Purpose: Atherosclerosis detection remains challenging in coronary CT angiography for patients with cardiac implants. Pacing electrodes of a pacemaker or lead components of a defibrillator can create substantial blooming and streak artifacts in the heart region, severely hindering the visualization of a plaque of interest. We present a novel reconstruction method that incorporates a deformable model for metal leads to eliminate metal artifacts and improve anatomy visualization even near the boundary of the component. Methods: The proposed reconstruction method, referred as STF-dKCR, includes a novel parameterization of the component that integrates deformation, a 3D-2D preregistration process that estimates component shape and position, and a polyenergetic forward model for x-ray propagation through the component where the spectral properties are jointly estimated. The methodology was tested on physical data of a cardiac phantom acquired on a CBCT testbench. The phantom included a simulated vessel, a metal wire emulating a pacing lead, and a small Teflon sphere attached to the vessel wall, mimicking a calcified plaque. The proposed method was also compared to the traditional FBP reconstruction and an interpolation-based metal correction method (FBP-MAR). Results: Metal artifacts presented in standard FBP reconstruction were significantly reduced in both FBP-MAR and STF- dKCR, yet only the STF-dKCR approach significantly improved the visibility of the small Teflon target (within 2 mm of the metal wire). The attenuation of the Teflon bead improved to 0.0481 mm^-1 with STF-dKCR from 0.0166 mm^-1 with FBP and from 0.0301 mm^-1 with FBP-MAR – much closer to the expected 0.0414 mm^-1. Conclusion: The proposed method has the potential to improve plaque visualization in coronary CT angiography in the presence of wire-shaped metal components.

Date Published: 9 March 2017
PDF: 6 pages
Proc. SPIE 10132, Medical Imaging 2017: Physics of Medical Imaging, 1013213 (9 March 2017);

Published in SPIE Proceedings Vol. 10132:
Medical Imaging 2017: Physics of Medical Imaging
Thomas G. Flohr; Joseph Y. Lo; Taly Gilat Schmidt, Editor(s)