Quantitative Accuracy of HRRT List-mode Reconstructions: Effect of Low Statistics.

Previous studies showed that iterative image reconstruction algorithms may produce overestimations of activity in low-activity regions in low-count frames. The purpose of this study was (1) to evaluate the quantitative accuracy of the MOLAR list-mode iterative reconstruction method in the context of ligand-receptor PET studies in low counts, and (2) to determine the minimum noise equivalent counts (NEC) per frame to avoid bias. Evaluation of clinical data was performed for 4 tracers using dynamic brain PET studies. True activity was estimated from high-statistics frames (300s) and ROI analysis was performed to evaluate bias in low-activity regions in short acquisition frames (10-30s) from matching times. Bias in the ROI mean values was analyzed as function of NEC. In addition, accuracy was assessed using Hoffman phantom data and simulated list mode data based on human data, but without scatter and randoms.Unlike previous results, small biases of -3±3% for low statistics region across the 4 tracers were found for NEC >100K in each frame. Very similar results were found in the phantom and simulation data. We conclude that the MOLAR iterative reconstruction method provides accurate results even in very low-count frames. This improved performance may be attributed to some of the unique characteristics of MOLAR including randoms estimation from singles, iterative estimation of scatter within the algorithm, component-based normalization, and incorporation of a line-spread function model in the reconstruction.