Effect of Using 2 mm Voxels on Observer Performance for PET Lesion Detection

Positron emission tomography (PET) images are typically reconstructed with an in-plane pixel size of approximately 4 mm for cancer imaging. The objective of this work was to evaluate the effect of using smaller pixels on general oncologic lesion-detection. A series of observer studies was performed using experimental phantom data from the Utah PET Lesion Detection Database, which modeled whole-body FDG PET cancer imaging of a 92 kg patient. The data comprised 24 scans over 4 days on a Biograph mCT time-of-flight (TOF) PET/CT scanner, with up to 23 lesions (diam. 6–16 mm) distributed throughout the phantom each day. Images were reconstructed with 2.036 mm and 4.073 mm pixels using ordered-subsets expectation-maximization (OSEM) both with and without point spread function (PSF) modeling and TOF. Detection performance was assessed using the channelized non-prewhitened numerical observer with localization receiver operating characteristic (LROC) analysis. Tumor localization performance and the area under the LROC curve were then analyzed as functions of the pixel size. In all cases, the images with ${\sim}{2}\;\hbox{mm}$ pixels provided higher detection performance than those with ${\sim}{4}\;\hbox{mm}$ pixels. The degree of improvement from the smaller pixels was larger than that offered by PSF modeling for these data, and provided roughly half the benefit of using TOF. Key results were confirmed by two human observers, who read subsets of the test data. This study suggests that a significant improvement in tumor detection performance for PET can be attained by using smaller voxel sizes than commonly used at many centers. The primary drawback is a 4-fold increase in reconstruction time and data storage requirements.