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Xerostomia and radiation-induced salivary gland dysfunction remain a commonside effect for head-and-neck radiotherapy patients, and attempts have beenmade to quantify the heterogeneous dose response within parotid glands. Hereseveral models of parotid gland subregional importance are compared withprostate specific membrane antigen (PSMA) positron emission tomography (PET)uptake. PSMA ligands show high concentrations in salivary glands, whose uptakehas been previously found to relate to gland functionality. We develop apredictive model for relative importance estimates using PSMA PET and CTradiomic features, and demonstrate a methodology for predictingpatient-specific importance deviations from the population. Intra-parotid glanduptake was compared with four regional importance models using 30 [18F]DCFPyLPSMA PET images. A radiomics-based predictive model of population importancewas developed using a double cross-validation methodology. Populationimportance estimates were supplemented using patient-specific radiomicfeatures. Anticorrelative relationships were found to exist between PSMA PETuptake and four independent models of subregional parotid gland importance fromthe literature. Kernel Ridge Regression with principal component analysisfeature selection performed best over test sets (MAE = 0.08), with GLCMfeatures being particularly important. Deblurring PSMA PET images strengthenedcorrelations and improved model performance. This study suggests that regionsof relatively low PSMA PET concentration in parotid glands may exhibitrelatively high dose-sensitivity. We've demonstrated the utility of PSMA PETradiomic features for predicting relative importance within the parotid glands.PSMA PET appears promising for analyzing salivary gland functionality.

PSMA PET/CT as a predictive tool for sub-regional importance estimates in the parotid gland