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Do Implanted Pacemaker Leads and ICD Leads Cause Metal-Related Artifact in Cardiac PET/CT?

Department of Molecular and Functional Imaging, Cleveland Clinic Foundation, Cleveland, Ohio

View larger version (113K): [in a new window]   FIGURE 1. Topogram image of patient study shows ICD/pacing device, ICD lead with dual shock coils, and pacing lead with electrodes implanted in left ventricle. Sternal wires and surgical clips are visible from prior surgical procedure.

View larger version (45K): [in a new window]   FIGURE 2. Artifacts in phantom images of pacemaker leads (A) or ICD leads in uniform activity background (B). From left to right: CT image, transmission image, PET image (Biograph) using CT-AC, and PET image (ECAT HR+) using transmission source attenuation correction.

View larger version (44K): [in a new window]   FIGURE 3. CT slice images correspond to topogram image in Figure 1, illustrating relative intensities of artifacts from ICD lead and pacing leads. (A) CT image with body window. (B) CT image with lung window. (C) Filtered and down-sampled image used for PET attenuation correction.

View larger version (66K): [in a new window]   FIGURE 4. Three-dimensional renderings of segmented left ventricle, with color scale indicating relative 18F-FDG uptake. Metal artifact related to implanted ICD lead near inferoseptal wall is easily seen by comparing PET/CT data (A) with PET data (B).

View larger version (48K): [in a new window]   FIGURE 5. PET (A) and PET/CT (B) polar maps and circumferential profiles illustrate PET/CT metallic artifact from ICD lead. ANT = anterior; SEP = septal; LAT = lateral; INF = inferior.

View larger version (91K): [in a new window]   FIGURE 6. Fused PET/CT and PET images (short-axis views) from 2 studies show variation in ICD lead placement. Distance from shock coil to left ventricle is 0 mm in top images (A) and 20 mm in bottom images (B). Note different impact on left ventricular regional uptake depending on shock coil proximity.

View larger version (10K): [in a new window]   FIGURE 7. Plots of measured distance from ICD shock coils to left ventricle (A) and magnitude of corresponding artifact in CT-AC attenuation maps (B), with respect to presence or absence of metal-related artifact in PET/CT images.