External validation and time-stability analysis of STARE, a blood-free quantification tool for irreversible PET tracers

Rationale"Gold standard" blood-based quantification of dynamic 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) data has limited practical clinical applications due to cost and complexity of data collection and analysis. We previously presented a blood-free quantification alternative, STARE (Source-to-Target Automatic Rotating Estimation), that was validated on 18F-FDG data acquired on a ECAT EXACT HR+ scanner. Here, we extend that initial work by externally validating STARE using within-subject data acquired with both a Siemens Biograph mCT scanner and a portable Brain Biosciences CerePET scanner. MethodsPerformance was assessed by comparing regional net influx rates (Ki) estimated using STARE and the standard blood-based Patlak approach. Twenty participants underwent 60-minute 18F-FDG scans, on two different days, once in each scanner. The time-stability of both STARE- and Patlak-based Ki estimates was evaluated by applying each method to the first 20 (STARE only), 30, 40, and 50 minutes of data. ResultsSTARE demonstrated high correlation with Patlak Ki estimates across both scanner types, particularly in the Biograph mCT (r = 0.93), with lower correlation in the CerePET (r = 0.71). In the Biograph dataset, STARE provided reliable Ki estimates at all evaluated scan durations (20 minutes and above), while in the CerePET dataset, only the 50-minute duration yielded STARE Ki estimates that were not significantly different from the full 60 minutes. The Patlak approach provided Ki estimates at 40 minutes scan duration and above that did not differ from the 60-min scan results in both datasets. ConclusionSTARE is a viable, noninvasive alternative to traditional blood-based quantification of dynamic 18F-FDG PET data, facilitating shorter, blood-free acquisition. This advancement could make dynamic 18F-FDG PET imaging more accessible and comfortable for patients, promoting broader clinical adoption.