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

Pardis Ghafarian, S. M R Aghamiri, Mohammad R. Ay, Arman Rahmim, Thomas H. Schindler, Osman Ratib, Habib Zaidi

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)252-262
Number of pages11
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume38
Issue number2
DOIs
StatePublished - Feb 2011

Fingerprint

Implantable Defibrillators
Artifacts
Metals
Heart Ventricles
Myocardium
Electrocardiography
Thorax
Perfusion
Regression Analysis
Physicians

Keywords

  • Attenuation correction
  • Cardiac PET/CT
  • Metal artefact reduction
  • Metallic artefacts
  • Pacemaker

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads? / Ghafarian, Pardis; Aghamiri, S. M R; Ay, Mohammad R.; Rahmim, Arman; Schindler, Thomas H.; Ratib, Osman; Zaidi, Habib.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 38, No. 2, 02.2011, p. 252-262.

Research output: Contribution to journalArticle

Ghafarian, Pardis ; Aghamiri, S. M R ; Ay, Mohammad R. ; Rahmim, Arman ; Schindler, Thomas H. ; Ratib, Osman ; Zaidi, Habib. / Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?. In: European Journal of Nuclear Medicine and Molecular Imaging. 2011 ; Vol. 38, No. 2. pp. 252-262.
@article{f2ab67ff4da34eadb328d824a4c2a009,
title = "Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?",
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.",
keywords = "Attenuation correction, Cardiac PET/CT, Metal artefact reduction, Metallic artefacts, Pacemaker",
author = "Pardis Ghafarian and Aghamiri, {S. M R} and Ay, {Mohammad R.} and Arman Rahmim and Schindler, {Thomas H.} and Osman Ratib and Habib Zaidi",
year = "2011",
month = "2",
doi = "10.1007/s00259-010-1635-6",
language = "English (US)",
volume = "38",
pages = "252--262",
journal = "European Journal of Nuclear Medicine and Molecular Imaging",
issn = "1619-7070",
publisher = "Springer Verlag",
number = "2",

}

TY - JOUR

T1 - Is metal artefact reduction mandatory in cardiac PET/CT imaging in the presence of pacemaker and implantable cardioverter defibrillator leads?

AU - Ghafarian, Pardis

AU - Aghamiri, S. M R

AU - Ay, Mohammad R.

AU - Rahmim, Arman

AU - Schindler, Thomas H.

AU - Ratib, Osman

AU - Zaidi, Habib

PY - 2011/2

Y1 - 2011/2

N2 - 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.

AB - 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.

KW - Attenuation correction

KW - Cardiac PET/CT

KW - Metal artefact reduction

KW - Metallic artefacts

KW - Pacemaker

UR - http://www.scopus.com/inward/record.url?scp=79551545861&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79551545861&partnerID=8YFLogxK

U2 - 10.1007/s00259-010-1635-6

DO - 10.1007/s00259-010-1635-6

M3 - Article

C2 - 20959974

AN - SCOPUS:79551545861

VL - 38

SP - 252

EP - 262

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

IS - 2

ER -