Artefact-free late gadolinium enhancement imaging in patients with implanted cardiac devices using a modified broadband sequence: current strategies and results from a real-world patient cohort

Abstract

Using a modified broadband sequence for LGE imaging significantly increased the number of artefact-free myocardial segments thereby leading to improved diagnostic value of the CMR exam. Since the occurrence and extent of hyperintensity artefacts are closely related to the individual device, more studies are warranted to evaluate if the results can be extrapolated to other devices and manufacturers.

Clinical impact of cardiovascular magnetic resonance with optimized myocardial scar detection in patients with cardiac implantable devices

“…The impact on clinical management was most marked in the defibrillator group where 79% had non-diagnostic imaging using conventional LGE sequences, but with wideband LGE, diagnostic imaging across the whole group resulted in management changes in 87%. Although previously reported in small numbers, [29] our data suggest that wideband…”

Clinical experience regarding safety and diagnostic value of cardiovascular magnetic resonance in patients with a subcutaneous implanted cardioverter/defibrillator (S-ICD) at 1.5 T

“…It has been shown recently that a cardiac device in 5-10 cm distance to the heart usually results in a magnetic resonance frequency offset of 2-6 kHz in the myocardium at 1.5-T [15]. As recently shown in patients with conventional cardiac devices [13,[15][16][17][18][19][20][21][22][23], we have used an adiabatic wide-band inversionrecovery pulse with an adjustable frequency offset to improve the myocardial nulling even in the presence of offresonance effects. In the majority of our LGE-images (56%), the respective images showed sufficient quality for a meaningful diagnostic assessment.…”

“…A general statement and/or recommendation whether CMR in patients with S-ICD is "more" or "less" prone to imaging artefacts compared to conventional transvenous ICD devices is not possible, since the relevance and extent of such metal artefacts are mainly determined by the distance of the device to the heart [13,16]. Obviously, this distance is dependent on individual patient constitution and location of the respective device.…”

Schrittmacher und ICD in der Magnetresonanztomografie

“…Je nach den gewählten Aufnahmesequenzen kann es statt zu den Auslöschungsartefakten auch zu hyperintensen Artefakten kommen, die bei einer Narbendarstellung mit Kontrastmittel das Vorliegen einer Narbe vortäuschen. Häufig ist hiervon die apikale Vorderwand betroffen [11]. Durch die meist rechtspektorale Lage von Schrittmachern und den insgesamt kleineren Artefakten ist eine kardiale MRT bei diesen Aggregaten in der Regel problemlos möglich.…”