Effect of ¹⁸F-FDG Uptake Time on Lesion Detectability in PET Imaging of Early-Stage Breast Cancer

Prior reports have suggested that delayed ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) oncology imaging can improve the contrast-to-noise ratio (CNR) for known lesions. Our goal was to estimate realistic bounds for lesion detectability for static measurements within 1 to 4 hours between FDG injection and image acquisition. Tumor and normal tissue kinetic model parameters were estimated from dynamic PET studies of patients with early-stage breast cancer. These parameters were used to generate time-activity curves (TACs) for up to 4 hours, for which we assumed both nonreversible and reversible models with different rates of FDG dephosphorylation (k₄). For each pair of tumor and normal tissue TACs, 600 PET sinogram realizations were generated, and images were reconstructed using the ordered subsets expectation maximization reconstruction algorithm. Test statistics for each tumor and normal tissue region of interest were output from the computer model observers and evaluated using a receiver operating characteristic analysis, with the calculated area under the curve (AUC) providing a measure of lesion detectability. For the nonreversible model (k₄ = 0), the AUC increased in 11 of 23 (48%) patients for 1 to 2 hours after the current standard postradiotracer injection imaging window of 1 hour. This improvement was driven by increased tumor/normal tissue contrast before the impact of increased noise that resulted from radiotracer decay began to dominate the imaging signal. As k₄ was increased from 0 to 0.01 min⁻¹, the time of maximum detectability shifted earlier, due to decreasing FDG concentration in the tumor lowering the CNR. These results imply that delayed PET imaging may reveal inconspicuous lesions that otherwise would have gone undetected.