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Is Correction for Metallic Artefacts Mandatory in Cardiac Spect/Ct Imaging in the Presence of Pacemaker and Implantable Cardioverter Defibrillator Leads?



Etemadi Z1, 2, 3 ; Ghafarian P4, 5 ; Bitarafanrajabi A6 ; Malek H6 ; Rahmim A7, 8 ; Ay MR2, 3
Authors
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Authors Affiliations
  1. 1. Nuclear Medicine and Molecular Imaging Research Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
  2. 2. Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  6. 6. Cardiovascular Interventional Research Center, Department of Nuclear Medicine, Rajaei Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
  8. 8. Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States

Source: Iranian Journal of Nuclear Medicine Published:2018

Abstract

Introduction: Metallic artifacts due to pacemaker/ implantable cardioverter defibrillator (ICD) leads in CT images can produce artifactual uptake in cardiac SPECT/CT images. The aim of this study was to determine the influence of the metallic artifacts due to pacemaker and ICD leads on myocardial SPECT/CT imaging. Methods: The study included 9 patients who underwent myocardial perfusion imaging (MPI). A cardiac phantom with an inserted solid defect was used. The SPECT images were corrected for attenuation using both artifactual CT and CT corrected using metal artifact reduction (MAR). VOI-based analysis was performed in artifactual regions. Results: In phantom studies, mean-of-relative-difference in white-region, between artifact-free attenuation-map without/with MAR were changed from 9.2 and 2.1 to 3.7 and 1.2 for ICD and pacemaker lead, respectively. However, these values for typical patient were 9.7±7.0 and 3.8±2.4 for ICD and pacemaker leads respectively, in white-region. MAR effectively reduces the artifacts in white-regions while this reduction is not significant in black-regions. Conclusion: Following application of MAR, visual and quantification analyses revealed that while quality of CT images were significantly improved, the improvements in the SPECT/CT images were not as pronounced or significant. Therefore cardiac SPECT images corrected for attenuation using CT in the presence of metallic-leads can be interpreted without correction for metal artefacts. © 2018 Tehran University of Medical Sciences. All rights reserved.
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