1
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. RADIOLOGIA 2023; 65:269-284. [PMID: 37268369 DOI: 10.1016/j.rxeng.2022.09.014] [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: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 06/04/2023]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- M Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - B Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - D Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J L Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - T Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - E Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - A M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - S Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - R J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - C Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J M Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J A Hidalgo Pérez
- Servicio de Radiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - V Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - H Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Bloom J, Collins ML, Belovsky MP, Feduska E, Schofield P, Leong R, Augoustides JG, Lembrikov I, Kogan A, Frogel J, Rajkumar KP, Hicks MH, Fernando RJ. Perfusion-Dependent Focal Neurologic Deficits in a Critically Ill Heart Transplant Recipient: A Case of Tacrolimus-Associated Reversible Cerebral Vasospasm Syndrome? J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00235-5. [PMID: 37120321 DOI: 10.1053/j.jvca.2023.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 05/01/2023]
Abstract
TACROLIMUS, a mainstay of immunosuppression after orthotopic heart transplantation (OHT), is associated with a broad range of side effects. Vasoconstriction caused by tacrolimus has been proposed as a mechanism underlying common side effects such as hypertension and renal injury. Neurologic side effects attributed to tacrolimus include headaches, posterior reversible encephalopathy syndrome (PRES), or reversible cerebral vasospasm syndrome (RCVS). Six case reports have been published describing RCVS in the setting of tacrolimus administration after OHT. The authors report a case of perfusion-dependent focal neurologic deficits attributed to tacrolimus-induced RCVS in an OHT recipient.
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Affiliation(s)
- Jamie Bloom
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Mia P Belovsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Eric Feduska
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Ron Leong
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ilya Lembrikov
- Department of Anesthesiology, Sheba Medical Center-Tel HaShomer, Ramat Gan, Israel
| | - Alexander Kogan
- Department of Cardiac Surgery, Sheba Medical Center-Tel HaShomer, Ramat Gan, Israel
| | - Jonathan Frogel
- Department of Anesthesiology, Sheba Medical Center-Tel HaShomer, Ramat Gan, Israel
| | - Karuna Puttur Rajkumar
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Megan H Hicks
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:183-196. [PMID: 36539182 DOI: 10.1016/j.rec.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/23/2022]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Beatriz Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - David Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomás Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Eliseo Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - Alicia M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Susanna Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - Rosario J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - Gorka Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcelo Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - Covadonga Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - José F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José María Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Esther Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vicente Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Hug Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Zaman A, Zhao S, Kron J, Abbate A, Tomdio A, Hundley WG, Jordan JH. Role of Cardiac MRI Imaging of Focal and Diffuse Inflammation and Fibrosis in Cardiomyopathy Patients Who Have Pacemakers/ICD Devices. Curr Cardiol Rep 2022; 24:1529-1536. [PMID: 35984554 PMCID: PMC10123953 DOI: 10.1007/s11886-022-01770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This focused report aims to discuss and summarize the use of conventional and emerging methods using cardiovascular magnetic resonance (CMR) imaging in cardiomyopathy patients with implanted cardiac devices to identify diffuse and focal inflammation and fibrosis. RECENT FINDINGS Many cardiomyopathy patients with diffuse and focal myocardial fibrosis have a unique need for cardiac imaging that is complicated by cardiovascular implantable electronic devices (CIEDs). CMR imaging can accurately image myocardial fibrosis and inflammation using T1 mapping and late gadolinium enhancement (LGE) imaging. CMR imaging in CIED patients, however, has been limited due to severe imaging artifacts associated with the devices. The emergence of wideband imaging variants of LGE and T1 mapping techniques can successfully reduce or eliminate CIED artifacts for the evaluation of myocardial substrate in cardiomyopathy patients. Wideband imaging variants of LGE and T1 mapping techniques provide new tools for imaging focal and diffuse fibrosis and imaging in cardiomyopathy patients with implanted cardiac devices. These emerging techniques have the potential for great impact in clinical care of such patients as well as clinical research where imaging endpoints are desired.
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Affiliation(s)
- Ananna Zaman
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Samantha Zhao
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Jordana Kron
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA
| | - Antonio Abbate
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA
| | - Anna Tomdio
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA
| | - W Gregory Hundley
- Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA
| | - Jennifer H Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA. .,Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA.
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nath SS, Parashar S. Perioperative management of patients with prosthetic heart valves-A narrative review. Ann Card Anaesth 2022; 25:254-263. [PMID: 35799551 PMCID: PMC9387617 DOI: 10.4103/aca.aca_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting for pregnancies after having PHV. All patients with PHV present unique challenges for the anesthesiologists, surgeons and obstetricians (in case of deliveries). They have to deal with the perioperative management of anticoagulation and a host of other issues involved. We reviewed the English language medical literature relevant to the different aspects of perioperative management of patients with PHV, particularly the guidelines of reputed societies that appeared in the last 20 years. Regression of cardiac pathophysiology following valve replacement is variable both in extent and timeline. The extent to which reverse remodeling occurs depends on the perioperative status of the heart. We discussed the perioperative assessment of patients with PHV, including focused history and relevant investigations with the inferences drawn. We examined the need for prophylaxis against infective endocarditis and management of anticoagulation in such patients in the perioperative period and the guidelines of reputed societies. We also reviewed the conduct of anesthesia, including general and regional anesthesia (neuraxial and peripheral nerve/plexus blocks) in such patients. Finally, we discussed the management of delivery in this group of high-risk patients. From the discussion of different aspects of perioperative management of patients with PHV, we hope to guide in formulating the comprehensive plan of management of safe anesthesia in such patients.
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Affiliation(s)
- Soumya Sankar Nath
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Samiksha Parashar
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [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: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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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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Ruan W, Liu F, Sun X, Hu F, Wu T, Zhang Y, Lan X. Evaluating two respiratory correction methods for abdominal PET/MRI imaging. EJNMMI Phys 2022; 9:5. [PMID: 35099646 PMCID: PMC8804027 DOI: 10.1186/s40658-022-00430-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate two respiratory correction methods for abdominal PET/MRI images and further to analyse the effects on standard uptake values (SUVs) of respiratory motion correction, 17 patients with 25 abdominal lesions on 18F-FDG PET/CT were scanned with PET/MRI. PET images were reconstructed using end-expiratory respiratory gating and multi-bin respiratory gating. Meanwhile, full data and the first 3 min and 20 s of data acquired both without respiratory gating were reconstructed for evaluation. Five parameters, including the SUVmax and SUVmean in the lesions, the SUVmean and standard deviation (SD) in the background, and the signal-to-noise ratio (SNR), were calculated and used for statistical comparisons. The differences in multi-bin respiratory gating and reconstruction of full data, relative to the reconstruction of the first 3 min and 20 s of data acquired, were calculated. Results Compared with PET/CT, the longer scanning time of abdominal PET/MRI makes respiratory motion correction necessary. The multi-bin respiratory gating correction could reduce the PET image blur and increase the SUVmax (11.98%) and SUVmean (13.12%) of the lesions significantly (p = 0.00), which was much more effective than end-expiratory respiratory gating for abdominal PET/MRI. The added value of SUVmax caused by respiratory motion correction has no significant difference compared with that caused by count loss with the correction (p = 0.39), which was rarely reported by previous studies. Conclusion Based on the current parameters, the method of multi-bin respiratory gating was more effective for respiratory motion correction in abdominal PET/MRI in comparisons with the method of end-respiratory gating. However, the increased noise in gated images, due to the fact that PET data get discarded, is partly responsible for the increase in SUVmax.
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Affiliation(s)
- Weiwei Ruan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xun Sun
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | | | - Yongxue Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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11
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Chen CW, Fang YF, Tseng YH, Wong MY, Lin YH, Hsu YC, Lin BS, Huang YK. Before and after Endovascular Aortic Repair in the Same Patients with Aortic Dissection: A Cohort Study of Four-Dimensional Phase-Contrast Magnetic Resonance Imaging. Diagnostics (Basel) 2021; 11:diagnostics11101912. [PMID: 34679608 PMCID: PMC8534695 DOI: 10.3390/diagnostics11101912] [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: 08/02/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We used four-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) to evaluate the impact of an endovascular aortic repair (TEVAR) on aortic dissection. (2) Methods: A total of 10 patients received 4D PC-MRI on a 1.5-T MR both before and after TEVAR. (3) Results: The aortas were repaired with either a GORE TAG Stent (Gore Medical; n = 7) or Zenith Dissection Endovascular Stent (Cook Medical; n = 3). TEVAR increased the forward flow volume of the true lumen (TL) (at the abdominal aorta, p = 0.047). TEVAR also reduced the regurgitant fraction in the TL at the descending aorta but increased it in the false lumen (FL). After TEVAR, the stroke distance increased in the TL (at descending and abdominal aorta, p = 0.018 and 0.015), indicating more effective blood transport per heartbeat. Post-stenting quantitative flow revealed that the reductions in stroke volume, backward flow volume, and absolute stroke volume were greater when covered stents were used than when bare stents were used in the FL of the descending aorta. Bare stents had a higher backward flow volume than covered stents did. (4) Conclusions: TEVAR increased the stroke volume in the TL and increased the regurgitant fraction in the FL in patients with aortic dissection.
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Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital, Putzu City 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yueh-Fu Fang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan; (Y.-F.F.); (Y.-H.T.)
- Department of Thoracic Medicine, Chang Gung University, College of Medicine, Taoyuan 33302, Taiwan
| | - Yuan-Hsi Tseng
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan; (Y.-F.F.); (Y.-H.T.)
- Department of Thoracic Medicine, Chang Gung University, College of Medicine, Taoyuan 33302, Taiwan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Putzu City 61363, Taiwan; (M.Y.W.); (Y.-H.L.)
- Division of Thoracic and Cardiovascular Surgery, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yu-Hui Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Putzu City 61363, Taiwan; (M.Y.W.); (Y.-H.L.)
- Division of Thoracic and Cardiovascular Surgery, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital, Putzu City 61363, Taiwan; (C.-W.C.); (Y.-C.H.)
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan 33302, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan 71150, Taiwan;
- Department of Medical Research, Chi-Mei Medical Center, Tainan 30010, Taiwan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Putzu City 61363, Taiwan; (M.Y.W.); (Y.-H.L.)
- Division of Thoracic and Cardiovascular Surgery, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence:
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Chen CW, Tseng YH, Lin CC, Kao CC, Wong MY, Ting H, Huang YK. Aortic dissection assessment by 4D phase-contrast MRI with hemodynamic parameters: the impact of stent type. Quant Imaging Med Surg 2021; 11:490-501. [PMID: 33532250 DOI: 10.21037/qims-20-670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background To explore the diagnostic performance of 4-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) in evaluating aortic dissection in different clinical scenarios. Methods The study group comprised 32 patients with a known aortic dissection who each underwent computed tomography angiography (CTA), and then 4D PC-MRI with a 1.5-T MR scanner. The 4D PC-MRI images were compared with the CTA images to evaluate the aortic size, branch identification, and iliac and femoral arterial access. Results The patients were divided into three groups: (I) patients diagnosed with Type B aortic dissection but did not undergo intervention (n=8); (II) patients with residual aortic dissection after open repair of Type A dissection (n=7); (III) patients who underwent endovascular aortic repair with or without open surgery (n=17). Without radiation or contrast media injection, 4D PC-MRI provided similar aortic images for patients in Group 1 and most of those in Group 2. In Group 3, stainless steel stents affected image quality in three patients. High-quality 4D PC-MRI images were obtained for the remaining 14 patients in Group 3, who had non-stainless steel stents, and provided major aortic information comparable to that provided by CTA with contrast media. The hemodynamic parameters of true and false lumens were evaluated between three patients with Type B aortic dissections and three patients who underwent thoracic endovascular aortic repair for their aortic dissection. The stroke volume was higher in the true lumen of the patients with stent-grafts than in the patients with Type B aortic dissection without intervention. The regurgitant fraction, an indicator of nonlaminar flow, was higher in the false lumens than in the true lumens. All 32 patients in this study tolerated 4D PC-MRI without adverse events. Conclusions 4D PC-MRI is radiation- and contrast media-free option for imaging aortic dissection. It not only provided images comparable in quality to those obtained with CTA but also provided information on hemodynamic parameters, including endoleak detection after thoracic endovascular aortic repair. 4D PC-MRI was safe and accurate in evaluating chronic Type B aortic dissection and residual aortic dissection after surgery for acute Type A aortic dissection. Therefore, it could be a potential tool in treating pathology in aortic dissection, especially for patients with malperfusion syndrome of visceral vessels and in young patients with renal function impairment. However, certain endograft materials, especially stainless steel, may prevent the further application of 4D PC-MRI and should be avoided.
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Affiliation(s)
- Chien-Wei Chen
- Institute of Medicine, Chung Shan Medical University, Taichung.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, College of Medicine, Chang Gung University, Chiayi and Taoyuan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Chien-Chao Lin
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Chih-Chen Kao
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
| | - Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi
| | - Hua Ting
- Institute of Medicine, Chung Shan Medical University, Taichung
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi.,Chang Gung University, College of Medicine, Taoyuan
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Lebel K, Mondesert B, Robillard J, Pham M, Terrone D, Tan S. 2020 MR Safety for Cardiac Devices: An Update for Radiologists. Can Assoc Radiol J 2020; 72:814-830. [DOI: 10.1177/0846537120967701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.
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Affiliation(s)
- Kiana Lebel
- The University of Sherbrooke, Montreal, Quebec, Canada
| | | | | | - Magali Pham
- Montreal Heart Institute, Montreal, Quebec, Canada
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14
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Miften M, Mihailidis D, Kry SF, Reft C, Esquivel C, Farr J, Followill D, Hurkmans C, Liu A, Gayou O, Gossman M, Mahesh M, Popple R, Prisciandaro J, Wilkinson J. Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG-203 †. Med Phys 2019; 46:e757-e788. [PMID: 31571229 DOI: 10.1002/mp.13838] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 11/11/2022] Open
Abstract
Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter-defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG-34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.
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Affiliation(s)
- Moyed Miften
- Task Group 203, Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Dimitris Mihailidis
- Task Group 203, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA, 19104, USA
| | - Stephen F Kry
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chester Reft
- Department of Radiation Oncology, University of Chicago, Chicago, IL, 60637, USA
| | - Carlos Esquivel
- Department of Radiation Oncology, UT Health Sciences Center, San Antonio, TX, 78229, USA
| | - Jonathan Farr
- Division of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - David Followill
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Coen Hurkmans
- Department of Radiotherapy, Catharina Hospital, Eindhoven, the Netherlands
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Olivier Gayou
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburg, PA, 15212, USA
| | - Michael Gossman
- Department of Radiation Oncology, Tri-State Regional Cancer Center, Ashland, KY, 41101, USA
| | - Mahadevappa Mahesh
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama, Birmingham, AL, 35249, USA
| | - Joann Prisciandaro
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 48109, USA
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15
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Jabehdar Maralani P, Schieda N, Hecht EM, Litt H, Hindman N, Heyn C, Davenport MS, Zaharchuk G, Hess CP, Weinreb J. MRI safety and devices: An update and expert consensus. J Magn Reson Imaging 2019; 51:657-674. [PMID: 31566852 DOI: 10.1002/jmri.26909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.
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Affiliation(s)
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University, New York, New York, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Hindman
- Department of Radiology, New York University, New York, New York, USA
| | - Chinthaka Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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16
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Zheng J, Xia M, Kainz W, Chen J. Wire-based sternal closure: MRI-related heating at 1.5 T/64 MHz and 3 T/128 MHz based on simulation and experimental phantom study. Magn Reson Med 2019; 83:1055-1065. [PMID: 31468593 DOI: 10.1002/mrm.27963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/23/2019] [Accepted: 08/01/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE The paper investigates factors that affect the RF-induced heating for commonly used wire-based sternal closure under 1.5 T and 3 T MRI systems and clarifies the heating mechanisms. METHODS Numerical simulations based on the finite-difference time-domain method and experimental measurements in ASTM (American Society for Testing and Materials) phantom were used in the study. Various configurations of the wire-based sternal closure in the phantom were studied based on parameter sweeps to understand key factors related to the RF-induced heating. In vivo simulations were further performed to explore the RF-induced heating in computational human phantoms for clinically relevant scenarios. RESULTS The wire-based sternal closure can lead to peak 1-g averaged spatial absorption ratio of 106.3 W/kg and 75.2 W/kg in phantom and peak 1-g averaged specific absorption rate of 32.1 W/kg and 62.1 W/kg in computational human models near the device at 1.5 T and 3 T, respectively. In phantom, the simulated maximum temperature rises for 15-minute RF exposure are 9.4°C at 1.5 T and 5.8°C at 3 T. Generally, the RF-induced heating will be higher when the electrical length of the device is close to the resonant length or when multiple components are spaced closely along the longitudinal direction. CONCLUSION The RF-induced heating related to wire-based sternal closure can be significant due to the antenna effect and capacitive mutual coupling effect related to the specific geometries of devices.
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Affiliation(s)
- Jianfeng Zheng
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas
| | - Meiqi Xia
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas
| | - Wolfgang Kainz
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Ji Chen
- Department of Electrical and Computer Engineering, University of Houston, Houston, Texas
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17
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Sharif M, Wong CHM, Harky A. Sternal Wound Infections, Risk Factors and Management – How Far Are We? A Literature Review. Heart Lung Circ 2019; 28:835-843. [DOI: 10.1016/j.hlc.2019.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/01/2019] [Accepted: 01/08/2019] [Indexed: 01/11/2023]
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18
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Wilson SR, Shinde S, Appleby I, Boscoe M, Conway D, Dryden C, Ferguson K, Gedroyc W, Kinsella SM, Nathanson MH, Thorne J, White M, Wright E. Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019. Anaesthesia 2019; 74:638-650. [DOI: 10.1111/anae.14578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/02/2023]
Affiliation(s)
- S. R. Wilson
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (Co‐Chair)
| | - S. Shinde
- Department of Anaesthesia North Bristol NHS Trust BristolUK and Vice President, Association of Anaesthetists (Co‐Chair)
| | - I. Appleby
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland
| | - M. Boscoe
- Royal College of Anaesthetists LondonUK and Society of Anaesthetists in Radiology
| | - D. Conway
- Department of Anaesthesia Chelsea and Westminster Hospital LondonUK and Trainee Committee, Association of Anaesthetists
| | - C. Dryden
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital LiverpoolUK and Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - K. Ferguson
- Department of Anaesthesia Aberdeen Royal Infirmary Aberdeen UK and Association of Anaesthetists Safety Representative
| | - W. Gedroyc
- Imperial College LondonUK and Royal College of Radiologists
| | - S. M. Kinsella
- Department of Anaesthesia St Michaels Hospital BristolUK and Editor, Anaesthesia
| | - M. H. Nathanson
- Department of Anaesthesia Nottingham University Hospital NottinghamUK and Immediate Past Honorary Secretary, Association of Anaesthetists
| | - J. Thorne
- Department of Neurosurgery Salford Royal Foundation Trust SalfordUK and Society of British Neurological Surgeons
| | | | - E. Wright
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital Liverpool UK
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Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
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Krumm P, Mangold S, Gatidis S, Nikolaou K, Nensa F, Bamberg F, la Fougère C. Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Jpn J Radiol 2018. [PMID: 29524169 DOI: 10.1007/s11604-018-0727-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Combined PET/MRI is a novel imaging method integrating the advances of functional and morphological MR imaging with PET applications that include assessment of myocardial viability, perfusion, metabolism of inflammatory tissue and tumors, as well as amyloid deposition imaging. As such, PET/MRI is a promising tool to detect and characterize ischemic and non-ischemic cardiomyopathies. To date, the greatest benefit may be expected for diagnostic evaluation of systemic diseases and cardiac masses that remain unclear in cardiac MRI, as well as for clinical and scientific studies in the setting of ischemic cardiomyopathies. Diagnosis and therapeutic monitoring of cardiac sarcoidosis has the potential of a possible 'killer-application' for combined cardiac PET/MRI. In this article, we review the current evidence and discuss current and potential future applications of cardiac PET/MRI.
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Affiliation(s)
- Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Stefanie Mangold
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabian Bamberg
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University of Tübingen, Tübingen, Germany
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Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP. A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics 2016; 35:1722-37. [PMID: 26466181 DOI: 10.1148/rg.2015150108] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Magnetic resonance (MR) imaging can provide critical diagnostic and anatomic information while avoiding the use of ionizing radiation, but it has a unique set of safety risks associated with its reliance on large static and changing magnetic fields, high-powered radiofrequency coil systems, and exogenous contrast agents. It is crucial for radiologists to understand these risks and how to mitigate them to protect themselves, their colleagues, and their patients from avoidable harm and to comply with safety regulations at MR imaging sites. Basic knowledge of MR imaging physics and hardware is necessary for radiologists to understand the origin of safety regulations and to avoid common misconceptions that could compromise safety. Each of the components of the MR imaging unit can be a factor in injuries to patients and personnel. Safety risks include translational force and torque, projectile injury, excessive specific absorption rate, burns, peripheral neurostimulation, interactions with active implants and devices, and acoustic injury. Standards for MR imaging device safety terminology were first issued in 2005 and are required by the U.S. Food and Drug Administration, with devices labeled as "MR safe," "MR unsafe," or "MR conditional." MR imaging contrast agent safety is also discussed. Additional technical and safety policies relate to pediatric, unconscious, incapacitated, or pregnant patients and pregnant imaging personnel. Division of the MR imaging environment into four distinct, clearly labeled zones--with progressive restriction of entry and increased supervision for higher zones--is a mandatory and key aspect in avoidance of MR imaging-related accidents. All MR imaging facilities should have a documented plan to handle emergencies within zone IV, including cardiac arrest or code, magnet quench, and fires. Policies from the authors' own practice are provided for additional reference. Online supplemental material is available for this article.
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Affiliation(s)
- Leo L Tsai
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Aaron K Grant
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Koenraad J Mortele
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Justin W Kung
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
| | - Martin P Smith
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215
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Rafaelsen SR, Vagn-Hansen C, Sørensen T, Lindebjerg J, Pløen J, Jakobsen A. Elastography and diffusion-weighted MRI in patients with rectal cancer. Br J Radiol 2015; 88:20150294. [PMID: 26402215 DOI: 10.1259/bjr.20150294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The current literature has described the usefulness of elastography and diffusion-weighted MRI in patients with cancer, but to the best of our knowledge so far none of them has compared the two new methods. The tumour cell density is related to the MRI-measured apparent diffusion-weighted coefficient (ADC). The purpose of the present study was to compare quantitative elastography based on ultrasound shear wave measurements with MRI ADC. METHODS We prospectively examined 52 patients with histopathologically proven rectal cancer. The mean age was 67 years (range 42-90 years). Males: 39, females: 13. Tumour elasticity was measured transgluteally using the acoustic radiation force impulse (ARFI) to generate information on the mechanical properties of the tissue. The objective quantitative elastography shear wave velocity was blindly compared with the ADC measurements using a 1.5-T MRI system. RESULTS The mean tumour elasticity was 3.05 m s(-1) [standard deviation (SD): 0.79], and the mean ADC was 0.69 × 10(-3) mm(2) s(-1) (SD: 0.27). Elasticity was inversely strongly correlated with ADC, r = -0.65 (Salkin scale). ARFI = 4.392 - 1.949 × ADC, R(2) = 0.43, p < 0.0001. Intercept = 4.392 (95% CI: 3.92 to 4.86), slope = -1.949 (95% CI: -1.31 to -2.59), p < 0.0001. CONCLUSION Elasticity correlates with the estimated diffusion restriction by MRI ADC measurements in rectal tumours. The relationship between ARFI and ADC measurement was linear in our study population. ADVANCES IN KNOWLEDGE This work describes a correlation between tissue elasticity and diffusion in rectal cancer.
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Affiliation(s)
- Søren R Rafaelsen
- 1 Department of Radiology, CCE, Vejle Hospital, Vejle, Denmark.,2 Danish Colorectal Cancer Group South, Institute of Regional Health Research, CCE, University of Southern Denmark, Vejle, Denmark
| | | | - Torben Sørensen
- 1 Department of Radiology, CCE, Vejle Hospital, Vejle, Denmark
| | - Jan Lindebjerg
- 3 Department of Pathology, CCE, Vejle Hospital, Vejle, Denmark
| | - John Pløen
- 4 Department of Oncology, CCE, Vejle Hospital, Vejle, Denmark
| | - Anders Jakobsen
- 2 Danish Colorectal Cancer Group South, Institute of Regional Health Research, CCE, University of Southern Denmark, Vejle, Denmark.,4 Department of Oncology, CCE, Vejle Hospital, Vejle, Denmark
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Ley SJ, Koulakis D. Temporary Pacing After Cardiac Surgery. AACN Adv Crit Care 2015. [DOI: 10.4037/nci.0000000000000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- S. Jill Ley
- S. Jill Ley is Clinical Nurse Specialist, Cardiac Surgery, California Pacific Medical Center, 2351 Clay St, Ste S414-K, San Francisco, CA 94115 . Deirdre Koulakis is Clinical Nurse III, California Pacific Medical Center, MSICU, San Francisco, California
| | - Deirdre Koulakis
- S. Jill Ley is Clinical Nurse Specialist, Cardiac Surgery, California Pacific Medical Center, 2351 Clay St, Ste S414-K, San Francisco, CA 94115 . Deirdre Koulakis is Clinical Nurse III, California Pacific Medical Center, MSICU, San Francisco, California
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Wang J. Issues with radiofrequency heating in MRI. J Appl Clin Med Phys 2014; 15:5064. [PMID: 25207583 PMCID: PMC5711075 DOI: 10.1120/jacmp.v15i5.5064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/15/2014] [Indexed: 12/03/2022] Open
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Fanourgiakis J, Kanoupakis E. Cardiac rhythm management devices in a magnetic resonance environment. Expert Rev Med Devices 2014; 11:199-203. [PMID: 24471520 DOI: 10.1586/17434440.2014.882228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
MRI is the gold standard diagnostic tool for soft tissue imaging for many specialties. An impressive body of research has proven the effectiveness of cardiac rhythm management devices (CRMDs) objectively, in terms of parameters that include patient's quality of life, morbidity, and mortality. However, interaction between CRMDs and MRI scanners is a problem. Static main magnetic field, radiofrequency energy and the gradient magnetic field are three distinct mechanisms related to MRI and cause risks to CRMDs. Very often, patients with CRMDs have been excluded from undergoing MRI scans despite the fact that these scans were critical for the diagnosis and therapy of patients with serious medical conditions. In order for all patients with CRMDs to have the ability to perform this exam, the industry works hard to design devices that are MRI conditional.
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Londono-Obregon C, Fogel M. Imaging of aortic arch anomalies and associated findings. Expert Rev Cardiovasc Ther 2014; 10:1497-516. [DOI: 10.1586/erc.12.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Han BK, Lesser AM, Vezmar M, Rosenthal K, Rutten-Ramos S, Lindberg J, Caye D, Lesser JR. Cardiovascular imaging trends in congenital heart disease: a single center experience. J Cardiovasc Comput Tomogr 2013; 7:361-6. [PMID: 24331931 DOI: 10.1016/j.jcct.2013.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/04/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) and CT are available in the recent era at many pediatric cardiac centers. OBJECTIVE The aim was to provide a contemporary description of diagnostic imaging trends for definition of congenital heart disease (CHD). METHODS Echocardiography, cardiac catheterization, cardiac MRI, and cardiac CT use in patients with congenital heart disease at a single institution was retrospectively recorded (2005-2012). Surgical procedures were recorded. Total and modality-specific rates were estimated by Poisson regression and compared. The median age, studies in patients aged >17 years, and referral diagnosis were tabulated for the last year of review. RESULTS An average of 11,940 cardiovascular diagnostic tests was performed annually. The number of total studies, echocardiograms, catheterizations, and surgical procedures, did not change significantly across time. Echocardiography comprised 95% to 97% of all studies performed during each year of review. The use of cardiac MRI (2%) and cardiac CT (1%) increased linearly (P < .001), and the use of diagnostic catheterization decreased (0.7%; P = .0005). The median age was 3 years for echocardiography, 15 years for MRI, 11 years for CT, and 3 years for catheterization. The percentage of patients aged >17 years was 9% for echocardiography, 33% for cardiac MRI, 29% for cardiac CT, and 8% for catheterization. Most patients undergoing CT, MRI, and diagnostic catheterization had moderate or complex CHD. CONCLUSION Cardiac CT is used increasingly in the recent era for evaluation of CHD. The increased use of both cardiac CT and cardiac MRI are temporally associated with a decrease in diagnostic cardiac catheterization.
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Affiliation(s)
- B Kelly Han
- The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA; The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA.
| | - Andrew M Lesser
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - Marko Vezmar
- The Children's Heart Clinic at The Children's Hospitals and Clinics of Minnesota, 2530 Chicago Ave South, Suite 500, Minneapolis, MN 55404, USA
| | - Kristi Rosenthal
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | | | - Jana Lindberg
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - David Caye
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
| | - John R Lesser
- The Minneapolis Heart Institute and Foundation, Minneapolis, MN, USA
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Clevert DA, Sterzik A, Braunagel M, Notohamiprodjo M, Graser A. [Modern imaging of kidney tumors]. Urologe A 2013; 52:515-26. [PMID: 23571801 DOI: 10.1007/s00120-012-3098-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
If a renal mass is suspected on clinical examination or ultrasound the finding has to be confirmed by cross-sectional imaging. Methods that are used include multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Also contrast-enhanced ultrasound has been successfully implemented in renal imaging and now plays a major role in the differentiation of benign from malignant renal masses. In expert hands it can be used to show very faint vascularization and subtle enhancement. The MDCT technique benefits from the recently introduced dual energy technology that allows superior characterization of renal masses in a single-phase examination, thereby greatly reducing radiation exposure. For young patients and persons allergic to iodine MRI should be used and it provides excellent soft tissue contrast and visualizes contrast enhancement kinetics in multiphase examinations.This article aims at giving a comprehensive overview of these different imaging modalities, their clinical indications and contraindications, as well as a description of imaging findings of various renal masses.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81377 München, Deutschland
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[Cardiac magnetic resonance with a MRI compatible pacemaker]. Ann Cardiol Angeiol (Paris) 2013; 62:351-3. [PMID: 24112711 DOI: 10.1016/j.ancard.2013.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/12/2013] [Indexed: 11/20/2022]
Abstract
Patients with cardiac implantable electronic devices are usually excluded from MRI examinations due to contraindication for MRI. The MRI-conditional pacemaker system may allow the benefits of MRI (system 1.5T) to be more accessible to pacemaker patients. A 62-year-old man was admitted with acute coronary syndrome and atrial fibrillation. A conventional angiography showed normal coronaries. A cardiac cardioversion revealed a significant sinus node dysfunction and a magnetic resonance imaging (MRI) compatible dual chamber system was implanted. At 6-week follow-up, a cardiac MRI revealed a typical anterior myocardial infarction with diagnostic quality images despite pacemaker. This is one of the first reports of cardiovascular MRI in a patient with MRI-conditional pacing system.
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Ahmed S, Johnson PT, Fishman EK, Zimmerman SL. Role of Multidetector CT in Assessment of Repaired Tetralogy of Fallot. Radiographics 2013; 33:1023-36. [DOI: 10.1148/rg.334125114] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rafaelsen SR, Vagn-Hansen C, Sørensen T, Pløen J, Jakobsen A. Transrectal ultrasound and magnetic resonance imaging measurement of extramural tumor spread in rectal cancer. World J Gastroenterol 2012; 18:5021-6. [PMID: 23049209 PMCID: PMC3460327 DOI: 10.3748/wjg.v18.i36.5021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the agreement between transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI) in classification of ≥ T3 rectal tumors.
METHODS: From January 2010 to January 2012, 86 consecutive patients with ≥ T3 tumors were included in this study. The mean age of the patients was 66.4 years (range: 26-91 years). The tumors were all ≥ T3 on TRUS. The sub-classification was defined by the penetration of the rectal wall: a: 0 to 1 mm; b: 1-5 mm; c: 6-15; d: > 15 mm. Early tumors as ab (≤ 5 mm) and advanced tumors as cd (> 5 mm). All patients underwent TRUS using a 6.5 MHz transrectal transducer. The MRI was performed with a 1.5 T Philips unit. The TRUS findings were blinded to the radiologist performing the interpretation of the MRI images and measuring the depth of extramural tumor spread.
RESULTS: TRUS found 51 patients to have an early ≥ T3 tumors and 35 to have an advanced tumor, whereas MRI categorized 48 as early ≥ T3 tumors and 38 as advanced tumors. No patients with tumors classified as advanced by TRUS were found to be early on MRI. The kappa value in classifying early versus advanced T3 rectal tumors was 0.93 (95% CI: 0.85-1.00). We found a kappa value of 0.74 (95% CI: 0.63-0.86) for the total sub-classification between the two methods. The mean maximal tumor outgrowth measured by TRUS, 5.5 mm ± 5.63 mm and on MRI, 6.3 mm ± 6.18 mm, P = 0.004. In 19 of the 86 patients the following CT scan or surgery revealed distant metastases; of the 51 patients in the ultrasound ab group three (5.9%) had metastases, whereas 16 (45.7%) of 35 in the cd group harbored distant metastases, P = 0.00002. The odds ratio of having distant metastases in the ultrasound cd group compared to the ab group was 13.5 (95% CI: 3.5-51.6), P = 0.00002. The mean maximal ultrasound measured outgrowth was 4.3 mm (95% CI: 3.2-5.5 mm) in patients without distant metastases, while the mean maximal outgrowth was 9.5 mm (95% CI: 6.2-12.8 mm) in the patients with metastases, P = 0.00004. Using the MRI classification three (6.3%) of 48 in the MRI ab group had distant metastases, while 16 (42.1%) of the 38 in the MRI cd group, P = 0.00004. The MRI odds ratio was 10.9 (95% CI: 2.9-41.4), P = 0.00008. The mean maximal MRI measured outgrowth was 4.9 mm (95% CI: 3.7-6.1 mm) in patients without distant metastases, while the mean maximal outgrowth was 11.5 mm (95% CI: 7.8-15.2 mm) in the patients with metastases, P = 0.000006.
CONCLUSION: There is good agreement between TRUS and MRI in the pretreatment sub-classification of ≥ T3 tumors. Distant metastases are more frequent in the advanced group.
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Hsu C, Parker G, Puranik R. Implantable devices and magnetic resonance imaging. Heart Lung Circ 2012; 21:358-63. [PMID: 22542861 DOI: 10.1016/j.hlc.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 11/25/2022]
Abstract
The indications for cardiovascular implantable electronic devices (CIEDs) are ever expanding, seemingly in parallel to the similar widespread increase in the use of magnetic resonance imaging (MRI), where there are clear advantages of imaging with no ionizing radiation and superior tissue contrast. However, CIEDs have traditionally been considered an absolute contraindication to MRI, posing a major limitation to investigating various pathologies after implantation of such devices. In the last decade the traditional paradigm of avoiding MRI in patients with CIEDs has been challenged with studies demonstrating relative safety at 1.5T under certain circumstances. Now with the recent approval of 'MR conditional' devices, it is becoming increasingly apparent that CIEDs should no longer be considered an absolute contraindication to MRI.
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Affiliation(s)
- Chijen Hsu
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Myers PO, Kalangos A, Panos A. Safety of magnetic resonance imaging in cardiac surgery patients: annuloplasty rings, septal occluders, and transcatheter valves. Ann Thorac Surg 2012; 93:1019; author reply 1019-20. [PMID: 22365008 DOI: 10.1016/j.athoracsur.2011.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 08/25/2011] [Accepted: 10/11/2011] [Indexed: 11/16/2022]
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Abstract
This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.
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Hannan MA, Abbas SM, Samad SA, Hussain A. Modulation techniques for biomedical implanted devices and their challenges. SENSORS 2011; 12:297-319. [PMID: 22368470 PMCID: PMC3279214 DOI: 10.3390/s120100297] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 12/15/2011] [Accepted: 12/15/2011] [Indexed: 11/16/2022]
Abstract
Implanted medical devices are very important electronic devices because of their usefulness in monitoring and diagnosis, safety and comfort for patients. Since 1950s, remarkable efforts have been undertaken for the development of bio-medical implanted and wireless telemetry bio-devices. Issues such as design of suitable modulation methods, use of power and monitoring devices, transfer energy from external to internal parts with high efficiency and high data rates and low power consumption all play an important role in the development of implantable devices. This paper provides a comprehensive survey on various modulation and demodulation techniques such as amplitude shift keying (ASK), frequency shift keying (FSK) and phase shift keying (PSK) of the existing wireless implanted devices. The details of specifications, including carrier frequency, CMOS size, data rate, power consumption and supply, chip area and application of the various modulation schemes of the implanted devices are investigated and summarized in the tables along with the corresponding key references. Current challenges and problems of the typical modulation applications of these technologies are illustrated with a brief suggestions and discussion for the progress of implanted device research in the future. It is observed that the prime requisites for the good quality of the implanted devices and their reliability are the energy transformation, data rate, CMOS size, power consumption and operation frequency. This review will hopefully lead to increasing efforts towards the development of low powered, high efficient, high data rate and reliable implanted devices.
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Affiliation(s)
- Mahammad A Hannan
- Department of Electrical, Electronic & Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia, 43600 UKM Bangi Selangor, Malaysia.
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