Publication date: Available online 7 November 2018
Source: Academic Radiology
Author(s): Sebastian D. Reinartz, Robin F. Gohmann, Felix Hardt, Jonas Schmoee, Timm Dirrichs, Eric Tietz, Christiane K. Kuhl, Kerstin Fehrenbacher, Andreas Napp
Rationale and Objectives
To identify the influence and artifact burden in cardiac CT imaging of a leadless cardiac pacemaker (LCP) performed with all three generations of DualSource CT (DSCT) Scanners.
Materials and Methods
The LCP was examined in DSCT scanners of the first to third generation using DualEnergy (DECT) and DSCT as well as alterations of the current-time product. For DECT examinations, virtual monoenergetic images were computed manually on a dedicated workstation. Virtual voltage was manually selected by subjective assessment of the lowest artifact burden. Systematic variations of the pacemaker angle to the gantry were assessed, too. The angle was successively increased by 10°, ranging from 0° to 90°. Artifact burden was quantified on a five-point Likert scale (1- no artifacts, 2- few artifacts, 3- moderate artifacts, 4- many artifacts, and 5- massive artifacts). Likert values of 1–3 were considered diagnostic and assessed by two board-certified radiologists in consensus.
Results
In total, 200 examinations were analyzed, a mean Likert value of 1.93 ± 0.61 was found overall. None of the images were assessed Likert value >3. The positioning evaluation showed a clear and significant reduction of artifact burden toward lower angles, (0°: 1.4 ± 0.5 vs. 90° 2.55 ± 0.51). At scanner level, second-generation DSCT performed significantly better (1.68 ± 0.47) than both other scanners. Comparison of technique (DECT vs. DSCT) revealed a significantly improved image quality in DSCT examinations.
Conclusion
LCP can be safely examined in DSCT scanner of the first to third generation with the evaluated protocols and techniques, which are currently in use. Artifact burden can be significantly reduced by aligning or approaching the LCP's longitudinal axis toward the scanner's z-axis.
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