Comparative evaluation of Ordered Subset Expectation Maximization and Bayesian Penalized Likelihood algorithms for PET/CT image reconstruction in various malignancies using 18F-FDG and 68Ga-PSMA-11 tracers

Both reconstruction methods demonstrate clinical utility, with BPL producing statistically higher values for several quantitative metrics, such as SUVmax and TBR, without markedly improving lesion detectability. While strong correlations were observed between BPL and OSEM values, the wide limits of agreement, particularly for TBR in PSMA imaging, suggest these methods may not be directly interchangeable in longitudinal studies. Harmonization strategies may help reduce inter-method variability and improve scan comparability in longitudinal or multicenter settings. Prospective approaches, such as reconstruction-specific reference ranges or scaling factors, could further support harmonization efforts in clinical trials. For longitudinal monitoring, consistent use of the same reconstruction method is recommended to ensure reliable quantification.