Optimal dual time point for FDG-PET in the differentiation of benign from malignant lung lesions: a simulation study

Dual time point imaging has been proposed as a means of improving the accuracy of Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in the diagnosis of lung malignancy. However, various sampling schedules have been used, which makes direct comparisons between their results difficult. It is unclear whether these schedules have the same accuracy for the diagnosis of lung malignancy, limiting the further development and adoption of these techniques. Although theoretically malignant and benign lesions show increasing difference in FDG uptake with longer uptake periods, the increasing noise due to decay may counteract this advantage and increase variability. In this paper, a method for the design of an optimal dual time point 18F-FDG PET imaging protocol has been proposed to address this issue.