Rationale and Objective
To identify the influence of various parameters for reducing artifacts in computed
tomography (CT) of commonly used pacemakers or implantable cardioverter-defibrillator
(ICD) lead tips.
Materials and Methods
This ex vivo phantom study compared two CT techniques (Dual-Energy CT [DECT] vs. Dual-Source
CT [DSCT]), as well as the influence of incremental alterations of current-time product
and pacemaker lead-tip angle with respect to the gantry plane. Four pacemaker leads
and one ICD lead were evaluated. The images were assessed visually on a five-point
Likert scale (1 = artifact free to 5 = massive artifacts). Likert values 1–3 represent
clinically relevant, diagnostic image quality.
Results
344 of 400 total images were rated with diagnostic image quality. The DECT and dual-source
DSCT technique each scored 86% diagnostic image quality. Statistically, DECT images
showed significantly improved image quality (P < .05). Concerning the current-time product, no statistically significant change
was found. Regarding lead-tip positioning, an angle of ≤70° yielded 100% diagnostic
image quality. Pacemaker and ICD leads were assessed to have statistically significant
differences.
Conclusions
Surprisingly, the lead-tip angle of 70° has been established as the key angle under
which diagnostic image quality is always ensured, regardless of the imaging technique.
Thus, we call 70° the “Magic angle” in CT pacemaker imaging.
Key Words
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Article Info
Publication History
Published online: February 13, 2018
Accepted:
December 4,
2017
Received in revised form:
December 3,
2017
Received:
July 10,
2017
Footnotes
Kerstin Fehrenbacher and Andreas Napp contributed equally.
Identification
Copyright
© 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.