Improvement of brain perfusion SPET using iterative reconstruction with scatter and non-uniform attenuation correction

Filtered back-projection (FBP) is generally used as the reconstruction method for single-photon emission tomography although it produces noisy images with apparent streak artefacts. It is possible to improve the image quality by using an algorithm with iterative correction steps. The iterative reconstruction technique also has an additional benefit in that computation of attenuation correction can be included in the process. A commonly used iterative method, maximum-likelihood expectation maximisation (ML-EM), can be accelerated using ordered subsets (OS-EM). We have applied to the OS-EM algorithm a Bayesian one-step late correction method utilising median root prior (MRP). Methodological comparison was performed by means of measurements obtained with a brain perfusion phantom and using patient data. The aim of this work was to quantitate the accuracy of iterative reconstruction with scatter and non-uniform attenuation corrections and post-filtering in SPET brain perfusion imaging. SPET imaging was performed using a triple-head gamma camera with fan-beam collimators. Transmission and emission scans were acquired simultaneously. The brain phantom used was a high-resolution three-dimensional anthropomorphic JB003 phantom. Patient studies were performed in ten chronic pain syndrome patients. The images were reconstructed using conventional FBP and iterative OS-EM and MRP techniques including scatter and nonuniform attenuation corrections. Iterative reconstructions were individually post-filtered. The quantitative results obtained with the brain perfusion phantom were compared with the known actual contrast ratios. The calculated difference from the true values was largest with the FBP method; iteratively reconstructed images proved closer to the reality. Similar findings were obtained in the patient studies. The plain OS-EM method improved the contrast whereas in the case of the MRP technique the improvement in contrast was not so evident with post-filtering.