2020 MR Safety for Cardiac Devices: An Update for Radiologists

Abstract

Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.

CARJ 2021: Year in Review

“…In 2020 we were provided with a guideline and performance recommendations. 6 This update explained that MRI in the presence of implantable cardiac devices is much safer than historically thought and can be implemented into routine practice with a few considerations. First, the type of device must be considered as a few devices including permanent epicardial leads, temporary pacemakers, ventricular assist devices, and pulmonary artery monitoring devices remain contraindicated due to the potential for adverse events.…”

Keeping Pace: Our Experience With MR With Cardiac Devices

“…The authors reported that only 1% of their studies were nondiagnostic. 1 Others have reported a 90% diagnostic rate for thoracic and cardiac MRIs in patients with CIEDs. 2 We have found that our success rate is closer to 85-90%.…”

“…In their article ''2020 MR Safety for Cardiac Devices: An Update for Radiologists,'' Lebel et al review the current literature on cardiac magnetic resonance (CMR) in patients with cardiovascular implantable electronic devices (CIEDs) while providing a framework on how to safely image these patients. 1 They share their experience with performing CMR on CIED patients with specific emphasis on safety and work-flow. 1 With the growing number of patients with CIEDs and the increasing utility of CMR, we have also experienced an increased demand for CMR in patients with CIEDs.…”

“…1 They share their experience with performing CMR on CIED patients with specific emphasis on safety and work-flow. 1 With the growing number of patients with CIEDs and the increasing utility of CMR, we have also experienced an increased demand for CMR in patients with CIEDs. We started clinically scanning patients with CIEDs in 2016 and have scanned approximately 800 patients with both conditional and nonconditional CIEDs.…”

“…If artifact is encountered, the patient’s left arm is positioned above the ahead which helps move the device and metallic artifact to a location superior to that of the heart. 1 We also recommend using gradient echo cine images as they reduce metallic artifact relative to steady-state free precession. 1 In order to improve our post contrast images, we anticipate the use of a wideband late gadolinium enhance sequence.…”