LAUSR

Non-local mean (NLM) filtering has been broadly used for denoising of natural and medical images. The NLM filter relies on the redundant information, in the form of repeated patterns/textures, in the target image to discriminate the underlying structures/signals from noise. In PET (or SPECT) imaging, the raw data could be reconstructed using different parameters and settings, leading to different representations of the target image, which contain highly similar structures/signals to the target image contaminated with different noise levels (or properties). In this light, multiple-reconstruction NLM filtering (MR-NLM) is proposed, which relies on the redundant information provided by the different reconstructions of the same PET data (referred to as auxiliary images) to conduct the denoising process. Implementation of the MR-NLM approach involved the use of twelve auxiliary PET images (in addition to the target image) reconstructed using the same iterative reconstruction algorithm with different numbers of iterations and subsets. For each target voxel, the patches of voxels at the same location are extracted from the auxiliary PET images based on which the NLM denoising process is conducted. Through this, the exhaustive search scheme performed in the conventional NLM method to find similar patches of voxels is bypassed. The performance evaluation of the MR-NLM filter was carried out against the conventional NLM, Gaussian and bilateral post-reconstruction approaches using the experimental Jaszczak phantom and 25 whole-body PET/CT clinical studies. The signal-to-noise ratio (SNR) in the experimental Jaszczak phantom study improved from 25.1 when using Gaussian filtering to 27.9 and 28.8 when the conventional NLM and MR-NLM methods were applied (p value < 0.05), respectively. Conversely, the Gaussian filter led to quantification bias of 35.4%, while NLM and MR-NLM approaches resulted in a bias of 32.0% and 31.1% (p value < 0.05), respectively. The clinical studies further confirm the superior performance of the MR-NLM method, wherein the quantitative bias measured in malignant lesions (hot spots) decreased from − 12.3 ± 2.3% when using the Gaussian filter to − 3.5 ± 1.3% and − 2.2 ± 1.2% when using the NLM and MR-NLM approaches (p value < 0.05), respectively. The MR-NLM approach exhibited promising performance in terms of noise suppression and signal preservation for PET images, thus translating into higher SNR compared to the conventional NLM approach. Despite the promising performance of the MR-NLM approach, the additional computational burden owing to the requirement of multiple PET reconstruction still needs to be addressed.