Cardiac MRI in patients with cardiac pacemakers: practical methods for reducing susceptibility artifacts and optimizing image quality

Kaasalainen, Touko; Kivistö, Sari; Holmström, Miia; Peltonen, Juha; Pakarinen, Sami; Hänninen, Helena; Sipilä, O.

doi:10.1177/0284185115574873

Cited by 15 publications

(13 citation statements)

References 29 publications

(59 reference statements)

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“…For cardiac MRI, left-sided devices create more artifact and lead to reduced diagnostic accuracy. In a study of 32 patients, 100% of studies with right-sided devices had diagnostic quality but only 35% of studies with left-sided devices were diagnostic (44,79). In general, right ventricular studies are of higher quality than those of the left ventricle (80).…”

Section: Guidelines and Protocolsmentioning

confidence: 97%

MRI in Patients with Cardiac Implantable Electronic Devices

Muthalaly

Nerlekar

et al. 2018

Radiology

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Indications for MRI have grown considerably in recent years. However, many patients with cardiac implantable electronic devices are denied imaging due to physician misinterpretation of the risks associated with MRI. This review discusses the theoretical basis for the perceived risk by exploring preclinical literature. It then presents a detailed examination of the true rates of adverse events in clinical studies across both MR nonconditional (legacy) and MR conditional devices. Indeed, many of these adverse events are rare, nonexistent, and/or clinically insignificant in the wealth of published data. The authors then address image quality and the constituents of a safety checklist that institutions should consider when performing MRI in patients with a cardiac implantable electronic device. Lastly, the authors conclude with an overview of future directions for advancement in the field.

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Section: Guidelines and Protocolsmentioning

confidence: 97%

MRI in Patients with Cardiac Implantable Electronic Devices

Muthalaly

Nerlekar

et al. 2018

Radiology

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“…Numerous efforts have been made to improve MR image quality in different organs other than the prostate, including the heart [ 13 ], liver [ 14 ], brain [ 15 ], and breast [ 16 ], as radiologists should become familiar with the requirements for good-quality MRI and strive to meet the expected standards to enhance patient quality and safety.…”

Section: Discussionmentioning

confidence: 99%

Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

et al. 2022

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Objectives The Prostate Imaging Quality (PI-QUAL) score is a new metric to evaluate the diagnostic quality of multiparametric magnetic resonance imaging (MRI) of the prostate. This study assesses the impact of an intervention, namely a prostate MRI quality training lecture, on the participant’s ability to apply PI-QUAL. Methods Sixteen participants (radiologists, urologists, physicists, and computer scientists) of varying experience in reviewing diagnostic prostate MRI all assessed the image quality of ten examinations from different vendors and machines. Then, they attended a dedicated lecture followed by a hands-on workshop on MRI quality assessment using the PI-QUAL score. Five scans assessed by the participants were evaluated in the workshop using the PI-QUAL score for teaching purposes. After the course, the same participants evaluated the image quality of a new set of ten scans applying the PI-QUAL score. Results were assessed using receiver operating characteristic analysis. The reference standard was the PI-QUAL score assessed by one of the developers of PI-QUAL. Results There was a significant improvement in average area under the curve for the evaluation of image quality from baseline (0.59 [95 % confidence intervals: 0.50–0.66]) to post-teaching (0.96 [0.92–0.98]), an improvement of 0.37 [0.21–0.41] (p < 0.001). Conclusions A teaching course (dedicated lecture + hands-on workshop) on PI-QUAL significantly improved the application of this scoring system to assess the quality of prostate MRI examinations. Key Points • A significant improvement in the application of PI-QUAL for the assessment of prostate MR image quality was observed after an educational intervention. • Appropriate training on image quality can be delivered to those involved in the acquisition and interpretation of prostate MRI. • Further investigation will be needed to understand the impact on improving the acquisition of high-quality diagnostic prostate MR examinations.

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“… 3 , 4 , 5 However, CMR image quality (IQ) may be compromised in patients with CIED because of artifacts induced by the pacing device generator or pacing leads. 6 , 7 Traditional temporary pacemakers with floating pacing leads are considered an absolute contraindication because of safety hazards concerning especially excessive heating of the lead tip in ex vivo models. 8 , 9 Floating pacing leads can be implanted at the bedside, but the disadvantage is that the patient must stay on bed rest because of the risk for displacement and failure.…”

Section: Figurementioning

confidence: 99%

Cardiac Magnetic Resonance Imaging–Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing

Vuorinen

Lehtonen

Pakarinen

et al. 2022

JAHA

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Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18‐F‐fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high‐degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.

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Cardiac MRI in patients with cardiac pacemakers: practical methods for reducing susceptibility artifacts and optimizing image quality

Abstract: The artifacts caused by pacemakers typically did not compromise the diagnostic IQ. The use of frequency-scout prior to bSSFP cine or the use of SPGR-based sequences could also improve IQ.

Cited by 15 publications

References 29 publications

MRI in Patients with Cardiac Implantable Electronic Devices

MRI in Patients with Cardiac Implantable Electronic Devices

Promoting the use of the PI-QUAL score for prostate MRI quality: results from the ESOR Nicholas Gourtsoyiannis teaching fellowship

Cardiac Magnetic Resonance Imaging–Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing

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