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Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Cardiac PET/CT imaging is often performed in patients with pacemakers and implantable cardioverter defibrillator (ICD) leads. However, metallic implants usually produce artefacts on CT images which might propagate to CT-based attenuation-corrected (CTAC) PET images. The impact of metal artefact reduction (MAR) for CTAC of cardiac PET/CT images in the presence of pacemaker, ICD and ECG leads was investigated using both qualitative and quantitative analysis in phantom and clinical studies.

Methods

The study included 14 patients with various leads undergoing perfusion and viability examinations using dedicated cardiac PET/CT protocols. The PET data were corrected for attenuation using both artefactual CT images and CT images corrected using the MAR algorithm. The severity and magnitude of metallic artefacts arising from these leads were assessed on both linear attenuation coefficient maps (μ-maps) and attenuation-corrected PET images. CT and PET emission data were obtained using an anthropomorphic thorax phantom and a dedicated heart phantom made in-house incorporating pacemaker and ICD leads attached at the right ventricle of the heart. Volume of interest-based analysis and regression plots were performed for regions related to the lead locations. Bull’s eye view analysis was also performed on PET images corrected for attenuation with and without the MAR algorithm.

Results

In clinical studies, the visual assessment of PET images by experienced physicians and quantitative analysis did not reveal erroneous interpretation of the tracer distribution or significant differences when PET images were corrected for attenuation with and without MAR. In phantom studies, the mean differences between tracer uptake obtained without and with MAR were 10.16±2.1% and 6.86±2.1% in the segments of the heart in the vicinity of metallic ICD or pacemaker leads, and were 4.43±0.5% and 2.98±0.5% in segments far from the leads.

Conclusion

Although the MAR algorithm was able to effectively improve the quality of μ-maps, its clinical impact on the interpretation of PET images was not significant. Therefore cardiac PET images corrected for attenuation using CTAC in the presence of metallic leads can be interpreted without correction for metal artefacts. It should however be emphasized that in some special cases with multiple ICD leads attached to the myocardium wall, MAR might be useful for accurate attenuation correction.

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Acknowledgments

This work was supported by Shahid Behshti University and Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences, and the Swiss National Science Foundation (grant no. 31003A-125246). The authors would like to thank Mr. Mohammad Hossin Farhani for providing the software used for image processing and Biotronik (Geneva) for providing the ICD and pacemaker leads.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran

    Pardis Ghafarian & S. M. R. Aghamiri

  2. Division of Nuclear Medicine, Geneva University Hospital, CH-1211, Geneva 4, Switzerland

    Pardis Ghafarian, Osman Ratib & Habib Zaidi

  3. Research Center for Science and Technology in Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Pardis Ghafarian & Mohammad R. Ay

  4. Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad R. Ay

  5. Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad R. Ay

  6. Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Arman Rahmim

  7. Cardiovascular Center, Nuclear Cardiology, Geneva University, Geneva, Switzerland

    Thomas H. Schindler

  8. Geneva Neuroscience Center, Geneva University, Geneva, Switzerland

    Habib Zaidi

Authors
  1. Pardis Ghafarian
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  2. S. M. R. Aghamiri
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  3. Mohammad R. Ay
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  5. Thomas H. Schindler
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  6. Osman Ratib
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  7. Habib Zaidi
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Corresponding author

Correspondence to S. M. R. Aghamiri.

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Ghafarian, P., Aghamiri, S.M.R., Ay, M.R. et al. Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?. Eur J Nucl Med Mol Imaging 38, 252–262 (2011). https://doi.org/10.1007/s00259-010-1635-6

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  • DOI: https://doi.org/10.1007/s00259-010-1635-6

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