Maximum Likelihood Estimation Yields Accurate Line-of-Response Assignment for Positron + Prompt Gamma Ray Events in Multiplexed PET (mPET)

For accurate disease characterization using positron emission tomography (PET), it is desirable to image multiple radiotracers in a single scan. Conventional PET methods cannot do this due to the indistinguishable annihilation photons produced by different radiotracers. One approach is to label one radiotracer with a positron+prompt-gamma ($\beta^+\!\!-\!\!\gamma$) isotope producing triple coincidences, and another with a pure positron-emitting ($\beta^+$) isotope producing double coincidences. However, $\beta^+\!\!-\!\!\gamma$ emitters present challenges in correctly identifying the two annihilation photons, or equivalently, assigning the correct line-of-response (LOR) to triple-photon coincidence events. Here, we propose a maximum likelihood estimation (MLE) framework leveraging spatial, timing, and energy information to determine the most probable LOR. Simulation studies validated the method: simulations showed over 96\% and 94\% accuracy for LOR assignment of $\beta^+\!\!-\!\!\gamma$ emitters $^{22}$Na and $^{124}$I point sources, respectively. Furthermore, simulated phantom imaging of $^{22}$Na or $^{124}$I distributions alongside a $\beta^+$ emitter demonstrated that MLE LOR assignment achieved comparable image quality -- measured by contrast recovery coefficient (CRC) and cross-talk ratio (XR) -- to benchmark methods, where the prompt gamma was identified using an energy threshold ($\geq 650$ keV) for $^{22}$Na and as the highest-energy photon for $^{124}$I.