Effects of Pacemaker, Implantable Cardioverter–Defibrillator, and Left Ventricular Leads on CT-Based Attenuation Correction

Akira Suzuki; Kichiro Koshida; Kosuke Matsubara

doi:10.2967/jnmt.113.133736

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FIGURE 1.
Example images with pacemaker lead in body: SPECT with CTAC (A), fused CT and SPECT with CTAC (B), and CT (C). A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.
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FIGURE 2.
Configuration of phantom and point source: photograph showing normal resolution and high resolution (A), fused CT and SPECT images showing normal resolution and high resolution (B), photograph showing metal artifact from lead (C), and fused CT and SPECT images showing metal artifact from lead (D). A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.
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FIGURE 3.
Photograph showing configuration of phantom and lead.
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FIGURE 4.
Fused images and SPECT images: fused image in which phantom includes pacemaker and LV lead (A), SPECT image in which phantom includes pacemaker and LV lead (B), fused image with no lead (C), and PET image with no lead (D). In A, presence of LV lead seems to have an influence, but comparison with B proves that there is no influence. A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.
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FIGURE 5.
Polar maps obtained with no lead (A), pacemaker lead (B), ICD lead (C), and pacemaker and LV lead (D), and chart showing segmentation by American Heart Association (F). A color version of this figure is available as a supplemental file at http://tech.snmjournals.org.
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FIGURE 6.
Transaxial views showing metal artifact from ICD lead: CT image of artifact from ICD lead (A), μ map showing artifact from ICD lead (B); CT image of imitation human body (C), and μ map of imitation human body (D). Metal artifact is clear on CT but not on μ map.

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TABLE 1

Ratio of PS1 and Each Point Source in Simple Phantom

	High-resolution mode				Ultra-high-resolution mode
	Without AC		AC		Without AC		AC		Maximum generated metal artifacts (AC)
Lead	PS2/PS1	PS3/PS1	PS2/PS1	PS3/PS1	PS2/PS1	PS3/PS1	PS2/PS1	PS3/PS1	PS2/PS1	PS3/PS1
None	0.97 ± 0.00	1.00 ± 0.01	1.01 ± 0.01	1.00 ± 0.01	0.99 ± 0.00	0.99 ± 0.00	1.01 ± 0.00	0.99 ± 0.00	0.98 ± 0.00	1.00 ± 0.01
ICD	0.95 ± 0.01	0.98 ± 0.00	1.04 ± 0.01	0.99 ± 0.00	0.95 ± 0.00	0.98 ± 0.01	1.04 ± 0.01	1.00 ± 0.00	1.06 ± 0.01	1.01 ± 0.00
Pacemaker	0.97 ± 0.00	0.99 ± 0.00	1.02 ± 0.00	0.99 ± 0.00	0.98 ± 0.01	0.99 ± 0.01	1.02 ± 0.01	1.00 ± 0.01	1.01 ± 0.01	1.00 ± 0.00
LV	0.97 ± 0.00	0.99 ± 0.00	1.02 ± 0.00	0.99 ± 0.00	0.99 ± 0.00	0.99 ± 0.00	1.01 ± 0.00	0.99 ± 0.00	1.01 ± 0.01	1.00 ± 0.01

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TABLE 2

Relative Percentage Count Uptake of Each Segment

	Without AC				AC
Segment	Without lead	Pacemaker	ICD	Pacemaker + LV	Without lead	Pacemaker	ICD	Pacemaker + LV
1	64.0 ± 1.7	66.0 ± 1.7	65.3 ± 3.1	65.3 ± 2.1	85.3 ± 0.6	86.0 ± 1.0	86.6 ± 1.2	84.7 ± 2.5
2	58.7 ± 1.2	60.0 ± 1.0	60.7 ± 0.6	60.3 ± 0.6	75.0 ± 1.0	74.7 ± 1.2	76.0 ± 1.7	75.0 ± 3.0
3	65.7 ± 0.6	67.3 ± 1.2	67.3 ± 0.6	67.3 ± 0.6	85.0 ± 1.7	84.0 ± 1.0	84.3 ± 2.5	85.0 ± 3.6
4	63.7 ± 1.5	65.0 ± 1.0	64.3 ± 1.5	63.7 ± 1.5	82.6 ± 3.1	80.7 ± 2.1	80.3 ± 0.6	82.3 ± 3.5
5	59.0 ± 1.0	60.3 ± 1.2	60.7 ± 0.6	61.0 ± 1.0	79.0 ± 1.7	78.0 ± 1.0	78.3 ± 0.6	79.3 ± 2.1
6	62.0 ± 2.6	64.3 ± 2.1	63.3 ± 3.1	64.3 ± 2.9	80.0 ± 1.7	80.3 ± 2.3	80.7 ± 1.2	81.0 ± 1.0
7	71.0 ± 1.0	72.7 ± 0.6	73.3 ± 1.2	73.7 ± 0.6	88.6 ± 0.6	89.7 ± 0.6	91.0 ± 1.7	88.6 ± 0.6
8	58.3 ± 0.6	60.3 ± 1.2	60.7 ± 0.6	60.7 ± 0.6	71.7 ± 1.2	72.0 ± 1.0	73.0 ± 2.0	72.6 ± 2.1
9	63.7 ± 0.6	65.3 ± 1.2	65.3 ± 0.6	66.3 ± 1.2	83.0 ± 1.0	83.0 ± 1.0	84.7 ± 2.1	83.7 ± 1.5
10	64.3 ± 1.5	65.3 ± 1.5	65.0 ± 2.0	65.7 ± 1.5	85.3 ± 2.5	84.7 ± 2.1	86.3 ± 0.6	86.3 ± 2.1
11	61.0 ± 1.0	62.3 ± 0.6	62.3 ± 0.6	62.7 ± 0.6	77.7 ± 0.6	77.0 ± 1.0	78.0 ± 2.0	78.0 ± 2.0
12	69.0 ± 2.0	71.0 ± 2.0	71.0 ± 1.7	72.0 ± 1.7	84.0 ± 1.7	85.3 ± 1.5	85.7 ± 0.6	85.7 ± 1.5
13	77.0 ± 1.0	79.3 ± 1.2	79.3 ± 1.0	79.7 ± 0.6	87.3 ± 0.6	88.7 ± 0.6	89.0 ± 1.7	87.7 ± 1.2
14	62.0 ± 1.0	63.3 ± 0.6	63.7 ± 0.6	64.3 ± 1.2	72.0 ± 1.0	72.0 ± 1.0	73.7 ± 2.1	73.0 ± 2.0
15	67.0 ± 1.0	68.0 ± 1.0	67.7 ± 2.1	68.0 ± 1.0	85.7 ± 2.3	84.7 ± 2.9	84.7 ± 0.6	84.7 ± 1.5
16	72.0 ± 1.7	73.3 ± 0.6	73.3 ± 0.6	74.3 ± 1.2	82.7 ± 1.2	82.3 ± 0.6	83.7 ± 1.5	83.3 ± 2.1
17	75.7 ± 0.6	77.7 ± 0.6	76.7 ± 0.6	77.3 ± 0.6	81.3 ± 0.6	81.7 ± 0.6	81.7 ± 1.5	80.3 ± 1.5