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Updated: Jun 7, 2026
Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach
Published on: June 30, 2023
Novel method for 3D volume evaluation of the intracardiac leads using iterative metal artifact reduction technique in
Rafał Młynarski1, Michał Sosna1, Agnieszka Młynarska2
1Department of Electroradiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
Background:
Intracardiac leads commonly produce metal artifacts on computed tomography (CT) images. These artifacts may be reduced using dedicated metal artifact reduction algorithms, such as metal artifact reduction (MAR).
Objectives:
The aim of this study was to develop a method for measuring lead-related artifacts in CT and to assess the suitability of various reconstruction presets for lead visualization.
Material And Methods:
Fifty-four patients (mean age: 73.9 ±11.32 years) with implanted cardiac implantable electronic devices (CIEDs) who underwent cardiac CT, chest CT, or pulmonary angio-CT were included in the study. Images were reconstructed using at least 2 kernels (soft tissue and lung) with slice thicknesses of 0.6 mm or 1.0 mm. A tissue density volume >1,000 HU, corresponding to the presumed volume of hyperdense artifacts, was isolated within a manually drawn spherical region of interest (ROI), and the values were recorded. The obtained values for each iterative metal artifact reduction (iMAR) reconstruction preset were compared with native images (without iMAR) to calculate the percentage reduction in hyperdense artifacts.
Results:
All tested algorithm variants reduced artifact volume; however, only 2 presets achieved statistically significant reductions: "dental fillings" (p = 0.001) and "neuro coils" (p = 0.000). Pacemaker-dedicated presets reduced metal artifacts in all cases, although the reductions were not statistically significant (p = 0.667), which may limit their reliability in routine clinical practice.
Conclusions:
We proposed a method for evaluating intracardiac leads that enables precise three-dimensional (3D) assessment of hyperdense artifacts. The metal artifact reduction technique demonstrated promising results, particularly for the "dental fillings" and "neuro coils" presets.
