Uncertainty in measurements of ¹⁸F blood concentration and its effect on simplified dynamic PET analysis

The purpose of this study was to assess the accuracy and practicality of well counter- and thyroid probe-based methods, commonly available in nuclear medicine facilities, for measuring the concentration of (18)F-FDG in blood samples. The degree to which the accuracy of such methods influences quantitative analysis of dynamic PET scans was also assessed.

Thirty-five patients with cancer of the head and neck underwent dynamic PET imaging as part of a study intended to evaluate the utility of quantitative, image-based metrics for assessment of early treatment response. The activity in blood samples from the patients, necessary to provide an estimate of the input function for quantitative analysis, was measured both using a thyroid probe and using a well counter. Three calibration techniques were compared: single-point calibration using a standard solution for the thyroid probe (ProbePoint technique), single-point calibration using a standard solution for the well counter (WellPoint technique), and multiple-point calibration over the full range of expected blood activities for the well counter (WellCurve technique). The WellCurve method was assumed to provide the most accurate estimate of blood activity. The precision of measuring blood volume using a micropipette was also evaluated by obtaining multiple blood samples. Simplified-kinetic-analysis multiple-time-point (SKA-M) uptake rates for the primary tumor were calculated for all 35 patients using PET images and each of the 3 methods for assessing blood concentration.

Errors in blood activity measurements ranging from -9.5% to 7.6% were found using the ProbePoint method, whereas the error range was much less (from -1.3% to 0.9%) for the WellPoint method. The precision in blood volume measurements ranged from -6% to 12% in the 10 patients assessed. The errors in blood activity and volume measurements were reflected in the SKA-M measurements in the same range.

The WellPoint method provides a compromise between accuracy and clinical practicality. Random errors in both blood activity and volume measurements accumulate and may compromise parameters--such as the SKA-M estimate of tumor uptake rate--that depend not only on images but also on blood concentration data.