Recently, there has been great interest in developing finely pixellated position-sensitive scintillation detectors for ultra-high-resolution Positron Emission Tomography (PET) systems designed for breast cancer detection, diagnosis, and staging and for imaging small laboratory animals. We are developing a different high-resolution PET detector design that promotes nearly complete scintillation light collection in ⩽1mm wide, >10mm thick lutetium oxyorthosilicate (LSO) crystals. The design requires the use of semiconductor photodetector arrays in novel configurations that significantly improve the light collection aspect ratio for minute crystals. To reduce design complexity and dead area we are investigating the use of 1mm thick sheets of LSO in addition to discrete crystal rods, and the use of position-sensitive avalanche photodiodes (PSAPDs) which require only four readout channels per device, in addition to pixellated APD arrays. Using a 1mm thick scintillation crystal sheet coupled to a finely pixellated APD array results in a pseudo-discrete response to flood irradiation: due to a very narrow light spread function in the thin sheet we observe sharp (<1mm wide) peaks in sensitivity centered at the APD pixel locations in a very linear fashion all the way out to the crystal edge. We measured an energy resolution of 13.7% FWHM at 511keV for a 1mm LSO crystal coupled to two APD pixels. Using a 1mm thick crystal sheet coupled to a PSAPD the response to flood and edge-on irradiation with a 22Na point source shows a compressed dynamic range compared to that observed with discrete crystals or direct X-ray irradiation. With a discrete LSO crystal array the flood response is peaked at the crystal location where light is focused onto one spot on the PSAPD. We observed strong pin-cushioning effects in all PSAPD measurements. All LSO–PSAPD configurations studied had high aspect ratio for light collection and achieved energy resolutions ⩽12% FWHM at 511keV.