrast enhancement was observed in PU for both  11 C-labeled radiotracers, whereas SNR gain was significant in PU, only for  11 C-PiB in TOF reconstruction.    Conclusion  Time-of-flight leads to a better signal vs. noise trade-off than non-TOF in  11 C-labeled tracers between CN and PU, improving the SUVs, contrast, and SNR, which were valuable for reducing injected radiation dose. Improved timing resolution aided the rapid decay rate of short-lived  11 C-labeled tracers, and it shortened the scan time, increasing the patient comfort, and reducing the motion artifact among patients with AD/PD. However, one should adopt the combined TOF algorithm with caution for the quantitative analysis because it has different effects on the SUV max , contrast, and SNR of different brain regions.

Impact of TOF on Brain PET With Short-Lived 11C-Labeled Tracers Among Suspected Patients With AD/PD: Using Hybrid PET/MRI