The Effect of Electroencephalography Leads on Image Quality in Cerebral Perfusion SPECT and ¹⁸F-FDG PET/CT

Cerebral perfusion SPECT and ¹⁸F-FDG PET/CT are commonly performed diagnostic procedures for patients with epilepsy. Individuals undergoing these tests are often inpatients with electroencephalography leads. We have routinely removed these leads because of concern that they would lead to imaging artifacts. The leads would then be replaced at the conclusion of the scan. The goal of our study was to determine whether the electroencephalography leads actually do cause artifacts that can lead to erroneous scan interpretation or make the scan uninterpretable. Methods: ¹⁸F-FDG PET/CT and ^99mTc-pertechnetate SPECT were performed on a 2-dimensional brain phantom. The phantom was scanned with standard leads, CT/MR-compatible leads, and no leads. The quality of the images was ranked by 3 experienced nuclear medicine physicians, who then determined whether they could differentiate each of the scans from a scan in which it was known that no leads were present. Results: No differences could be detected between scans obtained without leads and scans obtained with either set of leads. The standard electroencephalography leads did create artifacts in the CT portion of the PET/CT images, whereas the CT/MR-compatible leads did not. Conclusion: This phantom study suggests that electroencephalography leads, whether standard or CT/MR-compatible, do not need to be removed for SPECT or PET procedures. Further study evaluating the effect on actual patient scans would be of value to support this conclusion.