Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

Vuorinen, Aino-Maija; Lehmonen, Lauri; Karvonen, J.; Holmström, Miia; Kivistö, Sari; Kaasalainen, Touko

doi:10.1007/s00330-022-09059-w

Cited by 9 publications

(6 citation statements)

References 50 publications

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“…Moreover, arm-raised imaging represents a straightforward method to reduce CMR artifacts in patients with left-sided CIEDs and can be used alongside other image quality improvement methods. In a study on 171 CMR scans in patients with CIEDs [24], patients with a right-sided pacemaker showed fewer artifacts (6.2% of segments in SSFP images) than patients with a left-sided pacemaker (17.8%, p < 0.001). In the same study, in patients with left-sided ICDs, arm-raised imaging reduced the artifacts from 37.5% to 12.5% (p = 0.02).…”

Section: Discussionmentioning

confidence: 97%

Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study

Barison,

Ricci,

Pavon

et al. 2023

JCM

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Background: Most recent cardiac implantable electronic devices (CIEDs) can safely undergo a cardiovascular magnetic resonance (CMR) scan under certain conditions, but metal artifacts may degrade image quality. The aim of this study was to assess the overall diagnostic yield of CMR and the extent of metal artifacts in a multicenter, multivendor study on CIED patients referred for CMR. Methods: We analyzed 309 CMR scans from 292 patients (age 57 ± 16 years, 219 male) with an MR-conditional pacemaker (n = 122), defibrillator (n = 149), or loop recorder (n = 38); CMR scans were performed in 10 centers from 2012 to 2020; MR-unsafe implants were excluded. Clinical and device parameters were recorded before and after the CMR scan. A visual analysis of metal artifacts was performed for each sequence on a segmental basis, based on a 5-point artifact score. Results: The vast majority of CMR scans (n = 255, 83%) were completely performed, while only 32 (10%) were interrupted soon after the first sequences and 22 (7%) were only partly acquired; CMR quality was non-diagnostic in 34 (11%) scans, poor (<1/3 sequences were diagnostic) in 25 (8%), or acceptable (1/3 to 2/3 sequences were diagnostic) in 40 (13%), while most scans (n = 201, 68%) were of overall good quality. No adverse event or device malfunctioning occurred, and only nonsignificant changes in device parameters were recorded. The most affected sequences were SSFP (median score 0.32 [interquartile range 0.07–0.91]), followed by GRE (0.18 [0.02–0.59]) and LGE (0.14 [0.02–0.55]). ICDs induced more artifacts (median score in SSFP images 0.87 [0.50–1.46]) than PMs (0.11 [0.03–0.28]) or ILRs (0.11 [0.00–0.56]). Moreover, most artifacts were located in the anterior, anteroseptal, anterolateral, and apical segments of the LV and in the outflow tract of the RV. Conclusions: CMR is a versatile imaging technique, with a high safety profile and overall good image quality even in patients with MR-conditional CIEDs. Several strategies are now available to optimize image quality, substantially enhancing overall diagnostic yield.

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Section: Discussionmentioning

confidence: 97%

Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study

Barison,

Ricci,

Pavon

et al. 2023

JCM

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“…In the present study, some CRT generator-related signal loss remained in the LV anterior wall segments on the cine images, even when using a spoiled gradient echo-based sequence ( Figure 5 ). However, it is worth highlighting that there was no significantly disruptive image artefact observed in the lateral wall, which would correspond to a lead-induced artefact originating from the LV coronary sinus lead [ 18 ]. On post-implant LGE images, extensive hyper-intensity artefacts were often present in the LV anterior region using the regular LGE sequence.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy

Hopman

Zweerink

Lingen

et al. 2023

JCM

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Objectives: This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. Methods: Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure–volume measurements were performed, matching the CRT settings used during CMR. Results: Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. Conclusions: Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.

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“…To minimize the heating risks, new lead designs have been developed to reduce the current induction. Moreover, abandoned electrocatheters generally carry a higher risk of heating, making MRI scans a contraindication in such cases [46,47].…”

Section: Issue: Safetymentioning

confidence: 99%

Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still “Enemies”?

Fogante,

Volpato,

Esposto Pirani

et al. 2024

Medicina

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The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams.

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Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

Cited by 9 publications

References 50 publications

Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study

Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study

Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy

Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still “Enemies”?

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