title: Radiographic and electrocardiography-gated noncontrast cardiac CT assessment of lead perforation: modality comparison and interobserver agreement.
abstract: BACKGROUND
  Pacemaker or implantable cardioverter-defibrillator lead extraction may be required because of infection, malfunction, or breakage. The preprocedural identification of lead tip position may help ensure safe performance of the procedure.
  
  
  OBJECTIVE
  To analyze the ability of chest radiography and CT imaging to characterize lead tip position and identify perforation in a population of patients who underwent lead extraction.
  
  
  METHODS
  Among patients who underwent lead extraction between November 2008 and April 2011, a nonrandom subset of 50 patients with 116 leads was selected for retrospective analysis. All patients had undergone chest radiography and thin-section electrocardiography-gated noncontrast cardiac CT. Two radiologists independently evaluated the imaging studies, using oblique multiplanar image reconstruction techniques for the CT examinations. Beam hardening artifacts were graded (0-3). Likelihood of perforation on each imaging study was graded on a 5-point scale.
  
  
  RESULTS
  Among 116 leads, 17 were identified as perforated on CT, 12 leads were equivocal, and 87 were not perforated. Interobserver agreement for CT perforation vs nonperforation was good (κ = 0.71); weighted kappa for the entire 5-point scale was moderate (κ = 0.54). Beam hardening artifacts were common, with a mean value of 2.1. The 2 observers identified perforation on chest radiography with an average sensitivity of 15% compared with CT. The 2 observers did not agree on any cases of chest radiographic perforation (κ = -0.1).
  
  
  CONCLUSIONS
  Electrocardiography-gated noncontrast cardiac CT imaging with oblique multiplanar analysis can identify potential lead perforation with a moderate-to-good level of interobserver agreement. Chest radiography demonstrates poor sensitivity and interobserver agreement compared with CT.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Division of Cardiology, Abington Memorial Hospital, Abington, PA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Balabanoff
authors.affiliation: Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 N.W., 12th Avenue, Miami, FL, USA; Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Cristopher E
authors.initials: CE
authors.lastname: Gaffney
authors.affiliation: Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 N.W., 12th Avenue, Miami, FL, USA.
authors.forename: Eduard
authors.initials: E
authors.lastname: Ghersin
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Medicine, Division of Cardiology, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Carrillo
authors.affiliation: Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 N.W., 12th Avenue, Miami, FL, USA. Electronic address: jfishman@med.miami.edu.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Fishman
mesh_terms: D000368:Aged; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D003287:Contrast Media; D004567:Electrodes, Implanted / Q000009:adverse effects*; D019544:Equipment Failure Analysis / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging* / Q000209:etiology
chemical_list: D003287:Contrast Media
keywords: Artificial; Defibrillators; Pacemaker; Radiography; Thoracic; Tomography; X-ray computed