MRI in Patients with Cardiac Implantable Electronic Devices

Muthalaly, Rahul G.; Nerlekar, Nitesh; Ge, Yin; Kwong, Raymond Y.; Nasis, Arthur

doi:10.1148/radiol.2018180285

Cited by 55 publications

(90 citation statements)

References 83 publications

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“…A complete ISO TS 10974 industry-standard guidelines for implant testing of the safety of the proposed µMS implant is lacking, and further MRI safety analysis is necessary (ISO/TS 10974, 2012;Cabot et al, 2013) before this technology is translated into the clinics. Further simulations on a finalized lead design with models that include all possible implant pathways and measurements with RF injection in the implant (Muthalaly et al, 2018;Brown et al, 2019) to simulate the exposure scenarios inside the scanner, as well as heating tests, will be required on the final implant. These tests are required by the FDA to ensure the worst-case scenario sufficiently meets the requirements for patient safety.…”

Section: Discussionmentioning

confidence: 99%

MRI-Induced Heating of Coils for Microscopic Magnetic Stimulation at 1.5 Tesla: An Initial Study

Bonmassar

Serano

2020

Front. Hum. Neurosci.

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Purpose: Deep brain stimulation (DBS) has proved to be effective in the treatment of movement disorders. However, the direct contact between the metal contacts of the DBS electrode and the brain can cause RF heating in magnetic resonance imaging (MRI) scanning, due to an increase of local specific absorption rate (SAR). Recently, micro coils (µMS) have demonstrated excitation of neuronal tissue through the electromagnetic induction both in vitro and in vivo experiments. In contrast to electrical stimulation, in µMS, there is no direct contact between the metal and the biological tissue.Methods: We compared the heating of a µMS coil with a control case of a metal wire. The heating was induced by RF fields in a 1.5 T MRI head birdcage coil (often used for imaging patients with implants) at 64 MHz, and normalized results to 3.2 W/kg whole head average SAR. Results:The µMS coil or wire implants were placed inside an anatomically accurate head saline-gel filled phantom inserted in the RF coil, and we observed approximately 1 • C initial temperature rise at the µMS coil, while the wire exhibited a 10 • C temperature rise in the proximity of the exposed end. The numerical simulations showed a 32-times increase of local SAR induced at the tips of the metal wire compared to the µMS. Conclusion:In this work, we show with measurements and electromagnetic numerical simulations that the RF-induced increase in local SAR and induced heating during MRI scanning can be greatly reduced by using magnetic stimulation with the proposed µMS technology.

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Section: Discussionmentioning

confidence: 99%

MRI-Induced Heating of Coils for Microscopic Magnetic Stimulation at 1.5 Tesla: An Initial Study

Bonmassar

Serano

2020

Front. Hum. Neurosci.

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“…A recent review and meta-analysis showed that late gadolinium enhancement on cardiac MRI is considerably correlated with ventricular arrhythmic events in the patients with ischemic or nonischemic CMP [OR 5.62 (95% CI: 4.20-7.51)] (12). In myocarditis, MRI has a poor sensitivity at the early stages of the disease; therefore, both im- (13,14). However, artifacts resulting from such cardiac devices may adversely affect the visualization of myocardial abnormalities.…”

Section: Diagnostic Testsmentioning

confidence: 99%

Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions

Babayiğit¹,

Ulus

Görenek

2020

Anatol J Cardiol

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Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions Premature ventricular contractions (PVCs) is one of the most common situations in the current cardiology practice. Although PVCs are generally benign in people without any structural heart disease, they may be associated with left ventricular dysfunction, cardiomyopathy, and, rarely, sudden death. Recently, there has been a considerable research in the pathophysiology of PVC, several clinical presentations in different situations, new proposals of successful diagnostic methods, and treatment modalities. Finally, the American College of Cardiology Electrophysiology Council has published a special report that deals with all the aspects of PVC. We reviewed the important points from this report that can be reflected in our daily practice.

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“…Software modifications with an BMRI mode^were introduced so reprogramming before and after scanning became straightforward and electromagnetic interference minimized. Since their approval in 2008, multiple studies and over 10,000 scans have demonstrated their safety, and are detailed elsewhere [7,12].…”

Section: New Technologymentioning

confidence: 99%

“…Historically, MRI has been contraindicated for safety but each of these individuals has an estimated need for MRI in their lifetime of 50-75%, particularly because they are older and have more comorbidities [6]. Now, technical developments have made it reasonable to perform MRI for these individuals [7], but provision remains grossly inadequate due to logistical difficulties. This review therefore discusses the significant non-technical barriers to developing a sustainable service.…”

Section: Introductionmentioning

confidence: 99%

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

et al. 2019

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More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this-newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.

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MRI in Patients with Cardiac Implantable Electronic Devices

Cited by 55 publications

References 83 publications

MRI-Induced Heating of Coils for Microscopic Magnetic Stimulation at 1.5 Tesla: An Initial Study

MRI-Induced Heating of Coils for Microscopic Magnetic Stimulation at 1.5 Tesla: An Initial Study

Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

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