European Radiology

, Volume 29, Issue 2, pp 963–974 | Cite as

Assessment of Cardiac Lead Perforation: Comparison Among Chest Radiography, Transthoracic Echocardiography and Electrocardiography-gated Contrast-enhanced Cardiac CT

  • Xiang Zhang
  • Chushan Zheng
  • Peiwei Wang
  • Dongye Wang
  • Boshui Huang
  • Guozhao Li
  • Huijun Hu
  • Zehong Yang
  • Xiaohui Duan
  • Shaoxin Zheng
  • Pinming Liu
  • Jingfeng Wang
  • Jun ShenEmail author



Cardiac lead perforation is a rare but potentially life-threatening event. The purpose of this study was to investigate the diagnostic performances of chest radiography, transthoracic echocardiography (TTE) and electrocardiography (ECG)-gated contrast-enhanced cardiac CT in the assessment of cardiac lead perforation.


This retrospective study was approved by the ethics review board of Sun Yat-Sen Memorial Hospital at Sun Yat-Sen University (Guangzhou, China), and the need to obtain informed consent was waived. Between May 2010 and Oct 2017, 52 patients were clinically suspected to have a cardiac lead perforation and received chest radiography, TTE and ECG-gated contrast-enhanced cardiac CT. Among them, 13 patients were identified as having cardiac lead perforation. The diagnostic performances of these three modalities were evaluated by receiver-operating characteristic (ROC) curves using a composite reference standard of surgical and electrophysiological results and clinical follow-up. The areas under ROCs (AUROCs) were compared with the McNemar test.


The accuracies of chest radiography, TTE and ECG-gated contrast-enhanced cardiac CT imaging for the diagnosis of cardiac lead perforation were 73.1%, 82.7% and 98.1%, respectively. ECG-gated contrast-enhanced cardiac CT had a higher AUROC than chest radiography (p < 0.001) and TTE (p < 0.001).


ECG-gated contrast-enhanced cardiac CT is superior to both chest radiography and TTE imaging for the assessment of cardiac lead perforation.

Key Points

• ECG-gated contrast-enhanced cardiac CT has an accuracy of 98.1% in the diagnosis of cardiac lead perforation.

• The AUROC of ECG-gated contrast-enhanced cardiac CT is higher than those of chest radiography and TTE imaging.

• ECG-gated contrast-enhanced cardiac CT imaging has better diagnostic performance than both chest radiography and TTE imaging for the assessment of cardiac lead perforation.


Heart injury Radiography Echocardiography Tomography, x-ray computed 



Area under the receiver-operating characteristic curve




Multiplanar reformation


Negative predictive value


Picture-archiving and communication system


Positive predictive value


Receiver-operating characteristic curve


Region of interest


Transthoracic echocardiography



This study has received funding by Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme (2017) and the Elite Young Scholars Program of Sun Yat-Sen Memorial Hospital (grant no. J201403).

Compliance with ethical standards


The scientific guarantor of this publication is Jun Shen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained from the Institutional Review Board of Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University (Guangzhou, China).


• Retrospective

• Diagnostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Xiang Zhang
    • 1
  • Chushan Zheng
    • 1
  • Peiwei Wang
    • 2
  • Dongye Wang
    • 1
  • Boshui Huang
    • 2
    • 3
  • Guozhao Li
    • 1
  • Huijun Hu
    • 1
  • Zehong Yang
    • 1
  • Xiaohui Duan
    • 1
  • Shaoxin Zheng
    • 2
  • Pinming Liu
    • 2
    • 3
  • Jingfeng Wang
    • 2
    • 3
  • Jun Shen
    • 1
    Email author
  1. 1.Department of Radiology, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of Cardiovascular Medicine, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  3. 3.Guangdong Provincial Key Laboratory of Electrocardio Physiology and Arrhythmia, Sun Yat-Sen Memorial HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China

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