Professional Documents
Culture Documents
Medicine, M.D. Anderson Cancer Center, Houston, Texas; and 2Imaging Physics, M. D. Anderson Cancer Center, Houston,
Texas
156
JOURNAL
OF
IMAGE ACQUISITION
Metallic Implants
157
FIGURE 3. (A) High-density metallic implants generate streaking artifacts and high CT numbers (arrow) on CT image. (B) High CT numbers
will then be mapped to high PET attenuation coefficients, leading to overestimation of activity concentration. (C) PET images without
attenuation correction help to rule out metal-induced artifacts.
the PET activity in that region and thereby to a falsepositive PET finding (Figs. 3 and 4). Nonattenuated PET
images, which do not manifest this error, can be used in
these cases to aid the interpretation of these metal-induced
artifacts (10 12). Not all metallic implants produce falsepositive PET results. High-density metallic implants such as
hip prosthetics produce high CT numbers because of their
high photon absorption (13). However, these implants also
attenuate the PET 511-keV photons, resulting in no emission data in the region of the implant (cold area). When CT
attenuation correction factors are applied to this photopenic
emission region, the PET images show diminished 18F-FDG
uptake in that area (Fig. 5). As a result, technologists should
ask patients to remove all metallic objects before imaging
and should document the location of nonremovable metallic
objects to minimize or identify such artifacts.
Respiratory Motion
FIGURE 4. Metal ring on left breast of patient (arrow) produces streaking artifacts and
high CT numbers (A), resulting in falsely increased radiotracer uptake on PET images with
CT attenuation correction (B), whereas PET image without attenuation correction shows only
background activity at level of metal ring (C).
158
JOURNAL
OF
FIGURE 7.
FIGURE 8.
FIGURE 6.
159
FIGURE 10.
160
FIGURE 11.
JOURNAL
OF
REFERENCES
1. Czernin J, Schelbert H. PET/CT imaging: facts, opinions, hopes, and
questions. J Nucl Med. 2004;45(suppl):1S.
2. Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK. PET
diagnostic accuracy: improvement with in-line PET-CT systeminitial
results. Radiology. 2002;225:575581.
3. Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for
clinical oncology. J Nucl Med. 2000;41:1369 1379.
4. Vogel W, Oyen W, Barentsz J, Kaanders J, Corstens F. PET/CT: panacea,
redundancy, or something in between. J Nucl Med. 2004;45(suppl):15S
24S.
5. Zanzonico P. Positron emission tomography: a review of basic principles,
scanner design and performance, and current systems. Semin Nucl Med.
2004;34:87111.
6. Rydberg J, Liang Y, Teague SD. Fundamentals of multichannel CT. Radiol
Clin North Am. 2003;41:465 474.
7. Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for
a combined 3D PET/CT scanner. Med Phys. 1998;25:2046 2053.
8. Burger C, Goerres G, Schoenes S, Buck A, Lonn AH, Von Schulthess GK.
PET attenuation coefficients from CT images: experimental evaluation of
the transformation of CT into PET 511-keV attenuation coefficients. Eur
J Nucl Med Mol Imaging. 2002;29:922927.
9. Carney JP, Townsend DW, Kinahan PE. CT-based attenuation correction
for PET/CT scanners. In: von-Schulthess Gk, ed. Clinical Molecular Anatomic Imaging: PET, PET/CT and SPECT/CT. Baltimore, MD: Lippincott,
Williams & Wilkins; 2002:46 58.
10. Goerres GW, Hany TF, Kamel E, et al. Head and neck imaging with PET
and PET/CT: artefacts from dental metallic implants. Eur J Nucl Med.
2002;29:369 370.
11. Kamel EM, Burger C, Buck A, von Schulthess GK, Goerres GW. Impact of
metallic dental implants on CT-based attenuation correction in a combined
PET/CT scanner. Eur Radiol. 2003;13:724 728.
12. Beyer T, Antoch G, Muller S, et al. Acquisition protocol considerations for
combined PET/CT imaging. J Nucl Med. 2004;45(suppl):25S35S.
13. Goerres GW, Ziegler SI, Burger C, Berthold T, von Schulthess GK, Buck
A. Artifacts at PET and PET/CT caused by metallic hip prosthetic material.
Radiology. 2003;226:577584.
14. Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S.
Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. Eur J Nucl Med. 2003;30:588
596.
15. Osman MM, Cohade C, Nakamoto Y, Wahl RL. Respiratory motion
artifacts on PET emission images obtained using CT attenuation correction
on PET-CT. Eur J Nucl Med Mol Imaging. 2003;30:603 606.
16. Cohade C, Osman M, Marshall LN, Wahl RL. PET-CT: accuracy of PET
and CT spatial registration of lung lesions. Eur J Nucl Med Mol Imaging.
2003;30:721726.
17. von Schulthess GK. Normal PET and PET/CT body scans: imaging pitfalls
and artifacts. In: von-Schulthess GK, ed. Clinical Molecular Anatomic
Imaging: PET, PET/CT and SPECT/CT. Baltimore, MD: Lippincott, Williams & Wilkins; 2002:252270.
18. Antoch G, Freudenberg LS, Egelhof T, et al. Focal tracer uptake: a potential
artifact in contrast-enhanced dual-modality PET/CT scans. J Nucl Med.
2002;43:1339 1342.
19. Cohade C, Osman M, Nakamoto Y, et al. Initial experience with oral
contrast in PET/CT: phantom and clinical studies. J Nucl Med. 2003;44:
412 416.
20. Dizendorf E, Hany TF, Buck A, von Schulthess GK, Burger C. Cause and
magnitude of the error induced by oral CT contrast in CT-based attenuation
correction of PET emission studies. J Nucl Med. 2003;44:732738.
21. Mawlawi O, Pan T, Erasmus JJ, et al. Quantifying the effect of intravenous
contrast media on PET/CT imaging: clinical evaluation [abstract]. J Nucl
Med. 2004;45(suppl):161P.
22. Carney J, Townsend DW, Kinahan PE, et al. CT-based attenuation correction: the effects of imaging with the arms in the field of view [abstract].
J Nucl Med. 2001;42(suppl):56P57P.
23. Mawlawi O, Pan T, Cody DD, et al. Evaluation of a new CT truncation
correction algorithm for accurate quantification of PET/CT images [abstract]. J Nucl Med. 2004;45(suppl):413P.
161
Information about reproducing figures, tables, or other portions of this article can be found online at:
http://tech.snmjournals.org/site/misc/permission.xhtml
Information about subscriptions to JNMT can be found at:
http://tech.snmjournals.org/site/subscriptions/online.xhtml