Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner

Kamel, EhabI M; Burger, Cyrill; Buck, Alfred; Schulthess, G; Goerres, GerhardI W

doi:10.1007/s00330-002-1564-2

Cited by 153 publications

(95 citation statements)

References 13 publications

(10 reference statements)

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“…This effect was greater in the lateroinferior, inferolateral and inferoseptal regions. This is in agreement with the observations of Goerres et al [8,24] and Kamel et al [9] who found that PET artefacts arising from metallic materials in PET/CT oncological imaging were more pronounced near the metallic components. It would be expected that the magnitude and extension of metallic artefacts particularly in patients with ICD leads are correlated with the closeness of the ICD to the left ventricle [5], the number of leads used in the patients and the metal used for metallic components.…”

Section: Discussionsupporting

confidence: 93%

“…Metallic implants produce streak artefacts on CT images and therefore affect the generated μ-maps and attenuationcorrected PET images in PET/CT imaging [9,24]. Since the CT images are used for attenuation correction of the PET images in CTAC, the propagation of these artefacts to the PET images is the main concern.…”

Section: Discussionmentioning

confidence: 99%

“…However, CT images may exhibit streak artefacts if highdensity materials such as metals [4,5] and oral and intravenous contrast agents [6,7] were present resulting in erroneous interpretation of both viability and perfusion PET images in those cases with severe artefact. Therefore, the use of CT data for attenuation correction can introduce artefacts into the corrected PET images if metallic artefacts are present, and this might influence the interpretation of the PET images [8,9]. Such artefacts introduced into the PET images usually result in either over-or underestimation of tracer uptake in some regions [7,10,11] and caution is therefore required during CTbased attenuation correction (CTAC) procedures.…”

Section: Introductionmentioning

confidence: 99%

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

Ghafarian

Aghamiri

et al. 2010

Eur J Nucl Med Mol Imaging

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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 CTbased 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 Nucl Med Mol Imaging (2011) 38:252-262 DOI 10.1007/s00259-010-1635 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.Eur J

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ghafarian

Aghamiri

et al. 2010

Eur J Nucl Med Mol Imaging

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“…Implanted materials, e.g. dental or orthopaedic implants, are often present in patients and lead to artificial AC, resulting in overestimation or underestimation of tracer uptake in PET/CT studies [2][3][4]. The integration of PET and MRI into one imaging modality (PET/MRI) necessitated MRI-based attenuation correction (MRAC).…”

Section: Advances In Knowledgementioning

confidence: 99%

Positron emission tomography (PET) attenuation correction artefacts in PET/CT and PET/MRI

Buchbender

Hartung-Knemeyer²,

Forsting³

et al. 2013

BJR

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Objective: To compare the effect of implanted medical materials on 18 F-fludeoxyglucose ( 18 F-FDG) positron emission tomography (PET)/ MRI using a Dixon-based segmentation method for MRI-based attenuation correction (MRAC), PET/CT and CT-based attenuation-corrected PET (PET CTAC ).Methods: 12 patients (8 males and 4 females; age 58611 years) with implanted medical materials prospectively underwent whole-body 18 F-FDG PET/CT and PET/MRI. CT, MRI and MRAC maps as well as PET CTAC and PET MRAC images were reviewed for the presence of artefacts. Their morphology and effect on the estimation of the 18 F-FDG uptake (no effect, underestimation, overestimation compared with non-corrected images) were compared. In PET MRAC images, a volume of interest was drawn in the area of the artefact and in a reference site (contralateral body part); the mean and maximum standardised uptake values (SUV mean ; SUV max ) were measured.Results: Of 27 implanted materials (20 dental fillings, 3 injection ports, 3 hip prostheses and 1 sternal cerclage), 27 (100%) caused artefacts in CT, 19 (70%) in T 1 weighted MRI and 17 (63%) in MRAC maps. 20 (74%) caused a visual overestimation of the 18 F-FDG uptake in PET CTAC , 2 (7%) caused an underestimation and 5 (19%) had no effect. In PET MRAC , 19 (70%) caused

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“…Metallic objects, such as prostheses [53] and dental implants [54], also complicate the use of CTbased attenuation correction. CT transmission scans are more prone to produce strong artifacts around metallic objects than the common PET transmission scans.…”

Section: Additional Challenges For Ct-based Attenuation Correctionmentioning

confidence: 99%

PET/CT scanner instrumentation, challenges, and solutions

Alessio¹,

Kinahan²,

Cheng³

et al. 2004

Radiologic Clinics of North America

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Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner

Cited by 153 publications

References 13 publications

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

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

Positron emission tomography (PET) attenuation correction artefacts in PET/CT and PET/MRI

PET/CT scanner instrumentation, challenges, and solutions

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