Cardiac Pacemakers and Central Venous Lines Can Induce Focal Artifacts on CT-Corrected PET Images

PET/CT imaging can be associated with focal artifactual (18)F-FDG uptake introduced by metallic implants or contrast agents. It is unknown whether cardiac pacemakers or permanent central venous catheters can also result in such artifacts. Twenty-seven patients with permanent central venous lines (13 men and 14 women; mean age +/- SD, 53.8 +/- 16.2 y) and 9 patients with pacemakers (7 men and 2 women; mean age +/- SD, 74.8 +/- 5.1 y) who were referred for a variety of oncologic indications were studied with lutetium-oxyorthosilicate-based dual-slice PET/CT after injection of 7.77 MBq/kg of (18)F-FDG. CT-corrected and -uncorrected PET images were reviewed, and (18)F-FDG uptake was graded as absent, mild, moderate, or intense. CT-corrected PET images revealed focally increased uptake of moderate intensity in all patients with cardiac pacemakers and focally increased uptake of mild intensity in 8 of 27 patients (29.6%) with central venous lines. Cardiac pacemakers and reservoirs of central venous lines can induce artifactual (18)F-FDG on CT-corrected PET images. Thus, in patients with permanent central lines or pacemakers, both corrected and uncorrected PET images need to be reviewed to avoid false-positive PET findings.