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Okasha O, Saeed IM, Gupta SK. Outcome of MRI in Patients with Nonconditional Devices with Mismatch between Manufacturer of Leads and Generator. Radiol Cardiothorac Imaging 2022; 4:e220014. [PMID: 35833162 PMCID: PMC9274310 DOI: 10.1148/ryct.220014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
In a series of 35 MRI examinations with non-MRI-conditional devices with a mismatch between the manufacturer of the device generators and leads, there were no adverse events.
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52
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Magnetic resonance imaging in patients with cardiac implantable electronic devices: A prospective study. Magn Reson Imaging 2022; 91:9-15. [DOI: 10.1016/j.mri.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/24/2022] [Accepted: 05/01/2022] [Indexed: 11/20/2022]
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53
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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54
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Reiter T, Weiss I, Weber OM, Bauer WR. Signal voids of active cardiac implants at 3.0 T CMR. Sci Rep 2022; 12:6285. [PMID: 35428775 PMCID: PMC9014817 DOI: 10.1038/s41598-022-09690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
Recent technical advancements allow cardiac MRI (CMR) examinations in the presence of so-called MRI conditional active cardiac implants at 3.0 T. However, the artifact burden caused by susceptibility effects remain an obstacle. All measurements were obtained at a clinical 3.0 T scanner using an in-house designed cubic phantom and optimized sequences for artifact evaluation (3D gradient echo sequence, multi-slice 2D turbo spin echo sequence). Reference sequences according to the American Society for Testing and Materials (ASTM) were additionally applied. Four representative active cardiac devices and a generic setup were analyzed regarding volume and shape of the signal void. For analysis, a threshold operation was applied to the grey value profile of each data set. The presented approach allows the evaluation of the signal void and shape even for larger implants such as ICDs. The void shape is influenced by the orientation of the B0-field and by the chosen sequence type. The distribution of ferromagnetic material within the implants also matters. The void volume depends both on the device itself, and on the sequence type. Disturbances in the B0 and B1 fields exceed the visual signal void. This work presents a reproducible and highly defined approach to characterize both signal void artifacts at 3.0 T and their influencing factors.
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Affiliation(s)
- Theresa Reiter
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany.
| | | | | | - Wolfgang R Bauer
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany
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Oebel S, Jahnke C, Hindricks G, Paetsch I. Nutzen der kardialen Magnetresonanzdiagnostik für Patienten mit Herzrhythmusstörungen. Herz 2022; 47:110-117. [DOI: 10.1007/s00059-022-05105-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
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56
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Sritharan K, Tree A. MR-guided radiotherapy for prostate cancer: state of the art and future perspectives. Br J Radiol 2022; 95:20210800. [PMID: 35073158 PMCID: PMC8978250 DOI: 10.1259/bjr.20210800] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/16/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022] Open
Abstract
Advances in radiotherapy technology have increased precision of treatment delivery and in some tumour types, improved cure rates and decreased side effects. A new generation of radiotherapy machines, hybrids of an MRI scanner and a linear accelerator, has the potential to further transform the practice of radiation therapy in some cancers. Facilitating superior image quality and the ability to change the dose distribution online on a daily basis (termed "daily adaptive replanning"), MRI-guided radiotherapy machines allow for new possibilities including increasing dose, for hard to treat cancers, and more selective sparing of healthy tissues, where toxicity reduction is the key priority.These machines have already been used to treat most types of cancer, although experience is still in its infancy. This review summarises the potential and current evidence for MRI-guided radiotherapy, with a predominant focus on prostate cancer. Current advantages and disadvantages are discussed including a realistic appraisal of the likely potential to improve patient outcomes. In addition, horizon scanning for near-term possibilities for research and development will hopefully delineate the potential role for this technology over the next decade.
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Multiparametric ultrasound versus multiparametric MRI to diagnose prostate cancer (CADMUS): a prospective, multicentre, paired-cohort, confirmatory study. Lancet Oncol 2022; 23:428-438. [DOI: 10.1016/s1470-2045(22)00016-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
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Kuroda K, Yatsushiro S. New Insights into MR Safety for Implantable Medical Devices. Magn Reson Med Sci 2022; 21:110-131. [PMID: 35228487 PMCID: PMC9199981 DOI: 10.2463/mrms.rev.2021-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/08/2022] [Indexed: 12/24/2022] Open
Abstract
Over the last two decades, the status of MR safety has dramatically changed. In particular, ever since the MR-conditional cardiac device was approved by the Food and Drug Administration (FDA) in 2008 and by the Pharmaceuticals and Medical Devices Agency (PMDA) in 2012, the safety of patients with an implantable medical device (IMD) has been one of the most important issues in terms of MR use. In conjunction with the regulatory approvals for various IMDs, standards, technical specifications, and guidelines have also been rapidly created and developed. Many invaluable papers investigating and reviewing the history and status of MR use in the presence of IMDs already exist. As such, this review paper seeks to bridge the gap between clinical practice and the information that is obtained by standard-based tests and provided by an IMD's package insert or instructions for use. Interpretation of the gradient of the magnetic flux density intensity of the static magnetic field with respect to the magnetic displacement force is discussed, along with the physical background of RF field. The relationship between specific absorption rate (SAR) and B1+RMS, and their effects on image quality are described. In addition, insofar as providing new directions for future research and practice, the feasibility of safety test methods for RF-induced heating of IMDs using MR thermometry, evaluation of tissue heat damage, and challenges in cardiac IMDs will be discussed.
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Affiliation(s)
- Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
| | - Satoshi Yatsushiro
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
- Biosim Laboratory, Bioview, Inc., Tokyo, Japan
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Wand AL, Chrispin J, Saad E, Mukherjee M, Hays AG, Gilotra NA. Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis. Front Cardiovasc Med 2022; 8:785279. [PMID: 35155601 PMCID: PMC8828956 DOI: 10.3389/fcvm.2021.785279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac sarcoidosis (CS) is an increasingly recognized cause of heart failure and arrhythmia. Historically challenging to identify, particularly in the absence of extracardiac sarcoidosis, diagnosis of CS has improved with advancements in cardiac imaging. Recognition as well as management may require interpretation of multiple imaging modalities. Echocardiography may serve as an initial screening study for cardiac involvement in patients with systemic sarcoidosis. Cardiac magnetic resonance imaging (CMR) provides information on diagnosis as well as risk stratification, particularly for ventricular arrhythmia in the setting of late gadolinium enhancement. More recently, 18F-fluorodeoxyglucose position emission tomography (FDG-PET) has assumed a valuable role in the diagnosis and longitudinal management of patients with CS, allowing for the assessment of response to treatment. Hybrid FDG-PET/CT may also be used in the evaluation of extracardiac inflammation, permitting the identification of biopsy sites for diagnostic confirmation. Herein we examine the approach to diagnosis and management of CS using multimodality imaging via a case-based review.
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Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elie Saad
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Bauer BK, Meier C, Bietenbeck M, Lange PS, Eckardt L, Yilmaz A. Cardiovascular Magnetic Resonance-Guided Radiofrequency Ablation: Where Are We Now? JACC Clin Electrophysiol 2022; 8:261-274. [PMID: 35210090 DOI: 10.1016/j.jacep.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
The possibilities of cardiovascular magnetic resonance (CMR) imaging for myocardial tissue characterization and catheter ablation guidance are accompanied by some fictional concepts. In this review, we present the available facts about CMR-guided catheter ablation procedures as well as promising, however unproven, theoretical concepts. CMR promises to visualize the respective arrhythmogenic substrate and may thereby make it more localizable for electrophysiology (EP)-based ablation. Robust CMR imaging is challenged by motion of the heart resulting from cardiac and respiratory cycles. In contrast to conventional "passive" tracking of the catheter tip by real-time CMR, novel approaches based on "active" tracking are performed by integrating microcoils into the catheter tip that send a receiver signal. Several experimental and clinical studies were already performed based on real-time CMR for catheter ablation of atrial and ventricular arrhythmias. Importantly, successful ablation of the cavotricuspid isthmus was already performed in patients with typical atrial flutter. However, a complete EP procedure with real-time CMR-guided transseptal puncture and subsequent pulmonary vein isolation has not been shown so far in patients with atrial fibrillation. Moreover, real-time CMR-guided EP for ventricular tachycardia ablation was only performed in animal models using a transseptal, retrograde, or epicardial access-but not in humans. Essential improvements within the next few years regarding basic technical requirements, such as higher spatial and temporal resolution of real-time CMR imaging as well as clinically approved cardiac magnetic resonance-conditional defibrillators, are ultimately required-but can also be expected-and will move this field forward.
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Affiliation(s)
- Bastian Klemens Bauer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany.
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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62
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Minaskeian N, Hajnal SP, Liu MB, Klooster LM, Devick KL, Schwartz L, Jokerst CE, Sorajja D, Scott LRP. Safety of magnetic resonance imaging in patients with cardiac implantable electronic devices with generator and lead(s) brand mismatch. J Appl Clin Med Phys 2022; 23:e13520. [PMID: 35066975 PMCID: PMC8906220 DOI: 10.1002/acm2.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a valuable imaging modality for the assessment of both cardiac and non‐cardiac structures. With a growing population of patients with cardiovascular implantable electronic devices (CIEDs), 50%–75% of these patients will need an MRI. MRI‐conditional CIEDs have demonstrated safety of MRI scanning with such devices, yet non‐conditional devices such as hybrid CIEDs which have generator and lead brand mismatch may pose a safety risk. In this retrospective study, we examined the outcomes of patients with hybrid CIEDs undergoing MRI compared to those patients with non‐hybrid CIEDs. A total of 349 patients were included, of which 24 patients (7%) had hybrid CIEDs. The primary endpoint was the safety of MRI for patients with hybrid CIEDs as compared to those with non‐hybrid devices, measured by the rate of adverse events, including death, lead or generator failure needing immediate replacement, loss of capture, new onset arrhythmia, or power‐on reset. Secondary endpoints consisted of pre‐ and post‐MRI changes of decreased P‐wave or R‐wave sensing by ≥50%, changes in pacing lead impedance by ≥50 ohms, increase in pacing thresholds by ≥ 0.5 V at 0.4 ms, and decreasing battery voltage of ≥ 0.04 V. The primary endpoint of any adverse reaction was present in 1 (4.2%) patient with a hybrid device, and consistent of atrial tachyarrhythmia, and in 10 (3.1%) patients with a non‐hybrid device, and consisted of self‐limited atrial and non‐sustained ventricular arrhythmias; this was not statistically significant. No significant differences were found in the secondary endpoints. This study demonstrates that MRI in patients with hybrid CIEDs does not result in increased patient risk or significant device changes when compared to those patients who underwent MRI with non‐hybrid CIEDs.
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Affiliation(s)
- Nareg Minaskeian
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Sofia P Hajnal
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Michael B Liu
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Katrina L Devick
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Linda Schwartz
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Dan Sorajja
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Luis RP Scott
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
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63
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Vuorinen AM, Paakkanen R, Karvonen J, Sinisalo J, Holmström M, Kivistö S, Peltonen JI, Kaasalainen T. Magnetic resonance imaging safety in patients with abandoned or functioning epicardial pacing leads. Eur Radiol 2022; 32:3830-3838. [PMID: 34989847 DOI: 10.1007/s00330-021-08469-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The European Society of Cardiology Guidelines on cardiac pacing from 2021 allow magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) but do not recommend MRI in patients with epicardial pacing leads. The clinical dilemma remains whether performing an MRI in patients with CIED and epicardial leads is safe. We aimed to evaluate the safety of performing an MRI in patients with CIED and abandoned or functioning epicardial pacing leads. METHODS We included all adult patients who underwent clinically indicated MRIs with CIED and functioning or abandoned epicardial leads in a single tertiary hospital between November 2011 and October 2019. The data were retrospectively collected. RESULTS Twenty-six MRIs were performed on 17 patients with functioning or abandoned epicardial pacing leads. Sixty-nine percent of the MRI scans (18/26) were conducted on patients with functioning epicardial pacing leads. A definite adverse event occurred in one MRI scan. This was a transient elevation of the pacing threshold in a patient with a functioning epicardial ventricular pacing lead implanted 29 years previously. An irreversible atrial pacing lead impedance elevation was detected 6 months after the MRI in another patient; the association with the previous MRI remained unclear. No adverse events were detected in MRIs performed on patients with modern (implanted in 2000 or later) functioning epicardial leads. CONCLUSIONS MRIs in patients with CIED and modern functioning epicardial pacing leads were performed without detectable adverse events. Further large-scale studies are necessary to confirm MRI safety in patients with epicardial pacing leads. KEY POINTS • Currently, MRI in patients with cardiac implantable electronic devices (CIEDs) and functioning or abandoned epicardial pacing leads is not recommended. • MRIs in patients with CIED and modern functioning epicardial leads (implanted in 2000 or later) were performed without detectable adverse events in our patient cohort. • Allowing MRI in patients with epicardial pacing leads may significantly improve the diagnostic work-up, especially in specific patient groups, such as patients with congenital heart disease.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland.
| | - Riitta Paakkanen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Juha I Peltonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 140] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Nguyen BT, Bhusal B, Rahsepar AA, Fawcett K, Lin S, Marks DS, Passman R, Nieto D, Niemzcura R, Golestanirad L. Safety of MRI in patients with retained cardiac leads. Magn Reson Med 2021; 87:2464-2480. [PMID: 34958685 PMCID: PMC8919805 DOI: 10.1002/mrm.29116] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Purpose To evaluate the safety of MRI in patients with fragmented retained leads (FRLs) through numerical simulation and phantom experiments. Methods Electromagnetic and thermal simulations were performed to determine the worst‐case RF heating of 10 patient‐derived FRL models during MRI at 1.5 T and 3 T and at imaging landmarks corresponding to head, chest, and abdomen. RF heating measurements were performed in phantoms implanted with reconstructed FRL models that produced highest heating in numerical simulations. The potential for unintended tissue stimulation was assessed through a conservative estimation of the electric field induced in the tissue due to gradient‐induced voltages developed along the length of FRLs. Results In simulations under conservative approach, RF exposure at B1+ ≤ 2 µT generated cumulative equivalent minutes (CEM)43 < 40 at all imaging landmarks at both 1.5 T and 3 T, indicating no thermal damage for acquisition times (TAs) < 10 min. In experiments, the maximum temperature rise when FRLs were positioned at the location of maximum electric field exposure was measured to be 2.4°C at 3 T and 2.1°C at 1.5 T. Electric fields induced in the tissue due to gradient‐induced voltages remained below the threshold for cardiac tissue stimulation in all cases. Conclusions Simulation and experimental results indicate that patients with FRLs can be scanned safely at both 1.5 T and 3 T with most clinical pulse sequences.
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Affiliation(s)
- Bach T Nguyen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bhumi Bhusal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Amir Ali Rahsepar
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kate Fawcett
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Stella Lin
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel S Marks
- Department of Electrophysiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Rod Passman
- Department of Electrophysiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Donny Nieto
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard Niemzcura
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Laleh Golestanirad
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
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Evaluation of Potential Cumulative Risk of Multiple 1.5-T MRI Examinations in Patients With Cardiac Implanted Electronic Devices. AJR Am J Roentgenol 2021; 218:831-832. [PMID: 34910536 DOI: 10.2214/ajr.21.26564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
While professional societies now support MRI in patients with non-conditional (legacy) cardiac implanted electronic devices (CIEDs), concern remains regarding potential cumulative effects of serial examinations. We evaluated 481 patients with CIEDs who underwent 599 1.5-T MRI examinations (44.5% cardiac examinations), including 68 who underwent multiple examinations (maximum, 7 examinations). No major events occurred. Minor adverse event rate was 5.6%. Multiple statistical evaluations showed no increase in adverse event rate with increasing number of previous examinations.
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Hong S, Hong K, Culver AE, Pathrose A, Allen BD, Wilcox JE, Lee DC, Kim D. Highly Accelerated Real-Time Free-Breathing Cine CMR for Patients With a Cardiac Implantable Electronic Device. Acad Radiol 2021; 28:1779-1786. [PMID: 32888766 DOI: 10.1016/j.acra.2020.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES To develop a 16-fold accelerated real-time, free-breathing cine cardiovascular magnetic resonance (CMR) pulse sequence with compressed sensing reconstruction and test whether it is capable of producing clinically acceptable summed visual scores (SVS) and accurate left ventricular ejection fraction (LVEF) in patients with a cardiac implantable electronic device (CIED). MATERIALS AND METHODS A 16-fold accelerated real-time cine CMR pulse sequence was developed using gradient echo readout, Cartesian k-space sampling, and compressed sensing. We scanned 13 CIED patients (mean age = 59 years; 9/4 males/females) using clinical standard, breath-hold cine and real-time, free-breathing cine. Two clinical readers performed a visual assessment of image quality in four categories (conspicuity of endocardial wall at end diastole, temporal fidelity of wall motion, any artifact level on the heart, noise) using a five-point Likert scale (1: worst; 3: clinically acceptable; 5: best). SVS was calculated as the sum of 4 individual scores, where 12 was defined as clinical acceptable. The Wilcoxon signed-rank test was performed to compare SVS, and the Bland-Altman analysis was conducted to evaluate the agreement of LVEF. RESULTS Median scan time was 3.7 times shorter for real-time (3.5 heartbeats per slice) than clinical standard (13 heartbeats per slice, excluding nonscanning time between successive breath-hold acquisitions). Median SVS was not significantly different between clinical standard (15.0) and real-time (14.5). The mean difference in LVEF was -2% (4.7% of mean), and the limits of agreement was 5.8% (13.5% of mean). CONCLUSION This study demonstrates that the proposed real-time cine method produces clinically acceptable SVS and relatively accurate LVEF in CIED patients.
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Vegunta S, Kling JM, Patel BK. Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals. Mayo Clin Proc 2021; 96:2891-2904. [PMID: 34686363 DOI: 10.1016/j.mayocp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient's mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.
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Affiliation(s)
- Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ.
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Bhavika K Patel
- Division of Breast Imaging, Mayo Clinic Hospital, Phoenix, AZ
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69
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Nguyen BT, Bhusal B, Fawcett K, Golestanirad L. Radiofrequency heating of retained cardiac leads during magnetic resonance imaging at 1.5 T and 3 T. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4986-4989. [PMID: 34892327 DOI: 10.1109/embc46164.2021.9629867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Patients with cardiovascular implantable electronic devices (CIEDs) are often prevented from receiving magnetic resonance imaging (MRI) due to risks associated with radiofrequency (RF) heating of tissue around the implanted leads. Although MR-conditional CIEDs are available, the safety labeling of such devices does not extend to patients with fragmented retained leads (FRLs), where segments of the leads are left in the tissue after the original device is extracted. Unlike intact and isolated leads of CIEDs, FRLs are often bare conductive lead fragments in direct contact with the tissue. No experimental work has been reported that assess RF heating of FRL during MRI thus far. In this work, we performed phantom experiments to measure RF heating of 4 patient-derived FRL models in a gel-based ASTM-like phantom during RF exposure at 64 MHz (proton imaging at 1.5 T) and 123 MHz (proton imaging at 3 T). We found FRL models to generate negligible temperature rise in the gel (∆T<1.84 °C) during a 10-minute scan at both 1.5 T and 3 T. These results are in agreement with previous simulation studies and suggest MRI may be performed safely in patients with fragmented retained leads.
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70
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 893] [Impact Index Per Article: 297.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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71
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Huang X, Jiang GJ. Magnetic resonance imaging interactions with a sacral neuromodulation system. Neurourol Urodyn 2021; 40:1862-1868. [PMID: 34487571 PMCID: PMC9290516 DOI: 10.1002/nau.24756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 11/08/2022]
Abstract
Aims Sacral neuromodulation (SNM) has successfully treated patients with functional urinary and/or bowel disorders for more than two decades. Historically, patients with the InterStim system (Medtronic) were contraindicated for Magnetic Resonance Imaging (MRI) scans. In 2012, Medtronic obtained Food and Drug Administration (FDA) approval for allowing 1.5 Tesla (T) MRI head scans. In September 2019, the Axonics System (Axonics) received FDA approval for 1.5 T full‐body MR Conditional labeling and then 3 T full‐body MR Conditional labeling in July 2020. In August 2020, Medtronic received 1.5 and 3 T full‐body MR Conditional labeling from the FDA for their new SNM systems (InterStim II and Micro devices with SureScanTM leads). With the advancements in MRI technology and availability of full‐body MRI eligible SNM systems, it is important for physicians to better understand MRI safety for these systems. Methods This paper explains the fundamentals of MRI physics, its interactions with active implantable medical devices (AIMDs), the subsequent potential safety hazards with emphasis on radio frequency (RF)‐related safety, and the risks associated with “Off‐label” scans, including abandoned and broken leads. Results MRI guidelines provided by the AIMD device manufacturer should be followed to ensure MRI scan safety and avoid any unnecessary risk to patients. Conclusions MRI guidelines provided by the device manufacturer are the best resource for guidance for performing safe MRI scanning. Specific conditions should be fully understood and generalizations on MRI safety claims based on partial analysis or case studies should be avoided.
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72
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Patel B, Monkhouse C, Manisty C, Papageorgiou N. Temporary device malfunction of an MR conditional cardiac resynchronization defibrillator when undergoing MRI without appropriate re-programming: a case report. EUROPEAN HEART JOURNAL - CASE REPORTS 2021; 5:ytab198. [PMID: 34557630 PMCID: PMC8454201 DOI: 10.1093/ehjcr/ytab198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 05/07/2021] [Indexed: 11/22/2022]
Abstract
Background Magnetic resonance (MR) imaging (MRI) for patients with implantable cardiac devices is becoming more routine, with the development of MR conditional devices allowing more patients access to the imaging they need. However, for this to be performed safely, strict protocols must be followed necessitating close collaboration between cardiology and radiology departments. We present a case where mandatory device re-programming of a cardiac resynchronization therapy defibrillator device into MRI mode was not performed pre-scan leading to temporary device dysfunction with no clinical consequences. Case summary A 72-year-old man presented to a device clinic for a routine device interrogation. An atrial tachycardia response episode was recorded at the same time as the patient reported having undergone an MRI scan at a local centre. The electrogram demonstrated temporary right ventricular loss of capture with standard output programming, and a short episode of oversensing on the atrial and ventricular channel which was not sustained for long enough to meet tachycardia detection. Discussion We demonstrate two potential electrophysiological effects of MRI on pacemakers, where the device had not been appropriately re-programmed pre-procedure. This illustrates that whilst MRI in patients with implantable cardiac devices is safe, strict protocols must be followed requiring robust multidisciplinary communication.
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Affiliation(s)
- Bhavisha Patel
- Barts Heart Centre, West Smithfield, London EC1A 7BE, UK
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73
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Bucciarelli-Ducci C, Vardas P. Reconsidering safety and reducing barriers to MRI in patients with cardiac implantable electronic devices. Eur Heart J 2021; 43:2479-2481. [PMID: 34472581 DOI: 10.1093/eurheartj/ehab469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chiara Bucciarelli-Ducci
- Royal Brompton & Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, King's College London, UK
| | - Panos Vardas
- Heart Sector, Hygeia Group Hospitals, Athens, Greece
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Bhuva AN, Moralee R, Brunker T, Lascelles K, Cash L, Patel KP, Lowe M, Sekhri N, Alpendurada F, Pennell DJ, Schilling R, Lambiase PD, Chow A, Moon JC, Litt H, Baksi AJ, Manisty CH. Evidence to support magnetic resonance conditional labelling of all pacemaker and defibrillator leads in patients with cardiac implantable electronic devices. Eur Heart J 2021; 43:2469-2478. [PMID: 34435642 PMCID: PMC9259370 DOI: 10.1093/eurheartj/ehab350] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Many cardiac pacemakers and defibrillators are not approved by regulators for magnetic resonance imaging (MRI). Even following generator exchange to an approved magnetic resonance (MR)-conditional model, many systems remain classified 'non-MR conditional' due to the leads. This classification makes patient access to MRI challenging, but there is no evidence of increased clinical risk. We compared the effect of MRI on non-MR conditional and MR-conditional pacemaker and defibrillator leads. METHODS AND RESULTS Patients undergoing clinical 1.5T MRI with pacemakers and defibrillators in three centres over 5 years were included. Magnetic resonance imaging protocols were similar for MR-conditional and non-MR conditional systems. Devices were interrogated pre- and immediately post-scan, and at follow-up, and adverse clinical events recorded. Lead parameter changes peri-scan were stratified by MR-conditional labelling. A total of 1148 MRI examinations were performed in 970 patients (54% non-MR conditional systems, 39% defibrillators, 15% pacing-dependent) with 2268 leads. There were no lead-related adverse clinical events, and no clinically significant immediate or late lead parameter changes following MRI in either MR-conditional or non-MR conditional leads. Small reductions in atrial and right ventricular sensed amplitudes and impedances were similar between groups, with no difference in the proportion of leads with parameter changes greater than pre-defined thresholds (7.1%, 95% confidence interval: 6.1-8.3). CONCLUSIONS There was no increased risk of MRI in patients with non-MR conditional pacemaker or defibrillator leads when following recommended protocols. Standardizing MR conditions for all leads would significantly improve access to MRI by enabling patients to be scanned in non-specialist centres, with no discernible incremental risk.
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Affiliation(s)
- Anish N Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK.,Health Data Research UK, University College London, London, UK
| | - Russell Moralee
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Tamara Brunker
- Department of Radiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen Lascelles
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Lizette Cash
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Kush P Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Martin Lowe
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Neha Sekhri
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Francisco Alpendurada
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Richard Schilling
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - Pier D Lambiase
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
| | - Anthony Chow
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
| | - Harold Litt
- Department of Radiology, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A John Baksi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, SW3 6NP, UK
| | - Charlotte H Manisty
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, WC1E 6HX, UK
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75
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Is diversity harmful?-Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging. Wien Klin Wochenschr 2021; 134:286-293. [PMID: 34402991 PMCID: PMC9023390 DOI: 10.1007/s00508-021-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
Background Many patients with cardiac implantable electronic devices (CIED) undergo magnetic resonance imaging (MRI); however, a relevant proportion have a CIED system that has not been classified as MRI-conditional because of generators and leads from different brands (mixed-brand group). The available data concerning the outcome of these mixed patients undergoing MRI is limited. Methods A retrospective single center study, including all patients with CIEDs undergoing MRI between January 2013 until May 2020, was performed. Primary endpoints were defined as death or any adverse event necessitating hospitalization or CIED revision. Secondary endpoints were the occurrence of any sign for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with 1–9 MRIs per patient. Of the patients 38 underwent 54 procedures in the mixed-brand group and 89 patients underwent 134 MRIs in the MRI-conditional group. Of the patients 31 were excluded since the MRI conditionality could not be determined. No primary endpoints occurred within the mixed-brand group but in 2.2% of the MRI-conditional group (p = 1.000), with 2 patients developing new atrial fibrillation during MRI, of whom one additionally had a transient CIED dysfunction. No secondary endpoints were met in the mixed-brand group compared to 3.4% in the MRI-conditional group (p = 0.554). No complications occurred in the excluded patients. Conclusion The complication rate of CIED patients undergoing MRI was low. Patients with a mixed CIED system showed no signs of increased risk of adverse events compared to patients with MRI-conditional CIED systems. Supplementary Information The online version of this article (10.1007/s00508-021-01924-w) contains supplementary material, which is available to authorized users.
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76
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Silemek B, Seifert F, Petzold J, Hoffmann W, Pfeiffer H, Speck O, Rose G, Ittermann B, Winter L. Rapid safety assessment and mitigation of radiofrequency induced implant heating using small root mean square sensors and the sensor matrix Q s. Magn Reson Med 2021; 87:509-527. [PMID: 34397114 DOI: 10.1002/mrm.28968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE Rapid detection and mitigation of radiofrequency (RF)-induced implant heating during MRI based on small and low-cost embedded sensors. THEORY AND METHODS A diode and a thermistor are embedded at the tip of an elongated mock implant. RF-induced voltages or temperature change measured by these root mean square (RMS) sensors are used to construct the sensor Q-Matrix (QS ). Hazard prediction, monitoring and parallel transmit (pTx)-based mitigation using these sensors is demonstrated in benchtop measurements at 300 MHz and within a 3T MRI. RESULTS QS acquisition and mitigation can be performed in <20 ms demonstrating real-time capability. The acquisitions can be performed using safe low powers (<3 W) due to the high reading precision of the diode (126 µV) and thermistor (26 µK). The orthogonal projection method used for pTx mitigation was able to reduce the induced signals and temperatures in all 155 investigated locations. Using the QS approach in a pTx capable 3T MRI with either a two-channel body coil or an eight-channel head coil, RF-induced heating was successfully assessed, monitored and mitigated while the image quality outside the implant region was preserved. CONCLUSION Small (<1.5 mm3 ) and low-cost (<1 €) RMS sensors embedded in an implant can provide all relevant information to predict, monitor and mitigate RF-induced heating in implants, while preserving image quality. The proposed pTx-based QS approach is independent of simulations or in vitro testing and therefore complements these existing safety assessments.
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Affiliation(s)
- Berk Silemek
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Frank Seifert
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Johannes Petzold
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Werner Hoffmann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Harald Pfeiffer
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Oliver Speck
- Biomedical Magnetic Resonance, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Georg Rose
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.,Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, Magdeburg, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Lukas Winter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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77
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Gao X, Abdi M, Auger DA, Sun C, Hanson CA, Robinson AA, Schumann C, Oomen PJ, Ratcliffe S, Malhotra R, Darby A, Monfredi OJ, Mangrum JM, Mason P, Mazimba S, Holmes JW, Kramer CM, Epstein FH, Salerno M, Bilchick KC. Cardiac Magnetic Resonance Assessment of Response to Cardiac Resynchronization Therapy and Programming Strategies. JACC Cardiovasc Imaging 2021; 14:2369-2383. [PMID: 34419391 DOI: 10.1016/j.jcmg.2021.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy. BACKGROUND CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain. METHODS CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets. RESULTS 100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50 years-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals <240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P < 0.001), LV end-systolic volume (r = -0.58; P < 0.001), and LVEF (r = -0.52; P < 0.001). CONCLUSIONS CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.
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Affiliation(s)
- Xu Gao
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel A Auger
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Changyu Sun
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher A Hanson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Austin A Robinson
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher Schumann
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pim J Oomen
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah Ratcliffe
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rohit Malhotra
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew Darby
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Oliver J Monfredi
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - J Michael Mangrum
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pamela Mason
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sula Mazimba
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Christopher M Kramer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Frederick H Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michael Salerno
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kenneth C Bilchick
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
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Yang E, Suzuki M, Nazarian S, Halperin H. Magnetic Resonance Imaging Safety in Patients with Cardiac Implantable Electronic Devices. Trends Cardiovasc Med 2021; 32:440-447. [PMID: 34384880 DOI: 10.1016/j.tcm.2021.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
High strength magnetic and electric fields used in magnetic resonance imaging (MRI) render images with unmatched soft tissue contrast. These imaging attributes have made MRI an increasingly preferred diagnostic tool in many medical conditions. Initially there was substantial concern regarding the safety of performing these imaging studies in patients with cardiac implantable electronic devices (CIEDs), which have the potential to be affected by the intense electric and magnetic fields of the MRI. More recently, there has been increasing evidence that MRI can be performed safely in patients with devices that have not been specifically labelled by regulatory agencies for use in an MRI environment (MRI nonconditional devices), which has allowed the Centers for Medicare and Medicaid Services (CMS) to start providing reimbursement for MRIs of patients with MRI nonconditional devices. For CMS to reimburse scans, a rigorous protocol must be followed, which recognizes that there are still potential adverse effects that can be mitigated by appropriate procedures. In this review we will survey the initial experiences and efforts to understand the magnitude of risk for device malfunction and harm, as well as current efforts to minimize the potential risks of MRI effects on devices and leads (heating, device movement, lead dislodgement, and device malfunction, the latter including inhibition of pacing and generation of arrhythmias).
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Affiliation(s)
- Eunice Yang
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD
| | - Masahito Suzuki
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD
| | - Saman Nazarian
- University of Pennsylvania, Division of Cardiology, Philadelphia, PA
| | - Henry Halperin
- Johns Hopkins Hospital, Division of Cardiology, Baltimore, MD; Johns Hopkins University, Departments of Radiology and Biomedical Engineering.
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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80
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Baritussio A, Scatteia A, Dellegrottaglie S, Bucciarelli-Ducci C. Evidence and Applicability of Stress Cardiovascular Magnetic Resonance in Detecting Coronary Artery Disease: State of the Art. J Clin Med 2021; 10:3279. [PMID: 34362063 PMCID: PMC8347143 DOI: 10.3390/jcm10153279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/28/2022] Open
Abstract
Cardiovascular magnetic resonance is increasingly used in clinical practice, as it has emerged over the years as an invaluable imaging technique for diagnosis and prognosis, with clear-cut applications in managing patients with both ischemic and non-ischemic heart disease. In this review, we focus on the evidence and clinical application of stress CMR in coronary artery disease from diagnosis to prognosis.
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Affiliation(s)
- Anna Baritussio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedale Università Padova, 35128 Padua, Italy;
| | - Alessandra Scatteia
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato “Villa dei Fiori”, 80011 Acerra, Italy; (A.S.); (S.D.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato “Villa dei Fiori”, 80011 Acerra, Italy; (A.S.); (S.D.)
- Zena and Michael A, Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029-5674, USA
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, London SW3 6LR, UK
- Guys’s and St Thomas’ Foundation Trust and Kings College London, London SE5 9NU, UK
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81
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Pohlan J, Stelbrink C, Tuttle N, Kubicka F, Kwon HJ, Jahnke P, Goehler F, Kershaw O, Gruber AD, Pumberger M, Diekhoff T. Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom. Acta Radiol 2021; 63:1118-1125. [PMID: 34219471 PMCID: PMC9272519 DOI: 10.1177/02841851211025863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Previously, dual-energy computed tomography (DECT) has been established for
imaging spinal fractures as an alternative modality to magnetic resonance
imaging (MRI). Purpose To analyze the diagnostic accuracy of DECT in visualizing intervertebral disc
(IVD) damage. Material and Methods The lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT
was performed as sequential volume technique on a single-source CT scanner.
IVDs were imaged before and after an injection of sodium chloride solution
and after anterior discectomy in single-source sequential volume DECT
technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were
reconstructed at 1 mm and compared with standard CT. Standardized regions of
interest (ROI) were placed in the anterior anulus fibrosus, nucleus
pulposus, and other sites. Three blinded readers classified all images as
intact disc, nucleus lesion, or anulus lesion. Additionally, clinical
examples from patients with IVD lesions were retrospectively identified from
the radiological database. Results Interrater reliability was almost perfect with a Fleiss kappa of 0.833 (95%
confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI
0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT
achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI
80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and
78.0% specificity (95% CI 64.0–88.5). Conclusion DECT reliably identified IVD damage in an ex vivo biophantom. Clinical
examples of patients with different lesions illustrate the accurate
depiction of IVD microstructure. These data emphasize the diagnostic
potential of DECT cMaps.
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Affiliation(s)
- Julian Pohlan
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Niklas Tuttle
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Felix Kubicka
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Ho Jung Kwon
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Paul Jahnke
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Friedemann Goehler
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Olivia Kershaw
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Achim D Gruber
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Matthias Pumberger
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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82
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Dahiya G, Wetzel A, Kyvernitakis A, Gevenosky L, Williams R, Shah M, Farah V, Doyle M, Biederman RW. Impact of magnetic resonance imaging on functional integrity of non-conditional cardiovascular implantable electronic devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1312-1319. [PMID: 34133778 DOI: 10.1111/pace.14298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/03/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiovascular implantable electronic devices (CIEDs) have historically restricted the use of magnetic resonance imaging (MRI) due to the potential clinical and configurational risks associated with electromagnetic interference. In this study, the authors investigated the impact of MRI on the functional integrity of non-conditional CIEDs and their clinical correlates. METHODS In this prospective, observational single-center study, we enrolled patients undergoing MRI over a 5-year period. Prior to assessing the impact of MRI on CIEDs, we performed interrogations in sequential duplication to assess the intrinsic variability of devices. Subsequently, we performed interrogations immediately after MRI, and monitored changes in device parameters and clinical events. RESULTS We completed 492 MRI studies, 58% in patients with permanent pacemakers (PPMs) and 42% with implantable cardioverter defibrillators (ICDs). Subsequent MRI exposures occurred in 15% encounters. Accounting for intrinsic variability in CIED leads, there were no significant changes in RA, RV, or LV parameters after MRI, regardless of the region imaged (thoracic vs. non-thoracic), type of CIED (PPMs vs. ICDs) and among those with serial MRIs. When ranked for % change pre- to post-MRI, the majority of RA, RV, and LV metrics for thresholds, sensing, and impedance conformed to ≤20% change from baseline. No significant clinical adverse cardiac events or effect on device microcircuitry occurred during the study. CONCLUSION Incorporating a novel reproducibility tactic, there were neither clinically meaningful device parameter changes nor adverse clinical events during or following MRIs, suggesting the effects of MRI on non-conditional CIED integrity are far less than previously perceived.
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Affiliation(s)
- Garima Dahiya
- Departments of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adam Wetzel
- Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Andreas Kyvernitakis
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Loretta Gevenosky
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Ronald Williams
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Moneal Shah
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Victor Farah
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark Doyle
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Robert Ww Biederman
- Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.,Center for Cardiovascular MRI Research and Development, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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83
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Yu L, Zhao J, Zhang Z, Wang J, Hu W. Commissioning of and preliminary experience with a new fully integrated computed tomography linac. J Appl Clin Med Phys 2021; 22:208-223. [PMID: 34151504 PMCID: PMC8292712 DOI: 10.1002/acm2.13313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose A new medical linear accelerator (linac) platform integrated with helical computed tomography (CT), the uRT‐linac 506c, was introduced into clinical application in 2019 by United Imaging Healthcare (UIH) Co., Ltd. (Shanghai, China). It combines a Carm linac with a diagnostic‐quality 16‐slice CT imager, providing seamless workflow from simulation to treatment. The aim of this report is to assess the technical characteristics, commissioning results and preliminary experiences stemming from clinical usage. Methods The mechanical and imaging test procedures, commissioning data collection and TPS validation were summarized. CTIGRT accuracy was investigated with different loads and couch extensions. A series of end‐to‐end cases for different treatment sites and delivery techniques were tested preclinically to estimate the overall accuracy for the entire treatment scheme. The results of patient‐specific QA and machine stability during a one‐year operation are also reported. Results Gantry/couch/collimator isocentricity was measured as 0.63 mm in radius. The TPS models were in agreement with the beam commissioning data within a deviation of 2%. An overall submillimeter accuracy was demonstrated for the CT‐IGRT process under all conditions. The absolute point dose difference for all the preclinical end‐to‐end tests was within 3%, and the gamma passing rate of the 2D dose distribution measured by EBT3 film was better than 90% (3% DD, 3 mm DTA and 10% threshold). Pretreatment QA of clinical cases resulted with better than 3% point dose difference and more than 99% gamma passing rate (3% DD/2 mm DTA/10% threshold) tested with Delta4. The output of the linac was mostly within 1% of variation in a one‐year operation. Conclusion The commissioning results and clinical QA results show that the uRT‐linac 506c platform exhibits good and stable performance in mechanical and dosimetric accuracy. The integrated CT system provides an efficient workflow for image guidance with submillimeter localization precision, and will be a good starting point to proceed advanced adaptive radiotherapy.
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Affiliation(s)
- Lei Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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84
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Lee EM, Ibrahim ESH, Dudek N, Lu JC, Kalia V, Runge M, Srinivasan A, Stojanovska J, Agarwal PP. Improving MR Image Quality in Patients with Metallic Implants. Radiographics 2021; 41:E126-E137. [PMID: 34143712 DOI: 10.1148/rg.2021200092] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The number of implanted devices such as orthopedic hardware and cardiac implantable devices continues to increase with an increase in the age of the patient population, as well as an increase in the number of indications for specific devices. Many patients with these devices have or will develop clinical conditions that are best depicted at MRI. However, implanted devices containing paramagnetic or ferromagnetic substances can cause significant artifact, which could limit the diagnostic capability of this modality. Performing imaging with MRI when an implant is present may be challenging, and there are numerous techniques the radiologist and technologist can use to help minimize artifacts related to implants. First, knowledge of the presence of an implant before patient arrival is critical to ensure safety of the patient when the device is subjected to a strong magnetic field. Once safety is ensured, the examination should be performed with the MRI system that is expected to provide the best image quality. The selection of the MRI system includes multiple considerations such as the effects of field strength and availability of specific sequences, which can reduce metal artifact. Appropriate patient positioning, attention to MRI parameters (including bandwidth, voxel size, and echo), and appropriate selection of sequences (those with less metal artifact and advanced metal reduction sequences) are critical to improve image quality. Patients with implants can be successfully imaged with MRI with appropriate planning and understanding of how to minimize artifacts. This improves image quality and the diagnostic confidence of the radiologist. ©RSNA, 2021.
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Affiliation(s)
- Elizabeth M Lee
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - El-Sayed H Ibrahim
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Nancy Dudek
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jimmy C Lu
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Vivek Kalia
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Mason Runge
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Ashok Srinivasan
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Jadranka Stojanovska
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
| | - Prachi P Agarwal
- From the Department of Radiology, Division of Cardiothoracic Imaging (E.M.L., J.S., P.P.A.), Department of Radiology (N.D.), Department of Pediatrics, Division of Cardiology, CS Mott Children's Hospital (J.C.L.), Department of Radiology, Division of Musculoskeletal Radiology (V.K.), University of Michigan Medical School (M.R.), and Department of Radiology, Division of Neuroradiology (A.S.), University of Michigan, University Hospital Floor B1 Reception C, 1500 E Medical Center Dr, SPC 5030, Ann Arbor, MI 48109; and Center for Imaging Research, Medical College of Wisconsin, Milwaukee, Wis (E.H.I.)
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85
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Sohns C, Sommer P. Magnetic resonance imaging in all patients with implanted cardiac devices - Yes, We Can! Int J Cardiol 2021; 338:274-275. [PMID: 34118323 DOI: 10.1016/j.ijcard.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
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86
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Yao A, Goren T, Samaras T, Kuster N, Kainz W. Radiofrequency-induced heating of broken and abandoned implant leads during magnetic resonance examinations. Magn Reson Med 2021; 86:2156-2164. [PMID: 34080721 PMCID: PMC8362172 DOI: 10.1002/mrm.28836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
Purpose The risks of RF‐induced heating of active implantable medical device (AIMD) leads during MR examinations must be well understood and realistically assessed. In this study, we evaluate the potential additional risks of broken and abandoned (cut) leads. Methods First, we defined a generic AIMD with a metallic implantable pulse generator (IPG) and a 100‐cm long lead containing 1 or 2 wires. Next, we numerically estimated the deposited in vitro lead‐tip power for an intact lead, as well as with wire breaks placed at 10 cm intervals. We studied the effect of the break size (wire gap width), as well as the presence of an intact wire parallel to the broken wire, and experimentally validated the numeric results for the configurations with maximum deposited in vitro lead‐tip power. Finally, we performed a Tier 3 assessment of the deposited in vivo lead‐tip power for the intact and broken lead in 4 high resolution virtual population anatomic models for over 54,000 MR examination scenarios. Results The enhancement of the deposited lead‐tip power for the broken leads, compared to the intact lead, reached 30‐fold in isoelectric exposure, and 16‐fold in realistic clinical exposures. The presence of a nearby intact wire, or even a nearby broken wire, reduced this enhancement factor to <7‐fold over the intact lead. Conclusion Broken and abandoned leads can pose increased risk of RF‐induced lead‐tip heating to patients undergoing MR examinations. The potential enhancement of deposited in vivo lead‐tip power depends on location and type of the wire break, lead design, and clinical routing of the lead, and should be carefully considered when performing risk assessment for MR examinations and MR conditional labeling.
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Affiliation(s)
- Aiping Yao
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Tolga Goren
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland
| | - Theodoros Samaras
- Department of Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Niels Kuster
- Foundation of Research on Information Technologies in Society (IT'IS), Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, ETH Zurich, Zurich, Switzerland
| | - Wolfgang Kainz
- Center for Devices and Radiological Health, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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87
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Ian Paterson D, White JA, Butler CR, Connelly KA, Guerra PG, Hill MD, James MT, Kirpalani A, Lydell CP, Roifman I, Sarak B, Sterns LD, Verma A, Wan D, Crean AM, Grosse-Wortmann L, Hanneman K, Leipsic J, Manlucu J, Nguyen ET, Sandhu RK, Villemaire C, Wald RM, Windram J. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol 2021; 37:835-847. [PMID: 34154798 DOI: 10.1016/j.cjca.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
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Affiliation(s)
| | - D Ian Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - James A White
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Guerra
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Michael D Hill
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anish Kirpalani
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carmen P Lydell
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley Sarak
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Elsie T Nguyen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Villemaire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rachel M Wald
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Windram
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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88
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Sabottke C, Breaux M, Lee R, Foreman A, Spieler B. Analysis of Potential for User Errors in Mobile Deployment of Radiology Deep Learning for Cardiac Rhythm Device Detection. J Digit Imaging 2021; 34:572-580. [PMID: 33742333 PMCID: PMC8329116 DOI: 10.1007/s10278-021-00443-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/28/2020] [Accepted: 03/01/2021] [Indexed: 11/28/2022] Open
Abstract
We examine how convolutional neural networks (CNNs) for cardiac rhythm device detection can exhibit failures in performance under suboptimal deployment scenarios and examine how medically adversarial image presentation can further impair neural network performance. We validated the publicly available Pacemaker-ID web server and mobile app on 43 local hospital emergency department (ED) cases of patients presenting with a cardiac rhythm device on anterior-posterior (AP) chest radiograph and assessed performance using Cohen's kappa coefficient for inter-rater reliability. To illustrate adversarial performance concerns, we then produced example CNN models using the 65,379 patient MIMIC-CXR chest radiograph retrospective database and evaluated performance with area under the receiver operating characteristic (AUROC). In retrospective review of 43 patients with cardiac rhythm devices on AP chest radiographs during our study period (January 1, 2020 to March 1, 2020), 74.4% (32/43) had device manufacturer information readily available within the electronic medical record. A total of 25.6% of patients (11/43) did not have this information documented in the patient chart and could ostensibly benefit from CNN-based identification of device manufacturer. For patients with known device manufacturer, the Pacemaker-ID prediction was accurate in 87.5% of cases (28/32). Mobile app accuracy varied from 62.5 to 93.75% depending on image capture settings and presentation. Cohen's kappa coefficient varied from 0.448 to 0.897 depending on mobile image capture conditions. For our additional analysis of medically adversarial performance failures with a DenseNet121 trained on MIMIC-CXR images, we showed that an AUROC of 0.9807 ± 0.0051 could be achieved on an example testing dataset while masking a 30% false positive rate in identification of cardiac rhythm devices versus clinically distinct entities such as vagal nerve stimulators. Despite the promise of CNN approaches for cardiac rhythm device analysis on chest radiographs, further study is warranted to assess potential for errors driven by user misuse when deploying these models to mobile devices as well as for cases when performance can be impaired by the presence of other support apparatuses.
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Affiliation(s)
- Carl Sabottke
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Marc Breaux
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rebecca Lee
- Department of Internal Medicine, University Hospital and Clinics, Lafayette, LA, USA
| | - Adam Foreman
- Department of Neurology, Lafayette General Medical Center, Lafayette, LA, USA
| | - Bradley Spieler
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Mangini F, Samar H, Gevenosky L, Williams RB, Shah M, Doyle M, Yamrozik JA, Lombardi R, Bonnet CA, Mansour A, Biederman RWW. Where do we go from here? Beyond the MagnaSafe trial: A focus beyond a 'safety-first' notion. An MRI study in 500 consecutive patients. Int J Cardiol 2021; 336:113-120. [PMID: 34029619 DOI: 10.1016/j.ijcard.2021.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 05/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND In patients with conventional pacemakers or ICD's, MRI is infrequently performed due to safety concerns. Recent reports have allayed many of these concerns. However, the additive clinical value of scanning patients with cardiac implants has not been established. OBJECTIVE Assessing the additive value of thoracic and non-thoracic MRI in patients with implantable cardiac devices. METHODS AND RESULTS Prospective data were analyzed in 500 patients with implanted cardiac devices that underwent MRI over a 12 year period at a single institution (Allegheny General Hospital, Pittsburgh, PA). A set of three questions were answered following scan interpretation by both the MRI technologist and interpreting MRI physician(s): 1) Did the primary diagnosis change? 2) Did MRI provide additional information to the existing diagnosis? 3) Did patient management change? If 'Yes' was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or guiding therapy. Scans encountered were neurological/neurosurgical 354 (70.8%), cardiac 98 (19.6%) and orthopedic 48 (9.6%) in nature. In 431 (86%) MRI added additional information to the primary diagnosis and in 277 (55.4%) MRI changed the primary diagnosis. In 304 (60.8%) cases management changed, 265 (53%) due to a change in diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered and no adverse effects of MRI scan were noted. CONCLUSIONS MRI in patients with implanted cardiac devices was of additive value to diagnosis and management thereby informing risk-benefit considerations. CONDENSED ABSTRACT 500 patients with implanted cardiac devices who underwent a MRI examination over a 12 year period were followed prospectively. Imaging primarily focus on three anatomical regions (neurological/neurosurgical, cardiac and orthopedic) providing added information to the primary diagnosis in 431 (86%) cases and changing the primary diagnosis in 277 (55.4%) cases. In 304 (60.8%) cases management changed with 265 (53%) being due to a change of diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered using a defined protocol. CONCLUSIONS MR imaging retains its diagnostic yield in patients with implanted devices.
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Affiliation(s)
- Francesco Mangini
- Cardiovascular Unit, "Dario Camberlingo" Hospital, ASL Br, Francavilla Fontana (Br), Italy - Cardiac MRI Unit - "Di Summa - Perrino" Hospital, ASL BR, Brindisi, Italy.
| | - Huma Samar
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Loma Linda Veterans Affairs Hospital, Benton Street, Loma Linda, CA, USA.
| | - Loretta Gevenosky
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Ronald B Williams
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Moneal Shah
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Mark Doyle
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - June A Yamrozik
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
| | - Richard Lombardi
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Christopher A Bonnet
- Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA; Division of Electrophysiology, Cardiovascular Institute, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA.
| | - Anas Mansour
- Eastern Maine Medical Center, 302 Husson Ave, Bangor, ME, USA.
| | - Robert W W Biederman
- Division of Cardiology, Centre for Cardiac MRI, Allegheny General Hospital, Allegheny Health Network, East North Ave, Pittsburgh, PA, USA; Cardiovascular Institute, Allegheny Health Network, 320 East North Ave, Pittsburgh, PA, USA.
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91
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Age-dependent microstructural changes of the intervertebral disc: a validation of proteoglycan-sensitive spectral CT. Eur Radiol 2021; 31:9390-9398. [PMID: 33993329 PMCID: PMC8589800 DOI: 10.1007/s00330-021-08028-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022]
Abstract
Objective To analyze the two major components of the intervertebral disc (IVD) in an ex vivo phantom, as well as age-related changes in patients. Methods Collagen and chondroitin sulfate were imaged at different concentrations in agar solution. Age-related changes in disc density were retrospectively analyzed in normal-appearing discs in dual-energy computed tomography (DECT) images from a patient cohort with various spinal pathologies (n = 136). All computed tomography (CT) scans were acquired using single-source DECT at 80 and 135 kVp with automatic exposure calculation. In 136 patients, the attenuation of normal-appearing discs on collagen/chondroitin maps (cMaps) correlated with the patients’ age with Pearson’s r using standardized regions of interest in the anterior anulus fibrosus (AAF) and nucleus pulposus (NP). Results DECT collagen mapping revealed concentration-dependent Hounsfield units (HU) of IVD components. For collagen, we found Pearson’s r = 0.9610 (95% CI 0.6789–0.9959), p = 0.0023 at 120 kVe, and r = 0.8824 (95% CI 0.2495–0.9871), p = 0.0199 in cMap. For chondroitin sulfate, Pearson’s r was 0.9583 (95% CI 0.6603–0.9956), p = 0.0026 at 120 kVp, and r = 0.9646 (95% CI 0.7044–0.9963), p = 0.0019 in cMap. Analysis of normal-appearing IVDs revealed an inverse correlation of density with age in the AAF: Pearson’s r = − 0.2294 at 135 kVp (95% CI − 0.4012 to − 0.04203; p=0.0141) and r = − 0.09341 in cMap (95% CI − 0.2777 to 0.09754; p = 0.0003). In the NP, age and density did not correlate significantly at 135 kVp (p = 0.9228) and in cMap (p = 0.3229). Conclusions DECT-based collagen mapping allows microstructural analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. IVD density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. Age-related alterations of disc microstructure appear most pronounced in the AAF. Key Points • DECT-based collagen mapping allows precise analysis of the two main intervertebral disc components—collagen and chondroitin sulfate. • Intervertebral disc (IVD) density declines with age, presumably due to a reduction in collagen and chondroitin sulfate content. • Age-related alterations of disc microstructure are most pronounced in the anterior anulus fibrosus (AAF). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08028-z.
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92
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Russo RJ. Removing Obstacles to Magnetic Resonance Imaging for Patients With a Pacemaker or a Defibrillator. JAMA Cardiol 2021; 6:556-557. [PMID: 33595594 DOI: 10.1001/jamacardio.2020.7593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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93
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Rajiah P, Kirsch J, Bolen MA, Batlle JC, Brown RKJ, Francois CJ, Galizia MS, Hanneman K, Inacio JR, Johri AM, Lee DC, Singh SP, Villines TC, Wann S, Zimmerman SL, Abbara S. ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded). J Am Coll Radiol 2021; 18:S83-S105. [PMID: 33651982 DOI: 10.1016/j.jacr.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities. For variants 2 and 5, resting transthoracic echocardiography and MRI heart function and morphology without and with contrast are the usually appropriate imaging modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jacobo Kirsch
- Panel Chair, Cleveland Clinic Florida, Weston, Florida
| | - Michael A Bolen
- Panel Vice-Chair, Cleveland Clinic, Cleveland, Ohio, Radiology Fellowship Director for Cardiovascular CT/MRI Cleveland Clinic Main Campus
| | - Juan C Batlle
- Miami Cardiac and Vascular Institute and Baptist Health of South Florida, Miami, Florida
| | - Richard K J Brown
- University of Utah, Department of Radiology and Imaging Sciences, Salt Lake City, Utah
| | | | | | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada, Director, Cardiac Imaging Research, Department of Medical Imaging, University of Toronto
| | - Joao R Inacio
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Amer M Johri
- Queen's University, Kingston, Ontario, Canada, Cardiology expert
| | - Daniel C Lee
- Northwestern University Feinberg School of Medicine Chicago, Illinois, Society for Cardiovascular Magnetic Resonance, Co-Director, Cardiovascular Magnetic Resonance Imaging, Northwestern University Feinberg School of Medicine
| | | | - Todd C Villines
- University of Virginia Health System, Charlottesville, Virginia, Society of Cardiovascular Computed Tomography
| | - Samuel Wann
- Wisconsin Heart Hospital, Milwaukee, Wisconsin, Nuclear cardiology expert
| | | | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
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Schaller RD, Brunker T, Riley MP, Marchlinski FE, Nazarian S, Litt H. Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices With Abandoned Leads. JAMA Cardiol 2021; 6:549-556. [PMID: 33595595 DOI: 10.1001/jamacardio.2020.7572] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Magnetic resonance imaging (MRI) is the modality of choice for many conditions. Conditional devices and novel protocols for imaging patients with legacy cardiac implantable electronic devices (CIEDs) have increased access to MRI in patients with devices. However, the presence of abandoned leads remains an absolute contraindication. Objective To assess if the performance of an MRI in the presence of an abandoned CIED lead is safe and whether there are deleterious effects on concomitant active CIED leads. Design, Setting, and Participants This cohort study included consecutive CIED recipients undergoing 1.5-T MRI with at least 1 abandoned lead between January 2013 and June 2020. MRI scans were performed at the Hospital of the University of Pennsylvania. No patients were excluded. Exposures CIEDs were reprogrammed based on patient-specific pacing needs. Electrocardiography telemetry and pulse oximetry were monitored continuously, and live contact with the patient throughout the scan via visual and voice contact was performed if possible. After completion of the MRI, CIED evaluation was repeated and programming returned to baseline or to a clinically appropriate setting. Main Outcomes and Measures Variation in pre- and post-MRI capture threshold of 50% or more, ventricular sensing 40% or more, and lead impedance 30% or more, as well as clinical sequelae such as pain and sustained tachyarrhythmia were considered significant. Long-term follow-up lead-related data were analyzed if available. Results A total of 139 consecutive patients (110 men [79%]) with a mean (SD) age of 65.6 (13.4) years underwent 200 MRIs of various anatomic regions including the thorax. Repeat examinations were common with a maximum of 16 examinations for 1 patient. There was a total of 243 abandoned leads with a mean (SD) of 1.22 (0.45) per patient. The mean (SD) number of active leads was 2.04 (0.78) and 64 patients (46%) were pacemaker dependent. A transmit-receive radiofrequency coil was used in 41 patients (20.5%), all undergoing MRI of the brain. There were no abnormal vital signs or sustained tachyarrhythmias. No changes in battery voltage, power-on reset events, or changes of pacing rate were noted. CIED parameter changes including decreased right atrial sensing in 4 patients and decreased left ventricular R-wave amplitude in 1 patient were transiently noted. One patient with an abandoned subcutaneous array experienced sternal heating that subsided on premature cessation of the study. Conclusions and Relevance The risk of MRI in patients with abandoned CIED leads was low in this large observational study, including patients who underwent examination of the thorax. The growing aggregate of data questions the absolute contraindication for MRI in patients with abandoned CIED leads.
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Affiliation(s)
- Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Tamara Brunker
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Michael P Riley
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Harold Litt
- Department of Radiology, Division of Cardiovascular Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
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Pieri C, Bhuva A, Moralee R, Abiodun A, Gopalan D, Roditi GH, Moon JC, Manisty C. Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators. Open Heart 2021; 8:e001598. [PMID: 34031214 PMCID: PMC8149430 DOI: 10.1136/openhrt-2021-001598] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes. METHODS Retrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)). RESULTS Responses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units' scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED-MRI scans). CONCLUSIONS Provision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.
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Affiliation(s)
- Christopher Pieri
- Institute of Health Sciences, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Anish Bhuva
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Russell Moralee
- Department of Radiology, Imperial College London, London, UK
| | - Aderonke Abiodun
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Deepa Gopalan
- Department of Radiology, University of Glasgow, Glasgow, UK
| | - Giles H Roditi
- Department of Cardiovascular Imaging, Barts Heart Centre, London, Greater London, UK
| | - James C Moon
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
| | - Charlotte Manisty
- Department of Cardiology, Barts Health NHS Trust, London, UK
- Department of Radiology, Imperial College London, London, UK
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Gimelli A, Ernst S, Liga R. Multi-Modality Imaging for the Identification of Arrhythmogenic Substrates Prior to Electrophysiology Studies. Front Cardiovasc Med 2021; 8:640087. [PMID: 33996938 PMCID: PMC8113383 DOI: 10.3389/fcvm.2021.640087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Noninvasive cardiac imaging is crucial for the characterization of patients who are candidates for cardiac ablations, for both procedure planning and long-term management. Multimodality cardiac imaging can provide not only anatomical parameters but even more importantly functional information that may allow a better risk stratification of cardiac patients. Moreover, fusion of anatomical and functional data derived from noninvasive cardiac imaging with the results of endocavitary mapping may possibly allow a better identification of the ablation substrate and also avoid peri-procedural complications. As a result, imaging-guided electrophysiological procedures are associated with an improved outcome than traditional ablation procedures, with a consistently lower recurrence rate.
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Affiliation(s)
| | - Sabine Ernst
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Riccardo Liga
- Cardiothoracic and Vascular Department, Università di Pisa, Pisa, Italy
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97
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Napp AE, Diekhoff T, Stoiber O, Enders J, Diederichs G, Martus P, Dewey M. Audio-guided self-hypnosis for reduction of claustrophobia during MR imaging: results of an observational 2-group study. Eur Radiol 2021; 31:4483-4491. [PMID: 33855591 PMCID: PMC8213599 DOI: 10.1007/s00330-021-07887-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. Methods In this prospective observational 2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging. Results There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p = .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1; p = .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3; p = .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging (p = .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p = .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11; p = 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations. Conclusions Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. Key Points • Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. • Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia. • Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07887-w.
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Affiliation(s)
- Adriane E Napp
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charité Platz 1, 10117, Berlin, Germany.
| | - Olf Stoiber
- Hypnovita, Academy of Hypnotic Medical Arts, Josephsburgstraße 33, 81673, Munich, Germany
| | - Judith Enders
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charité Platz 1, 10117, Berlin, Germany
| | - Gerd Diederichs
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Vircho-Klinikum, Humboldt-Universität zu Berlin, Freie Universität Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Peter Martus
- Clinical Epidemiology and Applied Biometry, Universitätsklinikum Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charité Platz 1, 10117, Berlin, Germany.
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98
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Singh A, Chen W, Patel HN, Alvi N, Kawaji K, Besser SA, Tung R, Zou J, Lang RM, Mor-Avi V, Patel AR. Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device-Related Artifacts in Different Implantable Cardioverter-Defibrillator Types. J Magn Reson Imaging 2021; 54:1257-1265. [PMID: 33742522 DOI: 10.1002/jmri.27608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter-defibrillators (ICD) is limited by device-related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with different ICD types is not well known. PURPOSE To assess the effects of WB LGE imaging on DRA in different non-MR conditional ICD subtypes. STUDY TYPE Retrospective. POPULATION A total of 113 patients undergoing cardiac magnetic resonance imaging with three ICD subtypes: transvenous (TV-ICD, N = 48), cardiac-resynchronization therapy device (CRT-D, N = 48), and subcutaneous (S-ICD, N = 17). FIELD STRENGTH/SEQUENCE 5 T scanner, standard LGE, and WB LGE imaging with a phase-sensitive inversion recovery segmented gradient echo sequence. ASSESSMENT DRA burden was defined as the number of artifact-positive short-axis LGE slices as percentage of the total number of short-axis slices covering the left ventricle from based to apex, and was determined for WB and standard LGE studies for each patient. Additionally, artifact area on each slice was quantified. STATISTICAL TESTS Shapiro-Wilks, Kruskal-Wallis analysis of variance, Dunn tests with Bonferroni correction, and Mann-Whitney U-test. RESULTS In patients with TV-ICD, DRA burden was significantly reduced and nearly eliminated with WB LGE compared to standard LGE imaging (median [interquartile range]: 0 [0-7]% vs. 18 [0-50]%, P < 0.05), but WB imaging had less of an impact on DRA in the CRT-D (8 [0-23]% vs. 16 [0-45]%, p = 0.12) and S-ICD (60 [15-71]% vs. 67 [50-92]%, P = 0.09) patients. Residual DRA was significantly greater (P < 0.05) for S-ICD compared to other device types with WB LGE imaging, despite the generators of all three ICD types having similar proximity to the heart. The area of S-ICD associated DRA was smaller with WB LGE (P < 0.001) than with standard LGE imaging and the artifacts had different characteristics (dark signal void instead of a bright hyperenhancement artifact). DATA CONCLUSION Although WB LGE imaging reduced the burden of DRA caused by S-ICD, the residual artifact was greater than that observed with TV-ICD and CRT-D devices. Further developments are needed to better resolve S-ICD artifacts. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: STAGE: 5.
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Affiliation(s)
- Amita Singh
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Wensu Chen
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA.,Cardiology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hena N Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Keigo Kawaji
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Stephanie A Besser
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jiangang Zou
- Cardiology Department, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Victor Mor-Avi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
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99
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Gopalakrishnan PP, Gevenosky L, Biederman RWW. Feasibility of MRI in patients with non-Pacemaker/Defibrillator metallic devices and abandoned leads. ACTA ACUST UNITED AC 2021; 14:83-93. [PMID: 33777288 DOI: 10.4236/jbise.2021.143009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. Background Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. Methods We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes. Results The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up. Conclusions With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.
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Affiliation(s)
| | - Loretta Gevenosky
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
| | - Robert W W Biederman
- Cardiovascular MRI Center, Allegheny Health Network Cardiovascular Institute, Pittsburgh, PA 15212
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100
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Berruezo A, Penela D, Jáuregui B, Soto-Iglesias D. The role of imaging in catheter ablation of ventricular arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1115-1125. [PMID: 33527461 DOI: 10.1111/pace.14183] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 02/01/2023]
Abstract
Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) and multidetector cardiac computed tomography (MDCT) have emerged as novel, fascinating imaging tools for arrhythmogenic substrate identification and characterization. The role of these techniques for aiding and guiding the catheter ablation of ventricular tachycardia, either as a complement or a surrogate of the electroanatomic map, has been rising in recent years. Integrating pixel signal intensity maps or wall thickness maps delivered from LGE-CMR or MDCT, respectively, into the navigation system has become a cornerstone for VT ablation procedures in a few centers of excellence around the world. The pre-procedure scar characterization offers some advantages, helping decide for the best procedure planning and approach; complete substrate identification and characterization, helping to focus electroanatomical mapping in regions of interest and also has a positive impact in procedure efficiency and outcomes. In the present article, we perform a review of the most practical aspects for using LGE-CMR or MDCT when a VT ablation procedure is planned, from the image acquisition to the integration into the navigation system, analyzing the current role of the LGE-CMR and MDCT for arrhythmogenic substrate characterization as well as for guiding VT ablation.
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Affiliation(s)
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain
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