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Oebel S, Jahnke C, Bode K, Paetsch I. Electrophysiological Cardiovascular Magnetic Resonance (EP-CMR)-Guided Interventional Procedures: Challenges and Opportunities. Curr Cardiol Rep 2024:10.1007/s11886-024-02092-9. [PMID: 39023800 DOI: 10.1007/s11886-024-02092-9] [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: 07/02/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular magnetic resonance (CMR) imaging excels in providing detailed three-dimensional anatomical information together with excellent soft tissue contrast and has already become a valuable tool for diagnostic evaluation, electrophysiological procedure (EP) planning, and therapeutical stratification of atrial or ventricular rhythm disorders. CMR-based identification of ablation targets may significantly impact existing concepts of interventional electrophysiology. In order to exploit the inherent advantages of CMR imaging to the fullest, CMR-guided ablation procedures (EP-CMR) are justly considered the ultimate goal. RECENT FINDINGS Electrophysiological cardiovascular magnetic resonance (EP-CMR) interventional procedures have more recently been introduced to the CMR armamentarium: in a single-center series of 30 patients, an EP-CMR guided ablation success of 93% has been reported, which is comparable to conventional ablation outcomes for typical atrial flutter and procedure and ablation time were also reported to be comparable. However, moving on from already established workflows for the ablation of typical atrial flutter in the interventional CMR environment to treatment of more complex ventricular arrhythmias calls for technical advances regarding development of catheters, sheaths and CMR-compatible defibrillator equipment. CMR imaging has already become an important diagnostic tool in the standard clinical assessment of cardiac arrhythmias. Previous studies have demonstrated the feasibility and safety of performing electrophysiological interventional procedures within the CMR environment and fully CMR-guided ablation of typical atrial flutter can be implemented as a routine procedure in experienced centers. Building upon established workflows, the market release of new, CMR-compatible interventional devices may finally enable targeting ventricular arrhythmias.
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Affiliation(s)
- Sabrina Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
| | - Cosima Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Kerstin Bode
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
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Meier C, Israel C, Eisenblätter M, Hoyer A, Stoye FV, Yilmaz A, Gielen S. Safety of magnetic resonance imaging in patients with cardiac implantable electronic devices and abandoned or epicardial leads: a systematic review and meta-analysis. Europace 2024; 26:euae165. [PMID: 38918179 PMCID: PMC11200101 DOI: 10.1093/europace/euae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
AIMS Persistent reluctance to perform magnetic resonance imaging (MRI) in patients with abandoned and/or epicardial leads of cardiac implantable electronic devices is related to in vitro studies reporting tip heating. While there is a plethora of data on the safety of MRI in conditional and non-conditional implantable devices, there is a clear lack of safety data in patients with abandoned and/or epicardial leads. METHODS AND RESULTS Relevant literature was identified in Medline and CINAHL using the key terms 'magnetic resonance imaging' AND 'abandoned leads' OR 'epicardial leads'. Secondary literature and cross-references were supplemented. For reporting guidance, the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 was used. International Prospective Register of Systematic Reviews (PROSPERO) registration number 465530. Twenty-one publications with a total of 656 patients with 854 abandoned and/or epicardial leads and 929 MRI scans of different anatomical regions were included. No scan-related major adverse cardiac event was documented, although the possibility of under-reporting of critical events in the literature should be considered. Furthermore, no severe device dysfunction or severe arrhythmia was reported. Mainly transient lead parameter changes were observed in 2.8% in the subgroup of patients with functional epicardial leads. As a possible correlate of myocardial affection, subjective sensations occurred mainly in the subgroup with abandoned epicardial leads (4.0%), but no change in myocardial biomarkers was observed. CONCLUSION Existing publications did not report any relevant adverse events for MRI in patients with abandoned and/or epicardial leads if performed according to strict safety guidelines. However, a more rigorous risk-benefit calculation should be made for patients with epicardial leads.
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Affiliation(s)
- Claudia Meier
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Röntgenstraße 18, 32756 Detmold, Germany
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
| | - Carsten Israel
- Klinik für Innere Medizin, Kardiologie, Nephrologie und Diabetologie, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Michel Eisenblätter
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsinstitut für Diagnostische und Interventionelle Radiologie, Detmold, Germany
| | - Annika Hoyer
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Institut für Biostatistik und Medizinische Biometrie, Universität Bielefeld, Bielefeld, Germany
| | - Ferdinand Valentin Stoye
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
- Institut für Biostatistik und Medizinische Biometrie, Universität Bielefeld, Bielefeld, Germany
| | - Ali Yilmaz
- Herz-MRT-Zentrum, Universitätsklinikum Münster, Münster, Germany
| | - Stephan Gielen
- Campus Klinikum Lippe, Universitätsklinikum Ostwestfalen-Lippe, Universitätsklinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Röntgenstraße 18, 32756 Detmold, Germany
- Medizinische Fakultät, Universität Bielefeld, Postfach 10 01 31, 33501 Bielefeld, Germany
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3
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Greenhill M, Rangan P, Su W, Weiss JP, Zawaneh M, Unzek S, Tamarappoo B, Indik J, Tung R, Morris MF. MRI in Patients with Cardiovascular Implantable Electronic Devices and Fractured or Abandoned Leads. Radiol Cardiothorac Imaging 2024; 6:e230303. [PMID: 38869431 PMCID: PMC11211945 DOI: 10.1148/ryct.230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024]
Abstract
Purpose To examine the clinical effect of lead length and lead orientation in patients with cardiac implantable electronic devices (CIEDs) and lead fragments or abandoned leads undergoing 1.5-T MRI. Materials and Methods This Health Insurance Portability and Accountability Act-compliant retrospective study included patients with CIEDs and abandoned leads or lead fragments undergoing 1.5-T MRI from March 2014 through July 2020. CIED settings before and after MRI were reviewed, with clinically significant variations defined as a composite of the change in capture threshold of at least 50%, in sensing of at least 40%, or in lead impedance of at least 30% between before MRI and after MRI interrogation. Adverse clinical events were assessed at MRI and up to 30 days after. Univariable and multivariable analysis was performed. Results Eighty patients with 126 abandoned CIED leads or lead fragments underwent 107 1.5-T MRI examinations. Sixty-seven patients (median age, 74 years; IQR, 66-78 years; 44 male patients, 23 female patients) had abandoned leads, and 13 (median age, 66 years; IQR, 52-74 years; nine male patients, four female patients) had lead fragments. There were no reported deaths, clinically significant arrhythmias, or adverse clinical events within 30 days of MRI. Three patients with abandoned leads had a significant change in the composite of capture threshold, sensing, or lead impedance. In a multivariable generalized estimating equation analysis, lead orientation, lead length, MRI type, and MRI duration were not associated with a significant change in the composite outcome. Conclusion Use of 1.5-T MRI in patients with abandoned CIED leads or lead fragments of varying length and orientation was not associated with adverse clinical events. Keywords: Cardiac Assist Devices, MRI, Cardiac Implantable Electronic Device Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Mark Greenhill
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Pooja Rangan
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Wilber Su
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - J. Peter Weiss
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Michael Zawaneh
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Samuel Unzek
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Balaji Tamarappoo
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Julia Indik
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Roderick Tung
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
| | - Michael F. Morris
- From the Department of Radiology (M.G.) and Division of Cardiology
(J.I.), Banner University Medical Center Tucson, Tucson, Ariz; Division of
Clinical Data Analytics, University of Arizona College of Medicine Phoenix,
Phoenix, Ariz (P.R.); and Department of Radiology (S.U., B.T., M.F.M.) and
Division of Cardiology (W.S., J.P.W., M.Z., S.U., B.T., R.T., M.F.M.), Banner
University Medical Center Phoenix, 1111 E McDowell Rd, Phoenix, AZ 85006
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Deneke T, Kutyifa V, Hindricks G, Sommer P, Zeppenfeld K, Carbucicchio C, Pürerfellner H, Heinzel FR, Traykov VB, De Riva M, Pontone G, Lehmkuhl L, Haugaa K. Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology. Europace 2024; 26:euae108. [PMID: 38743765 PMCID: PMC11104536 DOI: 10.1093/europace/euae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.
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Affiliation(s)
- Thomas Deneke
- Clinic for Rhythmology at Klinikum Nürnberg Campus Süd, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
| | | | | | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Helmut Pürerfellner
- Department of Clinical Electrophysiology, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Frank R Heinzel
- Städtisches Klinikum Dresden, Department of Cardiology, Angiology and Intensive Care Medicine, Dresden, Germany
| | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Marta De Riva
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lukas Lehmkuhl
- Department of Radiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Germany
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De Leon-Benedetti LS, Ramirez-Suarez KI, Otero HJ, Rapp JB, Biko DM, Smith C, Serai SD, Janson C, Shah M, Englehardt G, Fogel M, White AM. How we do it: Cardiac implantable devices are not a contraindication to MRI: time for a paradigm shift. Pediatr Radiol 2024; 54:863-875. [PMID: 38488925 DOI: 10.1007/s00247-024-05902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
Magnetic resonance imaging (MRI) is now an indispensable diagnostic tool in medicine due to its outstanding contrast resolution and absence of radiation exposure, enabling detailed tissue characterization and three-dimensional anatomical representation. This is especially important when evaluating individuals with congenital heart disease (CHD) who frequently require cardiac implantable electrical devices (CIEDs). While MRI safety issues have previously limited its use in patients with CIEDs, new advances have called these limitations into question. However, difficulties persist in the pediatric population due to the continued lack of specific safety data both related to imaging young children and the specific CIED devices they often require. This paper discusses MRI safety considerations related to imaging patients with CIEDs, investigates pediatric-specific problems, and describes thorough methods for safe MRI access, highlighting the significance of specialized institutional guidelines.
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Affiliation(s)
- Laura S De Leon-Benedetti
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Smith
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christopher Janson
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Maully Shah
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - George Englehardt
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Mark Fogel
- Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Harwood M, Fahrenholtz SJ, Wellnitz CV, Kawashima A, Panda A. MRI in Adult Patients with Active and Inactive Implanted MR-conditional, MR-nonconditional, and Other Devices. Radiographics 2024; 44:e230102. [PMID: 38421911 DOI: 10.1148/rg.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Active implanted medical devices (AIMDs) enable therapy and patient monitoring by way of electrical activity and typically have a battery and electrical leads. The most common types of AIMDs include cardiac implantable electronic devices (CIEDs), spinal cord stimulators, deep brain stimulators, bone growth or fusion stimulators, other neurostimulators, and drug infusion pumps. As more patients with AIMDs undergo MRI, it is important to consider the safety of patients who have these implanted devices during MRI. The authors review the physics concepts related to MRI safety, such as peak spatial gradient magnetic field, specific absorption rate, root mean square value of the effective magnetic component of the transmitted RF pulse, and gradient slew rate, as well as the parameters necessary to remain within safety limits. The roles of MRI safety personnel, as set forth by the International Society of Magnetic Resonance in Medicine, are emphasized. In addition, the relevant information provided in vendor manuals is reviewed, with a focus on how to obtain relevant up-to-date information. The radiologist should be able to modify protocols to meet safety requirements, address possible alternatives to MRI, and weigh the potential benefits of MRI against the potential risks. A few more advanced topics, such as fractured or abandoned device leads and patients with multiple implanted medical devices, also are addressed. Recommended workflows for MRI in patients with implanted medical devices are outlined. It is important to implement an algorithmic MRI safety process, including a review of the MRI safety information; patient screening; optimal imaging; and monitoring patients before, during, and after the examination. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Shetty et al in this issue.
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Affiliation(s)
- Matthew Harwood
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Samuel J Fahrenholtz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Clinton V Wellnitz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Akira Kawashima
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Anshuman Panda
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
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Page N, Chia K, Brazier D, Manisty C, Kozor R. Access to MRI in Patients With Cardiac Implantable Electronic Devices is Variable and an Issue in Australia. Heart Lung Circ 2024; 33:362-367. [PMID: 38326134 DOI: 10.1016/j.hlc.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/11/2023] [Accepted: 11/09/2023] [Indexed: 02/09/2024]
Abstract
AIMS This study aimed to characterise the level of access to magnetic resonance imaging (MRI) in Australian hospitals for patients with MR-conditional and non-MR-conditional cardiac implantable electronic devices (CIED), and to identify any barriers impeding this access. METHODS All Australian Tertiary Referral Public Hospitals (n=38) were surveyed with a mixed qualitative and quantitative questionnaire. Provision of MRI to patients with MR-conditional and non-MR-conditional CIEDs; patient monitoring strategies during scan and personnel in attendance; barriers impeding MRI access. RESULTS Of the 35 (92%) hospitals that completed the survey, a majority (85.7%) scan MR-conditional CIEDs, while a minority (8.6%) scan non-MR-conditional CIEDs. MR-conditional device scanning is often limited to non-pacing dependent patients, excluding implantable cardioverter-defibrillators. In total, 21% of sites exclude thoracic MR scans for CIED patients. Although most centres scan on 1.5 Tesla (T) machines (59%), 10% scan at 3T and 31% scan at both strengths. Sites vary in patient monitoring strategies and personnel in attendance; 80% require staff with Advanced Cardiac Life Support to be present. Barriers to service expansion include an absence of national guidelines, formal training, and logistical device support. CONCLUSIONS Most surveyed Australian hospitals offer MRI for patients with MR-conditional CIEDs, however many still have exclusions for particular patient groups or scan requests. Only three surveyed sites offer MRI for patients with non-MR-conditional CIEDs in Australia. A national effort is needed to address the identified barriers including the development of national guidelines, formal training, and logistical support.
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Affiliation(s)
| | - Karin Chia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Charlotte Manisty
- University College London and Barts Health NHS Trust, London, United Kingdom
| | - Rebecca Kozor
- The University of Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW, Australia.
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Goldfarb JW, Mossa-Basha M, Nguyen KL, Hecht EM, Finn JP. Trends in magnetic resonance and computed tomography angiography utilization among Medicare beneficiaries between 2013 and 2020. Clin Imaging 2024; 107:110088. [PMID: 38277858 DOI: 10.1016/j.clinimag.2024.110088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE To evaluate relative and absolute utilization trends and practice patterns in the United States for MRA and CTA. METHODS Using Medicare Part B physician payment databases (2013-2020), MRA and CTA interpreting physicians and exams were identified using the unique MRA and CTA Healthcare Common Procedure Coding System codes. The number of exams, physicians, demographics, use of contrast, and payments were summarized annually and analyzed to evaluate trends before and during the first year of the COVID-19 pandemic. RESULTS From 2013 to 2019, the annual number of MRA exams performed decreased by 17.9 %, while the number of CTA exams increased by 90.3 %. The number of physicians interpreting MRA decreased in both hospital (-17.2 %) and outpatient (-7.5 %) environments. The number of physicians interpreting CTA increased in both hospital (+29.4 %) and outpatient (+54.3 %) environments. During the first year of the COVID-19 pandemic, MRA utilization decreased across all imaging environments by 25.0 % whereas CTA only decreased by 5.5 %. Intracranial MRA studies were most often performed without contrast, while contrast use for neck MRA was performed at similar rates as non-contrast exams. CONCLUSION The overall utilization of MRA and the number of interpreting physicians are decreasing. On the other hand, CTA use and its number of interpreting physicians are increasing. During the first year of the COVID-19 pandemic, use of both MRA and CTA decreased, but the utilization of MRA decreased at five times the rate of CTA.
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Affiliation(s)
- James W Goldfarb
- Division of Cardiovascular Imaging, St. Francis Hospital and Heart Center, Roslyn, NY, USA.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kim-Lien Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Cardiology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - J Paul Finn
- Diagnostic Cardiovascular Imaging Research Laboratory, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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10
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Bhuva A, Charles-Edwards G, Ashmore J, Lipton A, Benbow M, Grainger D, Lobban T, Gopalan D, Slade A, Roditi G, Manisty C. Joint British Society consensus recommendations for magnetic resonance imaging for patients with cardiac implantable electronic devices. Heart 2024; 110:e3. [PMID: 36104218 DOI: 10.1136/heartjnl-2022-320810] [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] [Indexed: 11/04/2022] Open
Abstract
Magnetic Resonance Imaging (MRI) is increasingly a fundamental component of the diagnostic pathway across a range of conditions. Historically, the presence of a cardiac implantable electronic device (CIED) has been a contraindication for MRI, however, development of MR Conditional devices that can be scanned under strict protocols has facilitated the provision of MRI for patients. Additionally, there is growing safety data to support MR scanning in patients with CIEDs that do not have MR safety labelling or with MR Conditional CIEDs where certain conditions are not met, where the clinical justification is robust. This means that almost all patients with cardiac devices should now have the same access to MRI scanning in the National Health Service as the general population. Provision of MRI to patients with CIED, however, remains limited in the UK, with only half of units accepting scan requests even for patients with MR Conditional CIEDs. Service delivery requires specialist equipment and robust protocols to ensure patient safety and facilitate workflows, meanwhile demanding collaboration between healthcare professionals across many disciplines. This document provides consensus recommendations from across the relevant stakeholder professional bodies and patient groups to encourage provision of safe MRI for patients with CIEDs.
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Affiliation(s)
- Anish Bhuva
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Geoff Charles-Edwards
- Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Representative for the British Institute of Radiology, London, UK
| | - Jonathan Ashmore
- Department of Medical Physics and Bioengineering, NHS Highland, Inverness, UK
- Representative for Institute of Physics and Engineering in Medicine, York, UK
| | | | - Matthew Benbow
- Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
- Representative for British Association of MR Radiographers, Sheffield, UK
| | - David Grainger
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Trudie Lobban
- Arrhythmia Alliance & Atrial Fibrillation Association, Stratford upon Avon, UK
| | - Deepa Gopalan
- Department of Radiology, Imperial College London, London, UK
- Representative for Royal College of Radiologists, London, UK
| | - Alistair Slade
- Cardiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Representative for British Heart Rhythm Society, Chipping Norton, UK
| | - Giles Roditi
- Radiology, Glasgow Royal Infirmary, Glasgow, UK
- Representative of the British Society of Cardiovascular Imaging and British Society of Cardiovascular CT, London, UK
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Representative of British Cardiovascular Society, London, UK
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11
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Kim D, Collins JD, White JA, Hanneman K, Lee DC, Patel AR, Hu P, Litt H, Weinsaft JW, Davids R, Mukai K, Ng MY, Luetkens JA, Roguin A, Rochitte CE, Woodard PK, Manisty C, Zareba KM, Mont L, Bogun F, Ennis DB, Nazarian S, Webster G, Stojanovska J. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device. J Cardiovasc Magn Reson 2024; 26:100995. [PMID: 38219955 PMCID: PMC11211236 DOI: 10.1016/j.jocmr.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.
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Affiliation(s)
- Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - James A White
- Departments of Cardiac Sciences and Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Kate Hanneman
- Department of Medical Imaging, University Medical Imaging Toronto, Toronto General Hospital and Peter Munk Cardiac Centre, University of Toronto, Toronto, Canada
| | - Daniel C Lee
- Department of Medicine (Division of Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amit R Patel
- Cardiovascular Division, University of Virginia, Charlottesville, VA, USA
| | - Peng Hu
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan W Weinsaft
- Department of Medicine (Division of Cardiology), Weill Cornell Medicine, New York, NY, USA
| | - Rachel Davids
- SHS AM NAM USA DI MR COLLAB ADV-APPS, Siemens Medical Solutions USA, Inc., Chicago, Il, USA
| | - Kanae Mukai
- Salinas Valley Memorial Healthcare System, Ryan Ranch Center for Advanced Diagnostic Imaging, Monterey, CA, USA
| | - Ming-Yen Ng
- Department of Diagnostic Radiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, the Hong Kong Special Administrative Region of China
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and Faculty of Medicine. Technion - Israel Institute of Technology, Israel
| | - Carlos E Rochitte
- Heart Institute, InCor, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Charlotte Manisty
- Institute of Cardiovascular Science, University College London, London, UK
| | - Karolina M Zareba
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lluis Mont
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Webster
- Department of Pediatrics (Cardiology), Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Jadranka Stojanovska
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY, USA
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12
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Stankovic I, Voigt JU, Burri H, Muraru D, Sade LE, Haugaa KH, Lumens J, Biffi M, Dacher JN, Marsan NA, Bakelants E, Manisty C, Dweck MR, Smiseth OA, Donal E. Imaging in patients with cardiovascular implantable electronic devices: part 2-imaging after device implantation. A clinical consensus statement of the European Association of Cardiovascular Imaging (EACVI) and the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J Cardiovasc Imaging 2023; 25:e33-e54. [PMID: 37861420 DOI: 10.1093/ehjci/jead273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/15/2023] [Accepted: 10/15/2023] [Indexed: 10/21/2023] Open
Abstract
Cardiac implantable electronic devices (CIEDs) improve quality of life and prolong survival, but there are additional considerations for cardiovascular imaging after implantation-both for standard indications and for diagnosing and guiding management of device-related complications. This clinical consensus statement (part 2) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients after implantation of conventional pacemakers, cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices. The document summarizes the existing evidence regarding the role and optimal use of various cardiac imaging modalities in patients with suspected CIED-related complications and also discusses CRT optimization, the safety of magnetic resonance imaging in CIED carriers, and describes the role of chest radiography in assessing CIED type, position, and complications. The role of imaging before and during CIED implantation is discussed in a companion document (part 1).
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Affiliation(s)
- Ivan Stankovic
- Clinical Hospital Centre Zemun, Department of Cardiology, Faculty of Medicine, University of Belgrade, Vukova 9, 11080 Belgrade, Serbia
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven/Department of Cardiovascular Sciences, Catholic University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA
- University of Baskent, Department of Cardiology, Ankara, Turkey
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
- Faculty of Medicine, Karolinska Institutet and Cardiovascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Joost Lumens
- Cardiovascular Research Center Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jean-Nicolas Dacher
- Department of Radiology, Normandie University, UNIROUEN, INSERM U1096-Rouen University Hospital, F 76000 Rouen, France
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart and Lung Center, Leiden University Medical Center, The Netherlands
| | - Elise Bakelants
- Cardiac Pacing Unit, Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Charlotte Manisty
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Otto A Smiseth
- Institute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
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13
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Gakenheimer-Smith L, Ou Z, Kuang J, Moore JP, Burrows A, Kovach J, Dechert B, Beach CM, Ayers M, Tan RB, Mostafavifar M, Mah DY, Conner TM, Turpin S, Avasarala K, Shah MJ, Webster G, Posey J, Etheridge SP, Binka E, Niu M, Asaki SY, Lambert LM, Pilcher TA. Multicenter retrospective evaluation of magnetic resonance imaging in pediatric and congenital heart disease patients with cardiac implantable electronic devices. Heart Rhythm 2023; 20:1752-1758. [PMID: 37648183 DOI: 10.1016/j.hrthm.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Guidelines addressing magnetic resonance imaging (MRI) in patients with cardiac implantable electronic devices (CIEDs) provide algorithms for imaging pediatric and congenital heart disease (CHD) patients. Guideline acceptance varies by institution. Guidelines also do not support routine MRI scans in patients with epicardial or abandoned leads, common in pediatric and CHD patients. OBJECTIVE The purpose of this study was to determine the incidence of MRI-related complications in pediatric and CHD patients with CIEDs, including epicardial and/or abandoned leads. METHODS A multicenter retrospective review included patients with CIEDs who underwent any MRI between 2007 and 2022 at congenital cardiac centers. The primary outcome was any patient adverse event or clinically significant CIED change after MRI, defined as pacing lead capture threshold increase >0.5 V with output change, P- or R- wave amplitude decrease >50% with sensitivity change, or impedance change >50%. RESULTS Across 14 institutions, 314 patients (median age 18.8 [1.3; 31.4] years) underwent 389 MRIs. There were 288 pacemakers (74%) and 87 implantable cardioverter-defibrillators (22%); 52% contained epicardial leads, and 14 (4%) were abandoned leads only. Symptoms or CIED changes occurred in 4.9% of MRI scans (6.1% of patients). On 9 occasions (2%), warmth or pain occurred. Pacing capture threshold or lead impedance changes occurred in 1.4% and 2.0% of CIEDs post-MRI and at follow-up. CONCLUSION Our data provide evidence that MRIs can be performed in pediatric and CHD patients with CIEDs, including non-MRI-conditional CIEDs and epicardial and/or abandoned leads, with rare minor symptoms or CIED changes but no other complications.
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Affiliation(s)
- Lindsey Gakenheimer-Smith
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jinqiu Kuang
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Jeremy P Moore
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California
| | - Austin Burrows
- Division of Cardiology, Department of Pediatrics, UCLA Medical Center, Los Angeles, California
| | - Joshua Kovach
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brynn Dechert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Mark Ayers
- Division of Pediatric Cardiology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Reina Bianca Tan
- Division of Pediatric Cardiology, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | | | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tracy Marrs Conner
- Division of Pediatric Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | - Susan Turpin
- UCSF Benioff Children's Hospital, Oakland, California
| | | | - Maully J Shah
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Webster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Jessica Posey
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia
| | - Susan P Etheridge
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Edem Binka
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Mary Niu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - S Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Linda M Lambert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Thomas A Pilcher
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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14
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Lloyd JW, Anavekar NS, Oh JK, Miranda WR. Multimodality Imaging in Differentiating Constrictive Pericarditis From Restrictive Cardiomyopathy: A Comprehensive Overview for Clinicians and Imagers. J Am Soc Echocardiogr 2023; 36:1254-1265. [PMID: 37619909 DOI: 10.1016/j.echo.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/27/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
In the evaluation of heart failure, 2 differential diagnostic considerations include constrictive pericarditis and restrictive cardiomyopathy. The often outwardly similar clinical presentation of these 2 pathologic entities routinely renders their clinical distinction difficult. Consequently, initial assessment requires a keen understanding of their separate pathophysiology, epidemiology, and hemodynamic effects. Following a detailed clinical evaluation, further assessment initially rests on comprehensive echocardiographic investigation, including detailed Doppler evaluation. With the combination of mitral inflow characterization, tissue Doppler assessment, and hepatic vein interrogation, initial differentiation of constrictive pericarditis and restrictive cardiomyopathy is often possible with high sensitivity and specificity. In conjunction with a compatible clinical presentation, successful differentiation enables both an accurate diagnosis and subsequent targeted management. In certain cases, however, the diagnosis remains unclear despite echocardiographic assessment, and additional evaluation is required. With advances in noninvasive tools, such evaluation can often continue in a stepwise, algorithmic fashion noninvasively, including both cross-sectional and nuclear imaging. Should this additional evaluation itself prove insufficient, invasive assessment with appropriate expertise may ultimately be necessary.
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Affiliation(s)
- James W Lloyd
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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15
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Crean AM, Small GR, Saleem Z, Maharajh G, Ruel M, Chow BJW. Application of Cardiovascular Computed Tomography to the Assessment of Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2023; 205:481-492. [PMID: 37683571 DOI: 10.1016/j.amjcard.2023.06.096] [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: 02/24/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertrophic cardiomyopathy is a common inherited cardiac condition in which regional myocardial thickening and scarring can lead to a range of symptoms including breathlessness, dizziness, chest pain, and collapse with loss of consciousness. It is vital to be able to understand the mechanisms behind these epiphenomena and to be able to distinguish, for example, between syncope because of arrhythmia versus syncope because of mechanical outflow tract obstruction. Therefore, we require a technique that can characterize anatomy, physiology, and myocardial substrate. Traditionally, this role has been the preserve of cardiac magnetic resonance (CMR) imaging. This review makes the case for cardiac computed tomography (CT) as an alternative imaging method. We review the use of functional CT to identify the components of outflow tract obstruction (and obstruction at other levels, which may be simultaneous), and as an aid to interventional and surgical planning. We demonstrate the added value of multiplanar isotropic reformats in this condition, particularly in cases where the diagnosis may be more challenging or where complications (such as early apical aneurysm) may be difficult to recognize with 2-dimensional techniques. In conclusion, our aim is to convince readers that cardiac CT is a highly valuable and versatile tool, which deserves wider usage and greater recognition in those caring for patients with hypertrophic cardiomyopathy.
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Affiliation(s)
- Andrew M Crean
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Gary R Small
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zain Saleem
- Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Gyaandeo Maharajh
- Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- Division of Cardiology, Ottawa Heart Institute, Ottawa, Ontario, Canada
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16
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 300] [Impact Index Per Article: 300.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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17
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Bivona DJ, Oomen PJA, Wang Y, Morales FL, Abdi M, Gao X, Malhotra R, Darby A, Mehta N, Monfredi OJ, Mangrum JM, Mason PK, Levy WC, Mazimba S, Patel AR, Epstein FH, Bilchick KC. Cardiac Magnetic Resonance, Electromechanical Activation, Kidney Function, and Natriuretic Peptides in Cardiac Resynchronization Therapy Upgrades. J Cardiovasc Dev Dis 2023; 10:409. [PMID: 37887856 PMCID: PMC10607260 DOI: 10.3390/jcdd10100409] [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: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
As the mechanism for worse prognosis after cardiac resynchronization therapy (CRT) upgrades in heart failure patients with RVP dependence (RVP-HF) has clinical implications for patient selection and CRT implementation approaches, this study's objective was to evaluate prognostic implications of cardiac magnetic resonance (CMR) findings and clinical factors in 102 HF patients (23.5% female, median age 66.5 years old, median follow-up 4.8 years) with and without RVP dependence undergoing upgrade and de novo CRT implants. Compared with other CRT groups, RVP-HF patients had decreased survival (p = 0.02), more anterior late-activated LV pacing sites (p = 0.002) by CMR, more atrial fibrillation (p = 0.0006), and higher creatinine (0.002). CMR activation timing at the LV pacing site predicted post-CRT LV functional improvement (p < 0.05), and mechanical activation onset < 34 ms by CMR at the LVP site was associated with decreased post-CRT survival in a model with higher pre-CRT creatinine and B-type natriuretic peptide (AUC 0.89; p < 0.0001); however, only the higher pre-CRT creatinine partially mediated (37%) the decreased survival in RVP-HF patients. In conclusion, RVP-HF had a distinct CMR phenotype, which has important implications for the selection of LV pacing sites in CRT upgrades, and only chronic kidney disease mediated the decreased survival after CRT in RVP-HF.
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Affiliation(s)
- Derek J. Bivona
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Pim J. A. Oomen
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA 92617, USA;
| | - Yu Wang
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
| | - Frances L. Morales
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Mohamad Abdi
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
| | - Xu Gao
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Rohit Malhotra
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Andrew Darby
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Nishaki Mehta
- Department of Medicine, William Beaumont Oakland University School of Medicine, Royal Oak, MI 48309, USA;
| | - Oliver J. Monfredi
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - J. Michael Mangrum
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Pamela K. Mason
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Wayne C. Levy
- Department of Medicine, University of Washington, Seattle, WA 98195, USA;
| | - Sula Mazimba
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Amit R. Patel
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
| | - Frederick H. Epstein
- Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, VA 22908, USA; (Y.W.); (M.A.); (F.H.E.)
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Kenneth C. Bilchick
- Department of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA; (D.J.B.); (F.L.M.); (R.M.); (A.D.); (O.J.M.); (J.M.M.); (P.K.M.); (S.M.); (A.R.P.)
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18
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Jiang F, Henry KR, Bhusal B, Sanpitak P, Webster G, Popescu A, Laternser C, Kim D, Golestanirad L. Age Matters: A Comparative Study of RF Heating of Epicardial and Endocardial Electronic Devices in Pediatric and Adult Phantoms during Cardiothoracic MRI. Diagnostics (Basel) 2023; 13:2847. [PMID: 37685385 PMCID: PMC10486594 DOI: 10.3390/diagnostics13172847] [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: 02/26/2023] [Revised: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023] Open
Abstract
This study focused on the potential risks of radiofrequency-induced heating of cardiac implantable electronic devices (CIEDs) in children and adults with epicardial and endocardial leads of varying lengths during cardiothoracic MRI scans. Infants and young children are the primary recipients of epicardial CIEDs, though the devices have not been approved as MR conditional by the FDA due to limited data, leading to pediatric hospitals either refusing the MRI service to most pediatric CIED patients or adopting a scan-all strategy based on results from adult studies. The study argues that risk-benefit decisions should be made on an individual basis. We used 120 clinically relevant epicardial and endocardial device configurations in adult and pediatric anthropomorphic phantoms to determine the temperature rise during RF exposure at 1.5 T. The results showed that there was significantly higher RF heating of epicardial leads than endocardial leads in the pediatric phantom, but not in the adult phantom. Additionally, body size and lead length significantly affected RF heating, with RF heating up to 12 °C observed in models based on younger children with short epicardial leads. The study provides evidence-based knowledge on RF-induced heating of CIEDs and highlights the importance of making individual risk-benefit decisions when assessing the potential risks of MRI scans in pediatric CIED patients.
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Affiliation(s)
- Fuchang Jiang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Kaylee R. Henry
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Bhumi Bhusal
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Pia Sanpitak
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL 60611, USA
| | - Andrada Popescu
- Division of Medical Imaging, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL 60611, USA
| | - Christina Laternser
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL 60611, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Laleh Golestanirad
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
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19
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Xiang J, Lamy J, Lampert R, Peters DC. Balanced Steady-State Free Precession Cine MR Imaging in the Presence of Cardiac Devices: Value of Interleaved Radial Linear Combination Acquisition With Partial Dephasing. J Magn Reson Imaging 2023; 58:782-791. [PMID: 36373998 PMCID: PMC11238270 DOI: 10.1002/jmri.28528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Balanced steady-state free precession (bSSFP) is important in cardiac MRI but suffers from off-resonance artifacts. The interpretation-limiting artifacts in patients with cardiac implants remain an unsolved issue. PURPOSE To develop an interleaved radial linear combination bSSFP (lcSSFP) method with partial dephasing (PD) for improved cardiac cine imaging when implanted cardiovascular devices are present. STUDY TYPE Prospective. PHANTOM AND SUBJECTS Flow phantom adjacent to a pacemaker and 10 healthy volunteers (mean age ± standard deviation: 31.9 ± 2.9 years, 4 females) with a cardioverter-defibrillator (ICD) positioned extracorporeally at the left chest in the prepectoral region. FIELD STRENGTH/SEQUENCE A 3-T, 1) Cartesian bSSFP, 2) Cartesian gradient echo (GRE), 3) Cartesian lcSSFP, and 4) radial lcSSFP cine sequences. ASSESSMENT Flow artifacts mitigation using PD was validated with phantom experiments. Undersampled radial lcSSFP with interleaving across phase-cyclings and cardiac phases (RLC-SSFP), combined with PD, was then employed for achieving improved quality of cine images from left ventricular short-axis view. The image quality in the presence of cardiac devices was qualitatively assessed by three independent raters (1 = worst, 5 = best), regarding five criteria (banding artifacts, streak artifacts, flow artifacts, cavity visibility, and overall image quality). STATISTICAL TESTS Wilcoxon rank-sum test for the five criteria between Cartesian bSSFP cine and RLC-SSFP with PD. Fleiss kappa test for inter-reader agreement. A P value < 0.05 was considered statistically significant. RESULTS Based on simulations and phantom experiments, 60 projections per phase cycling and 1/6 PD were chosen. The in vivo experiments demonstrated significantly reduced banding artifacts (4.8 ± 0.4 vs. 2.7 ± 0.7), fewer streak artifacts (3.7 ± 0.6 vs. 2.6 ± 0.7) and flow artifacts (4.4 ± 0.4 vs. 3.7 ± 0.6), therefore improved cavity visibility (4.1 ± 0.4 vs. 2.9 ± 0.9) and overall quality (4.0 ± 0.4 vs. 2.7 ± 0.7). DATA CONCLUSION RLC-SSFP method with PD may improve cine image quality in subjects with cardiac devices. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Jie Xiang
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
| | - Jerome Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Rachel Lampert
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, Connecticut, USA
| | - Dana C. Peters
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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20
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Kimberly WT, Sorby-Adams AJ, Webb AG, Wu EX, Beekman R, Bowry R, Schiff SJ, de Havenon A, Shen FX, Sze G, Schaefer P, Iglesias JE, Rosen MS, Sheth KN. Brain imaging with portable low-field MRI. NATURE REVIEWS BIOENGINEERING 2023; 1:617-630. [PMID: 37705717 PMCID: PMC10497072 DOI: 10.1038/s44222-023-00086-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 09/15/2023]
Abstract
The advent of portable, low-field MRI (LF-MRI) heralds new opportunities in neuroimaging. Low power requirements and transportability have enabled scanning outside the controlled environment of a conventional MRI suite, enhancing access to neuroimaging for indications that are not well suited to existing technologies. Maximizing the information extracted from the reduced signal-to-noise ratio of LF-MRI is crucial to developing clinically useful diagnostic images. Progress in electromagnetic noise cancellation and machine learning reconstruction algorithms from sparse k-space data as well as new approaches to image enhancement have now enabled these advancements. Coupling technological innovation with bedside imaging creates new prospects in visualizing the healthy brain and detecting acute and chronic pathological changes. Ongoing development of hardware, improvements in pulse sequences and image reconstruction, and validation of clinical utility will continue to accelerate this field. As further innovation occurs, portable LF-MRI will facilitate the democratization of MRI and create new applications not previously feasible with conventional systems.
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Affiliation(s)
- W Taylor Kimberly
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Annabel J Sorby-Adams
- Department of Neurology and the Center for Genomic Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew G Webb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed X Wu
- Laboratory of Biomedical Imaging and Signal Processing, Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Rachel Beekman
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
| | - Ritvij Bowry
- Departments of Neurosurgery and Neurology, McGovern Medical School, University of Texas Health Neurosciences, Houston, TX, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adam de Havenon
- Division of Vascular Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Francis X Shen
- Harvard Medical School Center for Bioethics, Harvard law School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Gordon Sze
- Department of Radiology, Yale New Haven Hospital and Yale School of Medicine, New Haven, CT, USA
| | - Pamela Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Centre for Medical Image Computing, University College London, London, UK
- Computer Science and AI Laboratory, Massachusetts Institute of Technology, Boston, MA, USA
| | - Matthew S Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale New Haven Hospital and Yale School of Medicine, Yale Center for Brain & Mind Health, New Haven, CT, USA
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21
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Hu WT, Nayyar A, Kaluzova M. Charting the Next Road Map for CSF Biomarkers in Alzheimer's Disease and Related Dementias. Neurotherapeutics 2023; 20:955-974. [PMID: 37378862 PMCID: PMC10457281 DOI: 10.1007/s13311-023-01370-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical prediction of underlying pathologic substrates in people with Alzheimer's disease (AD) dementia or related dementia syndromes (ADRD) has limited accuracy. Etiologic biomarkers - including cerebrospinal fluid (CSF) levels of AD proteins and cerebral amyloid PET imaging - have greatly modernized disease-modifying clinical trials in AD, but their integration into medical practice has been slow. Beyond core CSF AD biomarkers (including beta-amyloid 1-42, total tau, and tau phosphorylated at threonine 181), novel biomarkers have been interrogated in single- and multi-centered studies with uneven rigor. Here, we review early expectations for ideal AD/ADRD biomarkers, assess these goals' future applicability, and propose study designs and performance thresholds for meeting these ideals with a focus on CSF biomarkers. We further propose three new characteristics: equity (oversampling of diverse populations in the design and testing of biomarkers), access (reasonable availability to 80% of people at risk for disease, along with pre- and post-biomarker processes), and reliability (thorough evaluation of pre-analytical and analytical factors influencing measurements and performance). Finally, we urge biomarker scientists to balance the desire and evidence for a biomarker to reflect its namesake function, indulge data- as well as theory-driven associations, re-visit the subset of rigorously measured CSF biomarkers in large datasets (such as Alzheimer's disease neuroimaging initiative), and resist the temptation to favor ease over fail-safe in the development phase. This shift from discovery to application, and from suspended disbelief to cogent ingenuity, should allow the AD/ADRD biomarker field to live up to its billing during the next phase of neurodegenerative disease research.
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Affiliation(s)
- William T Hu
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA.
- Center for Innovation in Health and Aging Research, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA.
| | - Ashima Nayyar
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
| | - Milota Kaluzova
- Department of Neurology, Rutgers Biomedical and Health Sciences, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA
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22
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Sun YK, Zhou BY, Miao Y, Shi YL, Xu SH, Wu DM, Zhang L, Xu G, Wu TF, Wang LF, Yin HH, Ye X, Lu D, Han H, Xiang LH, Zhu XX, Zhao CK, Xu HX. Three-dimensional convolutional neural network model to identify clinically significant prostate cancer in transrectal ultrasound videos: a prospective, multi-institutional, diagnostic study. EClinicalMedicine 2023; 60:102027. [PMID: 37333662 PMCID: PMC10276260 DOI: 10.1016/j.eclinm.2023.102027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/22/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Identifying patients with clinically significant prostate cancer (csPCa) before biopsy helps reduce unnecessary biopsies and improve patient prognosis. The diagnostic performance of traditional transrectal ultrasound (TRUS) for csPCa is relatively limited. This study was aimed to develop a high-performance convolutional neural network (CNN) model (P-Net) based on a TRUS video of the entire prostate and investigate its efficacy in identifying csPCa. Methods Between January 2021 and December 2022, this study prospectively evaluated 832 patients from four centres who underwent prostate biopsy and/or radical prostatectomy. All patients had a standardised TRUS video of the whole prostate. A two-dimensional CNN (2D P-Net) and three-dimensional CNN (3D P-Net) were constructed using the training cohort (559 patients) and tested on the internal validation cohort (140 patients) as well as on the external validation cohort (133 patients). The performance of 2D P-Net and 3D P-Net in predicting csPCa was assessed in terms of the area under the receiver operating characteristic curve (AUC), biopsy rate, and unnecessary biopsy rate, and compared with the TRUS 5-point Likert score system as well as multiparametric magnetic resonance imaging (mp-MRI) prostate imaging reporting and data system (PI-RADS) v2.1. Decision curve analyses (DCAs) were used to determine the net benefits associated with their use. The study is registered at https://www.chictr.org.cn with the unique identifier ChiCTR2200064545. Findings The diagnostic performance of 3D P-Net (AUC: 0.85-0.89) was superior to TRUS 5-point Likert score system (AUC: 0.71-0.78, P = 0.003-0.040), and similar to mp-MRI PI-RADS v2.1 score system interpreted by experienced radiologists (AUC: 0.83-0.86, P = 0.460-0.732) and 2D P-Net (AUC: 0.79-0.86, P = 0.066-0.678) in the internal and external validation cohorts. The biopsy rate decreased from 40.3% (TRUS 5-point Likert score system) and 47.6% (mp-MRI PI-RADS v2.1 score system) to 35.5% (2D P-Net) and 34.0% (3D P-Net). The unnecessary biopsy rate decreased from 38.1% (TRUS 5-point Likert score system) and 35.2% (mp-MRI PI-RADS v2.1 score system) to 32.0% (2D P-Net) and 25.8% (3D P-Net). 3D P-Net yielded the highest net benefit according to the DCAs. Interpretation 3D P-Net based on a prostate grayscale TRUS video achieved satisfactory performance in identifying csPCa and potentially reducing unnecessary biopsies. More studies to determine how AI models better integrate into routine practice and randomized controlled trials to show the values of these models in real clinical applications are warranted. Funding The National Natural Science Foundation of China (Grants 82202174 and 82202153), the Science and Technology Commission of Shanghai Municipality (Grants 18441905500 and 19DZ2251100), Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), Shanghai Science and Technology Innovation Action Plan (21Y11911200), and Fundamental Research Funds for the Central Universities (ZD-11-202151), Scientific Research and Development Fund of Zhongshan Hospital of Fudan University (Grant 2022ZSQD07).
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Affiliation(s)
- Yi-Kang Sun
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Bo-Yang Zhou
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Yao Miao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumour, Shanghai Tenth People's Hospital, Ultrasound Institute of Research and Education, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound in Diagnosis and Treatment, Shanghai, China
| | - Yi-Lei Shi
- MedAI Technology (Wuxi) Co., Ltd., Wuxi, China
| | - Shi-Hao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Dao-Ming Wu
- Department of Ultrasound, Fujian Provincial Hospital, Fujian, China
| | - Lei Zhang
- MedAI Technology (Wuxi) Co., Ltd., Wuxi, China
| | - Guang Xu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumour, Shanghai Tenth People's Hospital, Ultrasound Institute of Research and Education, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound in Diagnosis and Treatment, Shanghai, China
| | - Ting-Fan Wu
- Bayer Healthcare, Radiology, Shanghai, China
| | - Li-Fan Wang
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Hao-Hao Yin
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Xin Ye
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Dan Lu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Hong Han
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Li-Hua Xiang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumour, Shanghai Tenth People's Hospital, Ultrasound Institute of Research and Education, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound in Diagnosis and Treatment, Shanghai, China
| | - Xiao-Xiang Zhu
- Chair of Data Science in Earth Observation, Technical University of Munich, Munich, Germany
| | - Chong-Ke Zhao
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Institute of Ultrasound in Medicine and Engineering, Fudan University, Shanghai, China
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23
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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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24
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Ma YD, Watson RE, Olson NE, Birgersdotter-Green U, Patel K, Mulpuru SK, Madhavan M, Deshmukh AJ, Killu AM, Friedman PA, Cha YM. Safety of Magnetic Resonance Imaging in Patients with Surgically Implanted Permanent Epicardial Leads. Heart Rhythm 2023:S1547-5271(23)02102-1. [PMID: 37075957 DOI: 10.1016/j.hrthm.2023.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/28/2023] [Accepted: 04/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) safety in patients with an epicardial cardiac implantable electronic device (CIED) is uncertain. OBJECTIVE To assess the safety and adverse effects of MRI in patients who had surgically implanted epicardial CIED. METHODS Patients with surgically implanted CIEDs who underwent MRI with an appropriate Cardiology-Radiology collaborative protocol between January 2008 and January 2021 were prospectively studied in two clinical centers. All patients underwent close cardiac monitoring through MRI procedures. Outcomes were compared between the epicardial CIED group and matched the non-MRI-conditional transvenous CIED group. RESULTS Twenty-nine consecutive patients with epicardial CIED (male 41.4%, mean age of 43 years) underwent 52 MRIs in the 57 anatomic regions. Sixteen patients had pacemakers, 9 had cardiac defibrillators or cardiac resynchronization therapy defibrillators, and 4 had no device generators. There were no significant adverse events in epicardial or transvenous CIED groups. The battery life, pacing, sensing thresholds, lead impedance and cardiac biomarkers were not significantly changed, except one patient had a transient decrease in atrial lead sensing function. CONCLUSION MRI of CIEDs with epicardially implanted leads does not represent a greater risk than the transvenous CIEDs when performed with a multidisciplinary collaborative protocol centered on patient safety.
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Affiliation(s)
- Yue-Dong Ma
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, China
| | | | - Nora E Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ulrika Birgersdotter-Green
- Department of Cardiovascular Medicine, University of California, San Diego Health System, 200 West Arbor Drive, San Diego, California
| | - Kavisha Patel
- Department of Cardiovascular Medicine, University of California, San Diego Health System, 200 West Arbor Drive, San Diego, California
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Cook N, Shelton N, Gibson S, Barnes P, Alinaghi-Zadeh R, Jameson MG. ACPSEM position paper: the safety of magnetic resonance imaging linear accelerators. Phys Eng Sci Med 2023; 46:19-43. [PMID: 36847966 PMCID: PMC10030425 DOI: 10.1007/s13246-023-01224-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 03/01/2023]
Abstract
Magnetic Resonance Imaging linear-accelerator (MRI-linac) equipment has recently been introduced to multiple centres in Australia and New Zealand. MRI equipment creates hazards for staff, patients and others in the MR environment; these hazards must be well understood, and risks managed by a system of environmental controls, written procedures and a trained workforce. While MRI-linac hazards are similar to the diagnostic paradigm, the equipment, workforce and environment are sufficiently different that additional safety guidance is warranted. In 2019 the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) formed the Magnetic Resonance Imaging Linear-Accelerator Working Group (MRILWG) to support the safe clinical introduction and optimal use of MR-guided radiation therapy treatment units. This Position Paper is intended to provide safety guidance and education for Medical Physicists and others planning for and working with MRI-linac technology. This document summarises MRI-linac hazards and describes particular effects which arise from the combination of strong magnetic fields with an external radiation treatment beam. This document also provides guidance on safety governance and training, and recommends a system of hazard management tailored to the MRI-linac environment, ancillary equipment, and workforce.
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Affiliation(s)
- Nick Cook
- Christchurch Hospital, Christchurch, New Zealand
| | - Nikki Shelton
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | | | | | - Reza Alinaghi-Zadeh
- Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, VIC, Australia
| | - Michael G Jameson
- GenesisCare, Sydney, NSW, Australia.
- University of New South Wales, Sydney, Australia.
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Ra J, Oberdier MT, Suzuki M, Vaidya D, Liu Y, Hansford R, McVeigh D, Weltin V, Tao S, Thiemann DR, Nazarian S, Halperin HR. Implantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance Imaging. Ann Intern Med 2023; 176:289-297. [PMID: 36716451 DOI: 10.7326/m22-2653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies have shown that magnetic resonance imaging (MRI) does not have clinically important effects on the device parameters of non-MRI-conditional implantable cardioverter-defibrillators (ICDs). However, data on non-MRI-conditional ICD detection and treatment of arrhythmias after MRI are limited. OBJECTIVE To examine if non-MRI-conditional ICDs have preserved shock function of arrhythmias after MRI. DESIGN Prospective cohort study. (ClinicalTrials.gov: NCT01130896). SETTING 1 center in the United States. PATIENTS 629 patients with non-MRI-conditional ICDs enrolled consecutively between February 2003 and January 2015. INTERVENTIONS 813 total MRI examinations at a magnetic field strength of 1.5 Tesla using a prespecified safety protocol. MEASUREMENTS Implantable cardioverter-defibrillator interrogations were collected after MRI. Clinical outcomes included arrhythmia detection and treatment, generator or lead exchanges, adverse events, and death. RESULTS During a median follow-up of 2.2 years from MRI to latest available ICD interrogation before generator or lead exchange in 536 patients, 4177 arrhythmia episodes were detected, and 97 patients received ICD shocks. Sixty-one patients (10% of total) had 130 spontaneous ventricular tachycardia or fibrillation events terminated by ICD shocks. A total of 210 patients (33% of total) are known to have died (median, 1.7 years from MRI to death); 3 had cardiac arrhythmia deaths where shocks were indicated without direct evidence of device dysfunction. LIMITATIONS Data were acquired at a single center and may not be generalizable to other clinical settings and MRI facilities. Implantable cardioverter-defibrillator interrogations were not available for a subset of patients; adjudication of cause of death relied solely on death certificate data in a subset. CONCLUSION Non-MRI-conditional ICDs appropriately treated detected tachyarrhythmias after MRI. No serious adverse effects on device function were reported after MRI. PRIMARY FUNDING SOURCE Johns Hopkins University and National Institutes of Health.
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Affiliation(s)
- Joshua Ra
- Department of Medicine, University of California San Francisco, San Francisco, California (J.R.)
| | - Matt T Oberdier
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Masahito Suzuki
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Dhananjay Vaidya
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Yisi Liu
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland (Y.L.)
| | - Rozann Hansford
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Diana McVeigh
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Valeria Weltin
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Susumu Tao
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - David R Thiemann
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland (M.T.O., M.S., D.V., R.H., D.M., V.W., S.T., D.R.T.)
| | - Saman Nazarian
- Department of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (S.N.)
| | - Henry R Halperin
- Department of Cardiology and Departments of Radiology and Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland (H.R.H.)
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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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Pitman BM, Ariyaratnam J, Williams K, Evans M, Reid-Smith N, Wilson L, Teo K, Young GD, Roberts-Thomson KC, Wong CX, Sanders P, Lau DH. The Burden of Cardiac Implantable Electronic Device Checks in the Peri-MRI Setting: The CHECK-MRI Study. Heart Lung Circ 2023; 32:252-260. [PMID: 36443175 DOI: 10.1016/j.hlc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most modern cardiac implantable electronic device (CIED) systems are now compatible with magnetic resonance imaging (MRI) scans. The requirement for both pre- and post-MRI CIED checks imposes significant workload to the cardiac electrophysiology service. Here, we sought to determine the burden of CIED checks associated with MRI scans. METHODS We identified all CIED checks performed peri-MRI scans at our institution over a 3-year period between 1 July 2017 to 30 June 2020, comprising three separate financial years (FY). Device check reports, MRI scan reports and clinical summaries were collated. The workload burden was determined by assessing the occasions and duration of service. Analysis was performed to determine cost burden/projections for this service and identify factors contributing to the workload. RESULTS A total of 739 CIED checks were performed in the peri-MRI scan setting (370 pre- and 369 post-MRI scan), including 5% (n=39) that were performed outside of routine hours (weekday <8 am or >5 pm, and weekends). MRIs were performed for 295 patients (75±13 years old, 64% male) with a CIED (88% permanent pacemaker, and 12% high voltage device), including 49 who had more than one MRI scan. The proportion of total MRI scans for patients with a CIED in-situ increased each FY (from 0.5% of all MRIs in FY1, to 0.9% in FY2, to 1.0% in FY3). The weekly workload increased (R2=0.2, p<0.001), but with week-to-week variability due to ad hoc scheduling (209 days with only one MRI vs 78 days with ≥2 MRIs for CIED patients). The projected annual cost of this service will increase to AUD$161,695 in 10 years for an estimated annual 546 MRI scans for CIED patients. CONCLUSIONS There is an increasing workload burden and expense associated with CIED checks in the peri-MRI setting. Appropriate budgeting, staff allocation and standardisation of automated CIED pre-programming features among manufacturers are urgently needed.
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Affiliation(s)
- Bradley M Pitman
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/pitmabm
| | - Jonathan Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kerry Williams
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michelle Evans
- Southern Area Local Health Network, Adelaide, SA, Australia
| | - Nicole Reid-Smith
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lauren Wilson
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Karen Teo
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Glenn D Young
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Kurt C Roberts-Thomson
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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29
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Goodwin E, Fogelson B, Cox JW, Mahlow WJ. An algorithm for pacing and cardioverting electronic devices undergoing magnetic resonance imaging: The PACED-MRI protocol. Magn Reson Imaging 2023; 96:44-49. [PMID: 36441043 DOI: 10.1016/j.mri.2022.10.012] [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: 05/05/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cardiac implantable electronic devices (CIEDs) have traditionally been a contraindication for magnetic resonance imaging (MRI). However, there is an increasing amount of literature to suggest that MRI can be safely performed in select patients with pacemakers and implantable cardioverter defibrillators by following a standardized protocol. We created an institutional protocol, made accessible as an online form, that is primarily technologist-driven and does not require direct electrophysiologist supervision. The purpose of this study was to evaluate the PACEDMRI protocol for screening and completing MRI in patients with MR conditional CIEDs. SUBJECTS AND METHODS After the implementation of our standardized PACED-MRI protocol, patients with MR conditional CIEDs who were referred for MRI were included in the study. On the day of the MRI, the device company representative utilized our protocol accessed through PACEDMRI.com. If all parameters and criteria within the protocol were met, the examination proceeded. The device representative programed the CIED to the appropriate mode for MRI as instructed by the PACED-MRI protocol. CIED interrogation was performed immediately before and after MRI. The on-call electrophysiology nurse practitioner was notified only if the protocol instructed the team to not proceed with MRI. CIED programming changes, malfunctions, and intraprocedural events were documented. Additionally, any adverse outcomes were recorded including peri-MRI symptom onset, arrhythmia, and death. RESULTS One hundred thirty-eight MRI examinations were performed on patients with MR conditional CIEDs (100 pacemakers: 38 implantable cardiac defibrillators). There was no incidence of symptom onset requiring early termination of the MRI, death, or arrhythmic events during or after MRI. No significant changes in lead parameters, including sensing amplitudes, lead thresholds, or lead impedances were noted on post-MRI device interrogation. Out of the 138 completed MRIs, the on-call electrophysiology provider was notified on one, non-urgent occasion. CONCLUSION The implementation of the standardized, technologists-driven PACED-MRI protocol allowed for a multidisciplinary approach to MRI for patients with MR conditional CIEDs. This study demonstrates that the PACED-MRI protocol can be used for patients with MR conditional CIEDs undergoing MRI without the need for direct electrophysiologist supervision.
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Affiliation(s)
- Elliott Goodwin
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
| | - Benjamin Fogelson
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James W Cox
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - William J Mahlow
- Department of Cardiology, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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Ng J, Gregucci F, Pennell RT, Nagar H, Golden EB, Knisely JPS, Sanfilippo NJ, Formenti SC. MRI-LINAC: A transformative technology in radiation oncology. Front Oncol 2023; 13:1117874. [PMID: 36776309 PMCID: PMC9911688 DOI: 10.3389/fonc.2023.1117874] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Advances in radiotherapy technologies have enabled more precise target guidance, improved treatment verification, and greater control and versatility in radiation delivery. Amongst the recent novel technologies, Magnetic Resonance Imaging (MRI) guided radiotherapy (MRgRT) may hold the greatest potential to improve the therapeutic gains of image-guided delivery of radiation dose. The ability of the MRI linear accelerator (LINAC) to image tumors and organs with on-table MRI, to manage organ motion and dose delivery in real-time, and to adapt the radiotherapy plan on the day of treatment while the patient is on the table are major advances relative to current conventional radiation treatments. These advanced techniques demand efficient coordination and communication between members of the treatment team. MRgRT could fundamentally transform the radiotherapy delivery process within radiation oncology centers through the reorganization of the patient and treatment team workflow process. However, the MRgRT technology currently is limited by accessibility due to the cost of capital investment and the time and personnel allocation needed for each fractional treatment and the unclear clinical benefit compared to conventional radiotherapy platforms. As the technology evolves and becomes more widely available, we present the case that MRgRT has the potential to become a widely utilized treatment platform and transform the radiation oncology treatment process just as earlier disruptive radiation therapy technologies have done.
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Affiliation(s)
- John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,*Correspondence: John Ng,
| | - Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Ryan T. Pennell
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Encouse B. Golden
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Said MA, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Garot P, Bousson V, Garot J. Safety, feasibility, and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Eur Heart J Cardiovasc Imaging 2023; 24:202-211. [PMID: 36214336 DOI: 10.1093/ehjci/jeac202] [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: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM). METHODS AND RESULTS Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5 T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction. Cox regression analyses were performed to determine the prognostic value of CMR parameters. The quality of CMR was rated by two observers blinded to clinical details. Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71 ± 9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI: 4.60-28.2]; and HR: 5.62 [95% CI: 2.02-16.21], both P < 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI: 2.58-14.0]; and HR: 2.28 [95% CI: 2.05-3.76]; both P < 0.001). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Lacotte
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Horvilleur
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Mina Ait Said
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Fiorella Salerno
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Laurent Fiorina
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Vladimir Manenti
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Amir Zouaghi
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris, Service de Cardiologie, Department of Cardiology and Electrophysiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Martin Nicol
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Tania Ah-Sing
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Valérie Bousson
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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Patel HN, Wang S, Rao S, Singh A, Landeras L, Besser SA, Carter S, Mishra S, Nishimura T, Shatz DY, Tung R, Nayak H, Kawaji K, Mor-Avi V, Patel AR. Impact of wideband cardiac magnetic resonance on diagnosis, decision-making and outcomes in patients with implantable cardioverter defibrillators. Eur Heart J Cardiovasc Imaging 2023; 24:181-189. [PMID: 36458878 PMCID: PMC10226743 DOI: 10.1093/ehjci/jeac227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 09/01/2022] [Accepted: 10/21/2022] [Indexed: 12/04/2022] Open
Abstract
AIMS Although myocardial scar assessment using late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging is frequently indicated for patients with implantable cardioverter defibrillators (ICDs), metal artefact can degrade image quality. With the new wideband technique designed to mitigate device related artefact, CMR is increasingly used in this population. However, the common clinical indications for CMR referral and impact on clinical decision-making and prognosis are not well defined. Our study was designed to address these knowledge gaps. METHODS AND RESULTS One hundred seventy-nine consecutive patients with an ICD (age 59 ± 13 years, 75% male) underwent CMR using cine and wideband pulse sequences for LGE imaging. Electronic medical records were reviewed to determine the reason for CMR referral, whether there was a change in clinical decision-making, and occurrence of major adverse cardiac events (MACEs). Referral indication was the most common evaluation of ventricular tachycardia (VT) substrate (n = 114, 64%), followed by cardiomyopathy (n = 53, 30%). Overall, CMR resulted in a new or changed diagnosis in 64 (36%) patients and impacted clinical management in 51 (28%). The effect on management change was highest in patients presenting with VT. A total of 77 patients (43%) experienced MACE during the follow-up period (median 1.7 years), including 65 in patients with evidence of LGE. Kaplan-Meier analysis showed that ICD patients with LGE had worse outcomes than those without LGE (P = 0.006). CONCLUSION The clinical yield from LGE CMR is high and provides management changing and meaningful prognostic information in a significant proportion of patients with ICDs.
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Affiliation(s)
- Hena N Patel
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Shuo Wang
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Swati Rao
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Amita Singh
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Luis Landeras
- Department of Radiology, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Stephanie A Besser
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Spencer Carter
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Satish Mishra
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Takuro Nishimura
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Dalise Y Shatz
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Roderick Tung
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Hemal Nayak
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Keigo Kawaji
- Illinois Institute of Technology, Department of Biomedical Engineering, Chicago, IL 60616, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Radiology, University of Chicago Medical Center, Chicago, IL 60637, USA
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Boarescu PM, Popa ID, Trifan CA, Roşian AN, Roşian ŞH. Practical Approaches to Transvenous Lead Extraction Procedures-Clinical Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:379. [PMID: 36612704 PMCID: PMC9819065 DOI: 10.3390/ijerph20010379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Transvenous lead extraction (TLE) is regarded as the first-line strategy for the management of complications associated with cardiac implantable electronic devices (CIEDs), when lead removal is mandatory. The decision to perform a lead extraction should take into consideration not only the strength of the clinical indication for the procedure but also many other factors such as risks versus benefits, extractor and team experience, and even patient preference. TLE is a procedure with a possible high risk of complications. In this paper, we present three clinical cases of patients who presented different indications of TLE and explain how the procedures were successfully performed. In the first clinical case, TLE was necessary because of device extravasation and suspicion of CIED pocket infection. In the second clinical case, TLE was necessary because occlusion of the left subclavian vein was found when an upgrade to cardiac resynchronization therapy was performed. In the last clinical case, TLE was necessary in order to remove magnetic resonance (MR) non-conditional leads, so the patient could undergo an MRI examination for the management of a brain tumor.
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Affiliation(s)
- Paul-Mihai Boarescu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Gheorghe Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Iulia Diana Popa
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Cătălin Aurelian Trifan
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiovascular Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
| | - Adela Nicoleta Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
| | - Ştefan Horia Roşian
- “Niculae Stăncioiu” Heart Institute Cluj-Napoca, Calea Moților Street, No. 19-21, 400001 Cluj-Napoca, Romania
- Department of Cardiology—Heart Institute, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 19-21 Calea Moților Street, 400001 Cluj-Napoca, Romania
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Fyenbo DB, Jensen MSK, Kronborg MB, Kristensen J, Nielsen JC, Witt CT. Magnetic resonance imaging in patients with temporary external pacemakers. Europace 2022; 24:1960-1966. [PMID: 36006800 DOI: 10.1093/europace/euac147] [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: 04/06/2022] [Accepted: 07/16/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS To describe safety and feasibility of magnetic resonance imaging (MRI) in patients with transvenous temporary external pacemakers and whether artefacts affect the diagnostic image quality during cardiac MRI. METHODS AND RESULTS We reviewed records of all patients treated with temporary external pacing between 2016 and 2020 at a tertiary centre. Temporary pacing was established using a transvenous standard active fixation pacing lead inserted percutaneously and connected to a MRI-conditional pacemaker taped to the skin. All patients undergoing cardiac or non-cardiac MRI during temporary transvenous pacing were identified. Before MRI, devices were programmed according to guidelines for permanent pacemakers, and patients were monitored with continuous electrocardiogram during MRI. Of 827 consecutive patients receiving a temporary external pacemaker, a total of 44 (5%) patients underwent MRI (mean age 71 years, 13 [30%] females). Cardiac MRI was performed in 22 (50%) patients, while MRI of cerebrum, spine, and other regions was performed in the remaining patients. Median time from implantation of the temporary device to MRI was 6 (3-11) days. During MRI, we observed no device-related malfunction or arrhythmia. Nor did we detect any change in lead sensing, impedance, or pacing threshold. We observed no artefacts from the lead or pacemaker compromising the diagnostic image quality of cardiac MRI. MRI provided information to guide the clinical management in all cases. CONCLUSION MRI is feasible and safe in patients with temporary external pacing established with a regular MRI-conditional pacemaker and a standard active fixation lead. No artefacts compromised the diagnostic image quality.
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Affiliation(s)
- Daniel Benjamin Fyenbo
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Morten Steen Kvistholm Jensen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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36
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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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37
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Nguyen A, Kumar S, Kulkarni AA. Nanotheranostic Strategies for Cancer Immunotherapy. SMALL METHODS 2022; 6:e2200718. [PMID: 36382571 PMCID: PMC11056828 DOI: 10.1002/smtd.202200718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Despite advancements in cancer immunotherapy, heterogeneity in tumor response impose barriers to successful treatments and accurate prognosis. Effective therapy and early outcome detection are critical as toxicity profiles following immunotherapies can severely affect patients' quality of life. Existing imaging techniques, including positron emission tomography, computed tomography, magnetic resonance imaging, or multiplexed imaging, are often used in clinics yet suffer from limitations in the early assessment of immune response. Conventional strategies to validate immune response mainly rely on the Response Evaluation Criteria in Solid Tumors (RECIST) and the modified iRECIST for immuno-oncology drug trials. However, accurate monitoring of immunotherapy efficacy is challenging since the response does not always follow conventional RECIST criteria due to delayed and variable kinetics in immunotherapy responses. Engineered nanomaterials for immunotherapy applications have significantly contributed to overcoming these challenges by improving drug delivery and dynamic imaging techniques. This review summarizes challenges in recent immune-modulation approaches and traditional imaging tools, followed by emerging developments in three-in-one nanoimmunotheranostic systems co-opting nanotechnology, immunotherapy, and imaging. In addition, a comprehensive overview of imaging modalities in recent cancer immunotherapy research and a brief outlook on how nanotheranostic platforms can potentially advance to clinical translations for the field of immuno-oncology is presented.
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Affiliation(s)
- Anh Nguyen
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, USA
| | - Sahana Kumar
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, USA
| | - Ashish A. Kulkarni
- Department of Chemical Engineering, University of Massachusetts, Amherst, MA, USA
- Center for Bioactive Delivery, Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA, USA
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Penso M, Babbaro M, Moccia S, Guglielmo M, Carerj ML, Giacari CM, Chiesa M, Maragna R, Rabbat MG, Barison A, Martini N, Pepi M, Caiani EG, Pontone G. Cardiovascular magnetic resonance images with susceptibility artifacts: artificial intelligence with spatial-attention for ventricular volumes and mass assessment. J Cardiovasc Magn Reson 2022; 24:62. [PMID: 36437452 PMCID: PMC9703740 DOI: 10.1186/s12968-022-00899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Segmentation of cardiovascular magnetic resonance (CMR) images is an essential step for evaluating dimensional and functional ventricular parameters as ejection fraction (EF) but may be limited by artifacts, which represent the major challenge to automatically derive clinical information. The aim of this study is to investigate the accuracy of a deep learning (DL) approach for automatic segmentation of cardiac structures from CMR images characterized by magnetic susceptibility artifact in patient with cardiac implanted electronic devices (CIED). METHODS In this retrospective study, 230 patients (100 with CIED) who underwent clinically indicated CMR were used to developed and test a DL model. A novel convolutional neural network was proposed to extract the left ventricle (LV) and right (RV) ventricle endocardium and LV epicardium. In order to perform a successful segmentation, it is important the network learns to identify salient image regions even during local magnetic field inhomogeneities. The proposed network takes advantage from a spatial attention module to selectively process the most relevant information and focus on the structures of interest. To improve segmentation, especially for images with artifacts, multiple loss functions were minimized in unison. Segmentation results were assessed against manual tracings and commercial CMR analysis software cvi42(Circle Cardiovascular Imaging, Calgary, Alberta, Canada). An external dataset of 56 patients with CIED was used to assess model generalizability. RESULTS In the internal datasets, on image with artifacts, the median Dice coefficients for end-diastolic LV cavity, LV myocardium and RV cavity, were 0.93, 0.77 and 0.87 and 0.91, 0.82, and 0.83 in end-systole, respectively. The proposed method reached higher segmentation accuracy than commercial software, with performance comparable to expert inter-observer variability (bias ± 95%LoA): LVEF 1 ± 8% vs 3 ± 9%, RVEF - 2 ± 15% vs 3 ± 21%. In the external cohort, EF well correlated with manual tracing (intraclass correlation coefficient: LVEF 0.98, RVEF 0.93). The automatic approach was significant faster than manual segmentation in providing cardiac parameters (approximately 1.5 s vs 450 s). CONCLUSIONS Experimental results show that the proposed method reached promising performance in cardiac segmentation from CMR images with susceptibility artifacts and alleviates time consuming expert physician contour segmentation.
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Affiliation(s)
- Marco Penso
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Mario Babbaro
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Sara Moccia
- The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Marco Guglielmo
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Maria Ludovica Carerj
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
- Department of Biomedical Sciences and Morphological and Functional Imaging, “G. Martino” University Hospital Messina, Messina, Italy
| | - Carlo Maria Giacari
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Mattia Chiesa
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
| | - Riccardo Maragna
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Mark G. Rabbat
- Loyola University of Chicago, Chicago, IL USA
- Edward Hines Jr. VA Hospital, Hines, IL USA
| | | | | | - Mauro Pepi
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
| | - Enrico G. Caiani
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
- Istituto di Elettronica e di Ingegneria dell’Informazione e delle Telecomunicazioni, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy
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Fluschnik N, Tahir E, Erley J, Müllerleile K, Metzner A, Wenzel JP, Guerreiro H, Adam G, Blankenberg S, Kirchhof P, Tönnis T, Nikorowitsch J. 3 Tesla magnetic resonance imaging in patients with cardiac implantable electronic devices: a single centre experience. Europace 2022; 25:571-577. [PMID: 36413601 PMCID: PMC9935018 DOI: 10.1093/europace/euac213] [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: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Three Tesla (T) magnetic resonance imaging (MRI) provides critical imaging information for many conditions. Owing to potential interactions of the magnetic field, it is largely withheld from patients with cardiac implantable electronic devices (CIEDs). Therefore, we assessed the safety of 3T MRI in patients with '3T MRI-conditional' and 'non-3T MRI-conditional' CIEDs. METHODS AND RESULTS We performed a retrospective single-centre analysis of clinically indicated 3T MRI examinations in patients with conventional pacemakers, cardiac resynchronization devices, and implanted defibrillators from April 2020 to May 2022. All CIEDs were interrogated and programmed before and after scanning. Adverse events included all-cause death, arrhythmias, loss of capture, inappropriate anti-tachycardia therapies, electrical reset, and lead or generator failure during or shortly after MRI. Changes in signal amplitude and lead impedance were systematically assessed. Statistics included median and interquartile range. A total of 132 MRI examinations were performed on a 3T scanner in 97 patients. Thirty-five examinations were performed in patients with 'non-3T MRI-conditional' CIEDs. Twenty-six scans were performed in pacemaker-dependent patients. No adverse events occurred during or shortly after MRI. P-wave or R-wave reductions ≥ 50 and ≥ 25%, respectively, were noted after three (2.3%) scans, all in patients with '3T MRI-conditional' CIEDs. Pacing and shock impedance changed by ± 30% in one case (0.7%). Battery voltage and stimulation thresholds did not relevantly change after MRI. CONCLUSION Pending verification in independent series, our data suggest that clinically indicated MRI scans at 3T field strength should not be withheld from patients with cardiac pacemakers or defibrillators.
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Affiliation(s)
- Nina Fluschnik
- Corresponding author. Phone: +49 (0) 40 7410 18576, Fax: +49 (0) 40 7410 58206, E-mail address:
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tobias Tönnis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
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40
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Bai R, He X, Huang J. A basic study for the molecular imaging of dual-energy CT in diagnosing anterior cruciate ligament injury of knee joint. Acta Radiol 2022; 64:1589-1599. [PMID: 36357954 DOI: 10.1177/02841851221135853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Anterior cruciate ligament (ACL) injury is a common disease in clinical practice that seriously affects the daily life of patients. Purpose To explore the molecular imaging basis of “diminution sign on dual-energy colour mapping” for the diagnosis of ACL injury by dual-energy computed tomography (DECT). Material and Methods The hydroxylysine and hydroxyproline reagents were prepared in different concentrations. The grouping was shown as follows: a simple concentration change group of an amino acid (group 1/2); a mixed solution group with the concentration increasing synchronously (group 3); a mixed solution group with the concentration reverse increasing and decreasing (group 4); and a mixed solution group that fix one amino acid with increasing concentration of the other (group 5/6). The samples were scanned by DECT. The solution CT value and image signal-to-noise ratio were analyzed. Results In group 1/2, the brightness of the dual-energy color mapping of each test tube solution and the CT value increased with increasing the concentration of amino acid. In group 6, there was no significant change in the brightness and brilliance of the dual-energy color mapping and the CT value. The remaining three groups showed an increase in the brightness and brilliance of the dual-energy color mapping and the CT value, and this increase was positively associated with the hydroxylysine concentration. Conclusion The dual-energy staining of the DECT imaging in “tendon” mode is related to hydroxylysine and hydroxyproline. Moreover, the degree of dual-energy color mapping is positively correlated with the change of CT value.
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Affiliation(s)
- Rui Bai
- Radiology Department, Gosun Medical Imaging Diagnostic Center, Guangzhou, PR China
| | - Xiaohua He
- Radiology Department, General Hospital of the Southern Theater, Guangzhou, PR China
| | - Juncheng Huang
- Radiology Department, Gosun Medical Imaging Diagnostic Center, Guangzhou, PR China
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O'Dell T, Papadaki A, Wilson SR. Anaesthesia in the MRI unit. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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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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Kim SJ, Ham H, Park YH, Choe YS, Kim YJ, Jang H, Na DL, Kim HJ, Moon SH, Seo SW. Development and clinical validation of CT-based regional modified Centiloid method for amyloid PET. Alzheimers Res Ther 2022; 14:157. [PMID: 36266688 PMCID: PMC9585745 DOI: 10.1186/s13195-022-01099-0] [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: 10/08/2021] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Background The standard Centiloid (CL) method was proposed to harmonize and quantify global 18F-labeled amyloid beta (Aβ) PET ligands using MRI as an anatomical reference. However, there is need for harmonizing and quantifying regional Aβ uptakes between ligands using CT as an anatomical reference. In the present study, we developed and validated a CT-based regional direct comparison of 18F-florbetaben (FBB) and 18F-flutemetamol (FMM) Centiloid (rdcCL). Methods For development of MRI-based or CT-based rdcCLs, the cohort consisted of 63 subjects (20 young controls (YC) and 18 old controls (OC), and 25 participants with Alzheimer’s disease dementia (ADD)). We performed a direct comparison of the FMM-FBB rdcCL method using MRI and CT images to define a common target region and the six regional VOIs of frontal, temporal, parietal, posterior cingulate, occipital, and striatal regions. Global and regional rdcCL scales were compared between MRI-based and CT-based methods. For clinical validation, the cohort consisted of 2245 subjects (627 CN, 933 MCI, and 685 ADD). Results Both MRI-based and CT-based rdcCL scales showed that FMM and FBB were highly correlated with each other, globally and regionally (R2 = 0.96~0.99). Both FMM and FBB showed that CT-based rdcCL scales were highly correlated with MRI-based rdcCL scales (R2 = 0.97~0.99). Regarding the absolute difference of rdcCLs between FMM and FBB, the CT-based method was not different from the MRI-based method, globally or regionally (p value = 0.07~0.95). In our clinical validation study, the global negative group showed that the regional positive subgroup had worse neuropsychological performance than the regional negative subgroup (p < 0.05). The global positive group also showed that the striatal positive subgroup had worse neuropsychological performance than the striatal negative subgroup (p < 0.05). Conclusions Our findings suggest that it is feasible to convert regional FMM or FBB rdcSUVR values into rdcCL scales without additional MRI scans. This allows a more easily accessible method for researchers that can be applicable to a variety of different conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-01099-0.
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Affiliation(s)
- Soo-Jong Kim
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hongki Ham
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Yu Hyun Park
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Yeong Sim Choe
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Young Ju Kim
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyemin Jang
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L. Na
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.414964.a0000 0001 0640 5613Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hee Jin Kim
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.414964.a0000 0001 0640 5613Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Seung Hwan Moon
- grid.264381.a0000 0001 2181 989XDepartment of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Won Seo
- grid.264381.a0000 0001 2181 989XDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351 Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea ,grid.264381.a0000 0001 2181 989XDepartment of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea ,grid.414964.a0000 0001 0640 5613Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
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Stühlinger M, Burri H, Vernooy K, Garcia R, Lenarczyk R, Sultan A, Brunner M, Sabbag A, Özcan EE, Ramos JT, Di Stolfo G, Suleiman M, Tinhofer F, Aristizabal JM, Cakulev I, Eidelman G, Yeo WT, Lau DH, Mulpuru SK, Nielsen JC, Heinzel F, Prabhu M, Rinaldi CA, Sacher F, Guillen R, de Pooter J, Gandjbakhch E, Sheldon S, Prenner G, Mason PK, Fichtner S, Nitta T. EHRA consensus on prevention and management of interference due to medical procedures in patients with cardiac implantable electronic devices. Europace 2022; 24:1512-1537. [PMID: 36228183 DOI: 10.1093/europace/euac040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Affiliation(s)
- Markus Stühlinger
- Department of Internal Medicine III - Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center of Heart Diseases, Zabrze, Poland
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at University Hospital Cologne, Cologne, Germany
| | - Michael Brunner
- Department of Cardiology and Medical Intensive Care, St Josefskrankenhaus, Freiburg, Germany
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Emin Evren Özcan
- Heart Rhythm Management Center, Dokuz Eylul University, İzmir, Turkey
| | - Jorge Toquero Ramos
- Cardiac Arrhythmia and Electrophysiology Unit, Cardiology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Giuseppe Di Stolfo
- Cardiac Intensive Care and Arrhythmology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mahmoud Suleiman
- Cardiology/Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | | | | | - Ivan Cakulev
- University Hospitals of Cleveland, Case Western University, Cleveland, OH, USA
| | - Gabriel Eidelman
- San Isidro's Central Hospital, Diagnóstico Maipú, Buenos Aires Province, Argentina
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Heinzel
- Department of Cardiology, Charité University Medicine, Campus Virchow-Klinikum, 13353 Berlin, Germany
| | - Mukundaprabhu Prabhu
- Associate Professor in Cardiology, In charge of EP Division, Kasturba Medical College Manipal, Manipal, Karnataka, India
| | | | - Frederic Sacher
- Bordeaux University Hospital, Univ. Bordeaux, Bordeaux, France
| | - Raul Guillen
- Sanatorio Adventista del Plata, Del Plata Adventist University Entre Rios Argentina, Entre Rios, Argentina
| | - Jan de Pooter
- Professor of Cardiology, Ghent University, Deputy Head of Clinic, Heart Center UZ Gent, Ghent, Belgium
| | - Estelle Gandjbakhch
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Institut de Cardiologie, ICAN, Paris, France
| | - Seth Sheldon
- The Department of Cardiovascular Medicine, University of Kansas Health System, Kansas City, KS 66160, USA
| | | | - Pamela K Mason
- Director, Electrophysiology Laboratory, University of Virginia, Charlottesville, VA, USA
| | - Stephanie Fichtner
- LMU Klinikum, Medizinische Klinik und Poliklinik I, Campus Großhadern, München, Germany
| | - Takashi Nitta
- Emeritus Professor, Nippon Medical School, Presiding Consultant of Cardiology, Hanyu General Hospital, Saitama, Japan
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Culbertson CJ, Perino AC, Gardner RM, Balasubramanian V, Vora N. Trends in Utilization of Magnetic Resonance Imaging for Stroke Patients With Cardiac Rhythm Devices. Neurohospitalist 2022; 12:624-631. [PMID: 36147760 PMCID: PMC9485690 DOI: 10.1177/19418744221115004] [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] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Magnetic resonance imaging (MRI) is safe for most patients with cardiovascular implantable electronic devices (CIEDs). However, patients presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) who have CIEDs may undergo MRI less frequently than patients without devices. We assessed contemporary use of MRI for patients with AIS/TIA and the effect of a recent coverage revision by the Center for Medicare and Medicaid Services (CMS) on MRI utilization. Methods Using Optum® claims data from January 2012 to June 2019, we performed an interrupted time series analysis of MRI utilization during AIS/TIA hospitalizations with the April 2018 CMS coverage revision serving as the intervention. For patients treated after the coverage revision, we used multivariable logistic regression to determine the association between lack of CIED and MRI utilization for AIS/TIA. Results We identified 417,899 patient hospitalizations for AIS/TIA, of which 30,425 (7%) had a CIED present (CIED vs non-CIED patients: age 77.6 ± 9.8 vs 72.7 ± 12.3 years; 45.5% vs 54.3% female). From 2012 to 2019, annual MRI utilization increased from 3% to 20% for CIED patients and 58% to 66% for non-CIED patients. The CMS coverage revision was associated with a 4.2% absolute additional increase in MRI utilization for CIED patients. Non-CIED patients treated after the CMS coverage revision were substantially more likely than CIED patients to undergo MRI (adjusted OR 6.7, 95% CI: 6.3-7.1, P<.001). Conclusions MRI utilization has increased for stroke patients with CIEDs but remains far lower than in similar patients without devices.
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Affiliation(s)
- Collin J. Culbertson
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Alexander C. Perino
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca M. Gardner
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Nirali Vora
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA, USA
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Neural Network Detection of Pacemakers for MRI Safety. J Digit Imaging 2022; 35:1673-1680. [PMID: 35768751 DOI: 10.1007/s10278-022-00663-2] [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: 10/31/2021] [Revised: 04/23/2022] [Accepted: 05/30/2022] [Indexed: 10/17/2022] Open
Abstract
Flagging the presence of cardiac devices such as pacemakers before an MRI scan is essential to allow appropriate safety checks. We assess the accuracy with which a machine learning model can classify the presence or absence of a pacemaker on pre-existing chest radiographs. A total of 7973 chest radiographs were collected, 3996 with pacemakers visible and 3977 without. Images were identified from information available on the radiology information system (RIS) and correlated with report text. Manual review of images by two board certified radiologists was performed to ensure correct labeling. The data set was divided into training, validation, and a hold-back test set. The data were used to retrain a pre-trained image classification neural network. Final model performance was assessed on the test set. Accuracy of 99.67% on the test set was achieved. Re-testing the final model on the full training and validation data revealed a few additional misclassified examples which are further analyzed. Neural network image classification could be used to screen for the presence of cardiac devices, in addition to current safety processes, providing notification of device presence in advance of safety questionnaires. Computational power to run the model is low. Further work on misclassified examples could improve accuracy on edge cases. The focus of many healthcare applications of computer vision techniques has been for diagnosis and guiding management. This work illustrates an application of computer vision image classification to enhance current processes and improve patient safety.
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Leitch J, Asakai H, Dawson L, Medi C, Norman M, Stevenson I, Toal E, Turnbull S, Young G. Cardiac Society of Australia and New Zealand (CSANZ) Position Statement on the Follow-Up of Cardiovascular Implantable Electronic Devices 2022. Heart Lung Circ 2022; 31:1054-1063. [PMID: 35760743 DOI: 10.1016/j.hlc.2022.05.001] [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: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 11/15/2022]
Abstract
Recognising the need for a national approach for the recommended best practice for the follow-up of implanted cardiac rhythm devices to ensure patient safety, this document has been produced by the Cardiac Society of Australia and New Zealand (CSANZ). It draws on accepted practice standards and guidelines of international electrophysiology bodies. It lays out methodology, frequency, and content of follow-up, including remote monitoring; personnel, including physician, allied health, nursing and industry; paediatric and adult congenital heart patients; and special considerations including magnetic resonance imaging scanning, perioperative management, and hazard alerts.
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Affiliation(s)
| | - James Leitch
- John Hunter Hospital, Newcastle, NSW, Australia.
| | - Hiroko Asakai
- The Children's Hospital at Westmead, Heart Centre for Children, Sydney, NSW, Australia
| | | | - Caroline Medi
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Edward Toal
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Glenn Young
- Royal Adelaide Hospital, Adelaide, SA, Australia
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Vuorinen AM, Lehtonen J, Pakarinen S, Holmström M, Kivistö S, Kaasalainen T. Cardiac Magnetic Resonance Imaging-Based Screening for Cardiac Sarcoidosis in Patients With Atrioventricular Block Requiring Temporary Pacing. J Am Heart Assoc 2022; 11:e024257. [PMID: 35658507 PMCID: PMC9238739 DOI: 10.1161/jaha.121.024257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Some myocardial diseases, such as cardiac sarcoidosis, predispose to complete atrioventricular block. The European Society of Cardiology Guidelines on cardiac pacing in 2021 recommend myocardial disease screening in patients with conduction disorder requiring pacemaker with multimodality imaging, including cardiac magnetic resonance (CMR) imaging. The ability of CMR imaging to detect myocardial disease in patients with a temporary pacing wire is not well documented. Methods and Results Our myocardial disease screening protocol is based on using an active fixation pacing lead connected to a reusable extracorporeal pacing generator (temporary permanent pacemaker) as a bridge to a permanent pacemaker. From 2011 to 2019, we identified 17 patients from our CMR database who underwent CMR imaging with a temporary permanent pacemaker for atrioventricular block. We analyzed their clinical presentations, CMR data, and pacemaker therapy. All CMRs were performed without adverse events. Pacing leads induced minor artifacts to the septal myocardial segments. The extent of late gadolinium enhancement in CMR imaging was used to screen patients for the presence of myocardial disease. Patients with evidence of late gadolinium enhancement underwent endomyocardial biopsy. If considered clinically indicated, also 18-F-fluorodeoxyglucose positron emission tomography and extracardiac tissue biopsy were performed if sarcoidosis was suspected. Eventually, 8 of 17 patients (47.1%) were diagnosed with histologically confirmed granulomatous inflammatory cardiac disease. Importantly, only 1 had a previously diagnosed extracardiac sarcoidosis at the time of presentation with high-degree atrioventricular block. Conclusions CMR imaging with temporary permanent pacemaker protocol is an effective and safe early screening tool for myocardial disease in patients presenting with atrioventricular block requiring immediate, continuous pacing for bradycardia.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jukka Lehtonen
- Heart and Lung Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sami Pakarinen
- Haartman HospitalUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Miia Holmström
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sari Kivistö
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Touko Kaasalainen
- Radiology HUS Diagnostic CenterUniversity of Helsinki and Helsinki University Hospital Helsinki Finland
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Bosch R. Nachsorge und MRT-Untersuchungen bei Patienten mit implantierten kardialen Aggregaten. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1738-0778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungIn den 2021 publizierten ESC-Leitlinien wird im Rahmen des Kapitels über die Aggregatnachsorge insbesondere die Bedeutung der Telemetrie hervorgehoben. Durch eine telemetrische Nachsorge
sind wesentlich seltener Präsenznachsorgen notwendig bei gleichwertiger oder sogar verbesserter Sicherheit. Eine telemetrische Überwachung sollte daher bei allen Patienten mit CIED erwogen
werden.Die Leitlinien beschreiben detailliert die Möglichkeiten und Einschränkungen von MRT-Untersuchungen bei Patienten mit CIED. Programmierempfehlungen für die verschiedenen Hersteller werden
dargestellt. Unter Einhaltung entsprechender Sicherheitsstandards kann eine MRT auch ohne größeres Risiko bei Patienten mit nicht MRT-kompatiblen Systemen erfolgen.
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Affiliation(s)
- Ralph Bosch
- Cardiology, Cardio-Centrum Ludwigsburg-Bietigheim, Ludwigsburg, Deutschland
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50
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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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