Collimator selection for SPECT brain imaging: the advantage of high resolution

We compared a prototype long-bore (LB) high-resolution collimator with a low-energy, general-purpose collimator (LEGP) using 99mTc and 123I. The LB collimator provided a 56% improvement in tomographic resolution (autocorrelation width) over the LEGP for 99mTc; for 123I, the gain was 79%, providing substantially improved contrast for small structures. The sensitivity of the LB collimator, however, is only 32% of that of the LEGP. The imaging tasks to be performed on [123I]IMP brain scans involve localization and discrimination of small, high-contrast brain structures and detection of abnormalities in shape, size, or uptake, rather than simple detection of lesions. Observer performance in such higher-order imaging tasks is known to depend on high spatial resolution, even at the cost of sensitivity. Patient studies confirmed that, for resolution-limited tasks, the increase in resolution outweighs the increased noise due to a loss in sensitivity. When the tomographic resolution of the LB collimator was degraded by smoothing to that of the LEGP, the noise in the LB images was lower than that of the LEGP by a factor of 2.9 for the same imaging time, demonstrating the advantage of high-resolution detectors and a smooth reconstruction filter over low-resolution detectors without smoothing. Therefore, collimators designed for high resolution, even at substantial cost in sensitivity, are expected to yield significant improvements for brain SPECT. Geometric calculations show that commercially available low-energy, high-resolution cast collimators promise to meet these requirements.