The Dementias Platform UK PET/MR harmonisation and test-retest study: assessment of PET repeatability and reproducibility across the national network

Purpose: Positron emission tomography combined with magnetic resonance imaging (PET/MR) has not yet achieved the level of adoption of PET/CT. This study aimed to harmonise PET imaging protocols across a national PET/MR network and to quantitatively assess whether PET/MR can achieve reliability comparable to PET/CT. While previous PET test-retest studies have demonstrated good repeatability, they have typically been limited to small cohorts or restricted site configurations.

Methods: We conducted a multi-site harmonisation and rigorous test-retest study across the network of eight PET/MR scanners. Thirty-seven healthy older participants (65-90 years) underwent harmonised one-hour amyloid PET/MR scans using either [F]flutemetamol or [F]florbetaben on two occasions. Retest scans were performed under conditions of same-site repeatability or multi-site reproducibility. Harmonised acquisition and reconstruction protocols were applied, and amyloid burden was quantified on the Centiloid (CL) scale.

Results: CL values across 74 scans showed excellent test-retest agreement (ICC = 0.968), improving to 0.987 after exclusion of one attenuation correction related outlier. Mean test-retest variability was 2.58%. No statistically significant differences were observed across repeatability versus reproducibility conditions, scanner types, or tracers. CL measurements were highly consistent with three independent blinded visual reads.

Conclusion: This study demonstrates that harmonised PET/MR achieves high reliability comparable to PET/CT. Although the accuracy of attenuation maps requires checks, this study supports the use of PET/MR for quantitative amyloid imaging in research and therapeutic trials, and provides a valuable open resource of image and raw PET/MR data for further methodological development.