Initial clinical experience with dedicated multi-pinhole (MPH) collimator for Tc-99m-HMPAO brain perfusion SPECT

Objective: Dedicated multi-pinhole (MPH) collimators have been successfully tested in selected clinical investigations. The aim of our work was to report initial experiences with an MPH collimator set designed for brain perfusion single photon emission tomography (SPECT). Subjects and Methods:Ten patients underwent sequential technetium-99m-hexamethylpropyleneamineoxime (Tc-99m-HMPAO) SPECT with a dual-head SPECT camera equipped with conventional low-energy parallel hole collimators (LEHR), and with a triple-head system equipped with MPH collimators. Low-energy parallel hole collimators data were reconstructed by filtered back projection (FBP), ordered subset expectation maximization (OSEM), software for tomographic image reconstruction (STIR). In addition, both the parallel hole data and MPH data were reconstructed by Tera-Tomo (TM) 3D iterative reconstruction denoted LEHR_TT3D and MPH_TT3D, respectively. Five medical experts visually compared the reconstructed images of the five data sets and defined a ranking sequence from the lowest (1) to the highest (5) image quality. Results were compared using the Friedman test. P values below 0.05 were considered significant. Results: Low-energy parallel hole collimators acquisition resulted in 5 million, while MPH acquisition in 13 million total counts with 30 and 34 minutes of acquisition time, respectively. Mean rank coefficients of the reconstruction methods were 1.96 +/- 0.52, 2.66 +/- 0.46, 2.86 +/- 0.60, 3.62 +/- 0.55, 3.9 +/- 0.68 for FBP, STIR, LEHR_TT3D, LEHR_OSEM, MPH_TT3D respectively. The differences between MPH_TT3D-F BP (P<0.01); MP H_TT3D-STIR (P<0.05); LEHR_OSEM-FBP (P<0.01) were significant. Conclusions: Image quality provided by MPH collimator is comparable to that provided by conventional LEHR imaging. Higher sensitivity has the potential to shorten acquisition time or to reduce the amount of administered activity.