1
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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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Reiter T, Weiss I, Weber OM, Bauer WR. Three-dimensional assessment of image distortion induced by active cardiac implants in 3.0T CMR. Sci Rep 2024; 14:11130. [PMID: 38750100 PMCID: PMC11096309 DOI: 10.1038/s41598-024-61283-0] [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: 09/13/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
CMR at 3.0T in the presence of active cardiac implants remains a challenge due to susceptibility artifacts. Beyond a signal void that cancels image information, magnetic field inhomogeneities may cause distorted appearances of anatomical structures. Understanding influencing factors and the extent of distortion are a first step towards optimizing the image quality of CMR with active implants at 3.0T. All measurements were obtained at a clinical 3.0T scanner. An in-house designed phantom with a 3D cartesian grid of water filled spheres was used to analyze the distortion caused by four representative active cardiac devices (cardiac loop recorder, pacemaker, 2 ICDs). For imaging a gradient echo (3D-TFE) sequence and a turbo spin echo (2D-TSE) sequence were used. The work defines metrics to quantify the different features of distortion such as changes in size, location and signal intensity. It introduces a specialized segmentation technique based on a reaction-diffusion-equation. The distortion features are dependent on the amount of magnetic material in the active implants and showed a significant increase when measured with the 3D TFE compared to the 2D TSE. This work presents a quantitative approach for the evaluation of image distortion at 3.0T caused by active cardiac implants and serves as foundation for both further optimization of sequences and devices but also for planning of imaging procedures.
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Affiliation(s)
- Theresa Reiter
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany.
- German Heart Center Munich, Electrophysiology, Munich, Germany.
| | | | | | - Wolfgang R Bauer
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany
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3
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Epstein R, Yomogida M, Donovan D, Butensky A, Aidala AA, Farooqi KM, Shah AM, Chelliah A, DiLorenzo MP. Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study. J Cardiovasc Comput Tomogr 2024; 18:267-273. [PMID: 38360501 DOI: 10.1016/j.jcct.2024.02.002] [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: 11/06/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. METHODS A 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. RESULTS Forty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. CONCLUSION While CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.
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Affiliation(s)
- Rebecca Epstein
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
| | - Maiko Yomogida
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Denis Donovan
- Division of Cardiology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Adam Butensky
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Angela A Aidala
- Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Kanwal M Farooqi
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Amee M Shah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
| | - Anjali Chelliah
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA; Division of Cardiology, Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA
| | - Michael P DiLorenzo
- Division of Cardiology, Department of Pediatrics, Columbia University Irving Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, USA
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4
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Kligerman S. Cardiac MRI Field Strength: Point-If I Could Only Have a Single MRI System, Why I Would Opt for a 1.5-T Scanner Over a 3-T Scanner. AJR Am J Roentgenol 2024; 222:e2330097. [PMID: 37729553 DOI: 10.2214/ajr.23.30097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Seth Kligerman
- Department of Diagnostic Radiology, National Jewish Health, 1400 Jackson St, Denver, CO 80206
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5
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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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6
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Kufel J, Bargieł-Łączek K, Koźlik M, Czogalik Ł, Dudek P, Magiera M, Bartnikowska W, Lis A, Paszkiewicz I, Kocot S, Cebula M, Gruszczyńska K, Nawrat Z. Chest X-ray Foreign Objects Detection Using Artificial Intelligence. J Clin Med 2023; 12:5841. [PMID: 37762783 PMCID: PMC10531506 DOI: 10.3390/jcm12185841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Diagnostic imaging has become an integral part of the healthcare system. In recent years, scientists around the world have been working on artificial intelligence-based tools that help in achieving better and faster diagnoses. Their accuracy is crucial for successful treatment, especially for imaging diagnostics. This study used a deep convolutional neural network to detect four categories of objects on digital chest X-ray images. The data were obtained from the publicly available National Institutes of Health (NIH) Chest X-ray (CXR) Dataset. In total, 112,120 CXRs from 30,805 patients were manually checked for foreign objects: vascular port, shoulder endoprosthesis, necklace, and implantable cardioverter-defibrillator (ICD). Then, they were annotated with the use of a computer program, and the necessary image preprocessing was performed, such as resizing, normalization, and cropping. The object detection model was trained using the You Only Look Once v8 architecture and the Ultralytics framework. The results showed not only that the obtained average precision of foreign object detection on the CXR was 0.815 but also that the model can be useful in detecting foreign objects on the CXR images. Models of this type may be used as a tool for specialists, in particular, with the growing popularity of radiology comes an increasing workload. We are optimistic that it could accelerate and facilitate the work to provide a faster diagnosis.
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Affiliation(s)
- Jakub Kufel
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland;
| | - Katarzyna Bargieł-Łączek
- Paediatric Radiology Students’ Scientific Association at the Division of Diagnostic Imaging, 40-752 Katowice, Poland; (K.B.-Ł.); (W.B.)
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Maciej Koźlik
- Division of Cardiology and Structural Heart Disease, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Łukasz Czogalik
- Professor Zbigniew Religa Student Scientific Association at the Department of Biophysic, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland; (Ł.C.); (P.D.); (M.M.); (I.P.)
| | - Piotr Dudek
- Professor Zbigniew Religa Student Scientific Association at the Department of Biophysic, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland; (Ł.C.); (P.D.); (M.M.); (I.P.)
| | - Mikołaj Magiera
- Professor Zbigniew Religa Student Scientific Association at the Department of Biophysic, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland; (Ł.C.); (P.D.); (M.M.); (I.P.)
| | - Wiktoria Bartnikowska
- Paediatric Radiology Students’ Scientific Association at the Division of Diagnostic Imaging, 40-752 Katowice, Poland; (K.B.-Ł.); (W.B.)
| | - Anna Lis
- Cardiology Students’ Scientific Association at the III Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Iga Paszkiewicz
- Professor Zbigniew Religa Student Scientific Association at the Department of Biophysic, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland; (Ł.C.); (P.D.); (M.M.); (I.P.)
| | - Szymon Kocot
- Bright Coders’ Factory, Technologiczna 2, 45-839 Opole, Poland;
| | - Maciej Cebula
- Individual Specialist Medical Practice, 40-754 Katowice, Poland;
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Zbigniew Nawrat
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19, 41-808 Zabrze, Poland;
- Foundation of Cardiac Surgery Development, 41-800 Zabrze, Poland
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Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population. J Am Acad Orthop Surg 2023; 31:e403-e411. [PMID: 36853883 DOI: 10.5435/jaaos-d-22-00634] [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] [Received: 07/12/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures. Special considerations are needed for these patients to prevent device damage or malfunction, which can pose additional risk to the patient. Additional planning before surgery is necessary to ensure appropriate equipment, and staff are available to ensure patient safety.
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8
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Mirzai S, Eck BL, Chen PH, Estep JD, Tang WHW. Current Approach to the Diagnosis of Sarcopenia in Heart Failure: A Narrative Review on the Role of Clinical and Imaging Assessments. Circ Heart Fail 2022; 15:e009322. [PMID: 35924562 PMCID: PMC9588634 DOI: 10.1161/circheartfailure.121.009322] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sarcopenia has been established as a predictor of poor outcomes in various clinical settings. It is particularly prevalent in heart failure, a clinical syndrome that poses significant challenges to health care worldwide. Despite this, sarcopenia remains overlooked and undertreated in cardiology practice. Understanding the currently proposed diagnostic process is paramount for the early detection and treatment of sarcopenia to mitigate downstream adverse health outcomes.
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Affiliation(s)
- Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Brendan L. Eck
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Po-Hao Chen
- Section of Musculoskeletal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Jerry D. Estep
- Department of Cardiology, Cleveland Clinic Florida, Weston, FL
| | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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White RD, Demirer M, Gupta V, Sebro RA, Kusumoto FM, Erdal BS. Pre-deployment assessment of an AI model to assist radiologists in chest X-ray detection and identification of lead-less implanted electronic devices for pre-MRI safety screening: realized implementation needs and proposed operational solutions. J Med Imaging (Bellingham) 2022; 9:054504. [PMID: 36310648 PMCID: PMC9603740 DOI: 10.1117/1.jmi.9.5.054504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/23/2022] [Indexed: 09/29/2023] Open
Abstract
Purpose Chest X-ray (CXR) use in pre-MRI safety screening, such as for lead-less implanted electronic device (LLIED) recognition, is common. To assist CXR interpretation, we "pre-deployed" an artificial intelligence (AI) model to assess (1) accuracies in LLIED-type (and consequently safety-level) identification, (2) safety implications of LLIED nondetections or misidentifications, (3) infrastructural or workflow requirements, and (4) demands related to model adaptation to real-world conditions. Approach A two-tier cascading methodology for LLIED detection/localization and identification on a frontal CXR was applied to evaluate the performance of the original nine-class AI model. With the unexpected early appearance of LLIED types during simulated real-world trialing, retraining of a newer 12-class version preceded retrialing. A zero footprint (ZF) graphical user interface (GUI)/viewer with DICOM-based output was developed for inference-result display and adjudication, supporting end-user engagement and model continuous learning and/or modernization. Results During model testing or trialing using both the nine-class and 12-class models, robust detection/localization was consistently 100%, with mAP 0.99 from fivefold cross-validation. Safety-level categorization was high during both testing ( AUC ≥ 0.98 and ≥ 0.99 , respectively) and trialing (accuracy 98% and 97%, respectively). LLIED-type identifications by the two models during testing (1) were 98.9% and 99.5% overall correct and (2) consistently showed AUC ≥ 0.92 (1.00 for 8/9 and 9/12 LLIED-types, respectively). Pre-deployment trialing of both models demonstrated overall type-identification accuracies of 94.5% and 95%, respectively. Of the small number of misidentifications, none involved MRI-stringently conditional or MRI-unsafe types of LLIEDs. Optimized ZF GUI/viewer operations led to greater user-friendliness for radiologist engagement. Conclusions Our LLIED-related AI methodology supports (1) 100% detection sensitivity, (2) high identification (including MRI-safety) accuracy, and (3) future model deployment with facilitated inference-result display and adjudication for ongoing model adaptation to future real-world experiences.
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Affiliation(s)
- Richard D. White
- Mayo Clinic, Department of Radiology, Center for Augmented Intelligence in Imaging, Jacksonville, Florida, United States
| | - Mutlu Demirer
- Mayo Clinic, Department of Radiology, Center for Augmented Intelligence in Imaging, Jacksonville, Florida, United States
| | - Vikash Gupta
- Mayo Clinic, Department of Radiology, Center for Augmented Intelligence in Imaging, Jacksonville, Florida, United States
| | - Ronnie A. Sebro
- Mayo Clinic, Department of Radiology, Center for Augmented Intelligence in Imaging, Jacksonville, Florida, United States
| | - Frederick M. Kusumoto
- Mayo Clinic, Department of Cardiovascular Medicine, Jacksonville, Florida, United States
| | - Barbaros Selnur Erdal
- Mayo Clinic, Department of Radiology, Center for Augmented Intelligence in Imaging, Jacksonville, Florida, United States
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10
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Compact pediatric cardiac magnetic resonance imaging protocols. Pediatr Radiol 2022:10.1007/s00247-022-05447-y. [PMID: 35821442 DOI: 10.1007/s00247-022-05447-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/25/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Cardiac MRI is in many respects an ideal modality for pediatric cardiovascular imaging, enabling a complete noninvasive assessment of anatomy, morphology, function and flow in one radiation-free and potentially non-contrast exam. Nonetheless, traditionally lengthy and complex imaging acquisition strategies have often limited its broader use beyond specialized centers. In this review, the author presents practical cardiac MRI imaging protocols to facilitate the performance of succinct yet successful exams that provide the most salient clinical data for the majority of congenital and acquired pediatric cardiac disease. In addition, the author reviews newer and evolving techniques that permit more rapid but similarly diagnostic MRI, including compressed sensing and artificial intelligence/machine learning reconstruction, four-dimensional flow acquisition and blood pool contrast agents. With the modern armamentarium of cardiac MRI methods, the goal of compact yet comprehensive exams in children can now be realized.
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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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Chyou JY, Sanz J. Chest Computed Tomography Imaging and Cardiac Implantable Electronic Devices. J Cardiovasc Electrophysiol 2022; 33:1341-1343. [DOI: 10.1111/jce.15476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Janice Y Chyou
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
| | - Javier Sanz
- Icahn School of Medicine at Mount Sinai, Medicine, CardiologyNew YorkNYUSA
- Icahn School of Medicine at Mount Sinai, Diagnostic, Molecular and Interventional RadiologyNew YorkNYUSA
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13
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Amaral AP, Montgomery JA. Remote Programming of Cardiac Implantable Electronic Devices for MRI: Are We Ready to Change the Channel? J Cardiovasc Electrophysiol 2022; 33:1010-1012. [PMID: 35245404 DOI: 10.1111/jce.15438] [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: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
Magnetic resonance imaging (MRI) has become an indispensable diagnostic tool across many fields of clinical medicine. Although reprogramming of cardiac implantable electronic devices (CIEDs) for MRI is now routine at most institutions, early experiences were notable for potential adverse effects such as device-related heating, device or lead movement, and device malfunction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ansel Philip Amaral
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jay Alan Montgomery
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN
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Siddamsetti S, Shinn A, Gautam S. Remote Programming of Cardiac Implantable Electronic Devices: A Novel Approach to Program Cardiac Devices for Magnetic Resonance Imaging. J Cardiovasc Electrophysiol 2022; 33:1005-1009. [PMID: 35243710 DOI: 10.1111/jce.15434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/13/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic Resonance imaging (MRI) in patients with MRI-conditional cardiovascular implantable electronic devices (CIED) remain a logistical issue for device programming during the scan. In current practice, a trained person needs to be present on-site to program CIED for MRI scan. This can cause delay in patient care, rescheduling of tests and increase healthcare costs. A novel remote programming (RP) strategy can be utilized to reprogram the CIED remotely. We sought to explore the feasibility and safety of RP of CIEDs in patients undergoing MRI scan. METHODS We implemented the Medtronic CIED RP software at our institution after ensuring HIPAA compliance. The MRI technician started the session by contacting an off-site remote operator and placing a programmer wand from the 2090 Medtronic programmer over the CIED. The remote operator logged into a remote access software and provided a unique access code to the MRI technician. After entering the access code into the programmer, the remote operator was able to program the device as needed. We conducted a periodic audit of the first 209 patients who underwent RP of CIEDs for MRI. Outcomes analyzed were successful completion of RP sessions and time saved per scan. RESULTS Of the 209 MRI scans, 51 scans were performed urgently. There were no connectivity and programming problems or need for MRI rescheduling. In-person reprogramming was not required for any patient. All scans were completed safely in a timely manner, and there were no reports of CIED malfunction. Time saved per scan was estimated to be 28 +/-10 minutes. CONCLUSIONS Remote programming of CIEDs for MRI scans is a safe and effective strategy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sisir Siddamsetti
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Alexander Shinn
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri Columbia, Columbia, Missouri
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Motazedian P, Prosperi-Porta G, Ahmed M, Hafeez M, Merchant N, Heydari B. Stress perfusion cardiac MRI with a 3.0 Tesla Scanner for myocardial viability in a patient with a conditional pacemaker. CJC Open 2022; 4:581-584. [PMID: 35734513 PMCID: PMC9207775 DOI: 10.1016/j.cjco.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
Cardiac magnetic resonance (CMR) imaging provides images with high spatial and temporal resolution, with high diagnostic and prognostic performance. An abundance of data indicate the safety and efficacy of noncardiac magnetic resonance imaging at both 1.5 Tesla (T) and 3T in patients with cardiac implantable electronic devices (CIEDs). Safety and efficacy have also been evaluated for stress perfusion (SP)-CMR for pateints with CIEDs, using 1.5T scanners, but no previous reports have been made of SP-CMR using 3T scanners. Herein, we report a case of a patient with a CIED who successfully and safely underwent SP-CMR imaging using a 3T scanner.
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Ramirez-Suarez KI, Otero HJ, Biko DM, Dori Y, Smith CL, Feudtner C, White AM. Magnetic resonance lymphangiography in post-Fontan palliation patients with MR non-conditional cardiac electronic devices: An institutional experience. Clin Imaging 2022; 86:43-52. [DOI: 10.1016/j.clinimag.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
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17
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Kim UH, Kim MY, Park EA, Lee W, Lim WH, Kim HL, Oh S, Jin KN. Deep Learning-Based Algorithm for the Detection and Characterization of MRI Safety of Cardiac Implantable Electronic Devices on Chest Radiographs. Korean J Radiol 2021; 22:1918-1928. [PMID: 34431249 PMCID: PMC8546129 DOI: 10.3348/kjr.2021.0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/07/2021] [Indexed: 02/02/2023] Open
Abstract
Objective With the recent development of various MRI-conditional cardiac implantable electronic devices (CIEDs), the accurate identification and characterization of CIEDs have become critical when performing MRI in patients with CIEDs. We aimed to develop and evaluate a deep learning-based algorithm (DLA) that performs the detection and characterization of parameters, including MRI safety, of CIEDs on chest radiograph (CR) in a single step and compare its performance with other related algorithms that were recently developed. Materials and Methods We developed a DLA (X-ray CIED identification [XCID]) using 9912 CRs of 958 patients with 968 CIEDs comprising 26 model groups from 4 manufacturers obtained between 2014 and 2019 from one hospital. The performance of XCID was tested with an external dataset consisting of 2122 CRs obtained from a different hospital and compared with the performance of two other related algorithms recently reported, including PacemakerID (PID) and Pacemaker identification with neural networks (PPMnn). Results The overall accuracies of XCID for the manufacturer classification, model group identification, and MRI safety characterization using the internal test dataset were 99.7% (992/995), 97.2% (967/995), and 98.9% (984/995), respectively. These were 95.8% (2033/2122), 85.4% (1813/2122), and 92.2% (1956/2122), respectively, with the external test dataset. In the comparative study, the accuracy for the manufacturer classification was 95.0% (152/160) for XCID and 91.3% for PPMnn (146/160), which was significantly higher than that for PID (80.0%,128/160; p < 0.001 for both). XCID demonstrated a higher accuracy (88.1%; 141/160) than PPMnn (80.0%; 128/160) in identifying model groups (p < 0.001). Conclusion The remarkable and consistent performance of XCID suggests its applicability for detection, manufacturer and model identification, as well as MRI safety characterization of CIED on CRs. Further studies are warranted to guarantee the safe use of XCID in clinical practice.
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Affiliation(s)
- Ue-Hwan Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Moon Young Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Eun-Ah Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Medical Research Collaborating Center, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Nam Jin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.
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Is diversity harmful?-Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging. Wien Klin Wochenschr 2021; 134:286-293. [PMID: 34402991 PMCID: PMC9023390 DOI: 10.1007/s00508-021-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
Background Many patients with cardiac implantable electronic devices (CIED) undergo magnetic resonance imaging (MRI); however, a relevant proportion have a CIED system that has not been classified as MRI-conditional because of generators and leads from different brands (mixed-brand group). The available data concerning the outcome of these mixed patients undergoing MRI is limited. Methods A retrospective single center study, including all patients with CIEDs undergoing MRI between January 2013 until May 2020, was performed. Primary endpoints were defined as death or any adverse event necessitating hospitalization or CIED revision. Secondary endpoints were the occurrence of any sign for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with 1–9 MRIs per patient. Of the patients 38 underwent 54 procedures in the mixed-brand group and 89 patients underwent 134 MRIs in the MRI-conditional group. Of the patients 31 were excluded since the MRI conditionality could not be determined. No primary endpoints occurred within the mixed-brand group but in 2.2% of the MRI-conditional group (p = 1.000), with 2 patients developing new atrial fibrillation during MRI, of whom one additionally had a transient CIED dysfunction. No secondary endpoints were met in the mixed-brand group compared to 3.4% in the MRI-conditional group (p = 0.554). No complications occurred in the excluded patients. Conclusion The complication rate of CIED patients undergoing MRI was low. Patients with a mixed CIED system showed no signs of increased risk of adverse events compared to patients with MRI-conditional CIED systems. Supplementary Information The online version of this article (10.1007/s00508-021-01924-w) contains supplementary material, which is available to authorized users.
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Gated single-photon emission computed tomography myocardial perfusion imaging phase analysis as an imaging biomarker for mortality prediction in heart failure patients undergoing cardiac resynchronization therapy. Nucl Med Commun 2021; 42:990-997. [PMID: 34001831 DOI: 10.1097/mnm.0000000000001426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure patients. The purpose of this study was to assess the value of gated myocardial perfusion single-photon emission computed tomography (GMPS) phase analysis for predicting survival in heart failure patients undergoing CRT. METHODS This retrospective cohort study evaluated heart failure patients who underwent GMPS prior to CRT. Phase histogram bandwidth (PHB) and phase SD (PSD) were calculated using GMPS data. Cox proportional hazards model was used to identify independent predictors of overall survival (OS). RESULTS A total of 35 patients (age 65.1 ± 13.3, 27 men and 8 women), who were followed for mean of 4.1 ± 2.9 years, were enrolled in the study. PSD of greater than 45° was found to be an independent predictor of poor OS (hazard ratio = 12.63, P = 0.011) when compared with age (hazard ratio = 1.00, P = 0.922), gender (hazard ratio = 0.31, P = 0.155), NYHA class (hazard ratio = 0.45, P = 0.087), QRS duration greater than 150 ms (hazard ratio = 2.38, P = 0.401), pre-CRT left ventricular ejection fraction (LVEF) (hazard ratio = 0.95, P = 0.175) and etiology of heart failure (hazard ratio = 1.42, P = 0.641). Furthermore, PHB greater than 140° was also found to be an independent predictor of poor OS (hazard ratio = 5.63, P = 0.040) when compared with age, gender, NYHA class, QRS duration greater than 150 ms, pre-CRT LVEF and etiology of heart failure. CONCLUSIONS PSD and PHB, measured by GMPS, may serve as biomarkers for the prediction of survival in patients undergoing CRT.
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Predictors of Cardiac Implantable Electronic Device Artifact on Cardiac MRI: The Utility of a Device Related Score. Heart Lung Circ 2021; 30:1348-1355. [PMID: 33744194 DOI: 10.1016/j.hlc.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Cardiac magnetic resonance imaging (CMR) image quality can be degraded by artifact in patients with cardiac implantable electronic devices (CIED). We aimed to establish a clinical risk score, so patient selection for diagnostic CMR could be optimised. METHODS In this retrospective cohort study, CMRs performed for clinical use in subjects with CIED from January 2016 to May 2019 were reviewed. Subject anthropometry, CIED generator/lead specifications and pre-scan chest X-ray (CXR) measurements were collected. Generator-related artifact size was measured on axial steady state free precession images. Interpretability of late gadolinium enhancement (LGE) imaging was performed based on a three-grade visual score attributed to each of 17 myocardial segments. RESULTS Fifty-seven (57) patients (59±16 years, 74% male) fitted the inclusion criteria. Artifact precluded left ventricle (LV) evaluation (≥5 segments) in 17 (30%). Artifact was more common with implantable cardioverter-defibrillators, related to generator volume, mass, height, width, thickness, and area, along with right ventricular (RV) lead length and diameter (all p<0.05). Artifact was associated with distance from generator to LV apex, generator to RV lead tip and shortest distance from generator to heart on CXR (all p<0.05). On multivariable regression modelling, RV lead diameter (OR 5.861, 95% CI 1.866-18.407, p=0.002) and distance from generator to LV apex (OR 0.693, 95% CI 0.511-0.940, p=0.019) were independent predictors of artifact. Multivariable predictors were used to develop Device Related CMR Artifact Prediction Score (DR-CAPS), where all patients with DR-CAPS=0 had fully interpretable LGE imaging. CONCLUSION Simple, readily available measures, such as lead characteristics and pre-scan CXR measures, can stratify patients via an artifact prediction score to optimise selection for diagnostic CMR.
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Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions. Anatol J Cardiol 2021; 23:196-203. [PMID: 32235139 PMCID: PMC7163219 DOI: 10.14744/anatoljcardiol.2020.91572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Premature ventricular contractions (PVCs) is one of the most common situations in the current cardiology practice. Although PVCs are generally benign in people without any structural heart disease, they may be associated with left ventricular dysfunction, cardiomyopathy, and, rarely, sudden death. Recently, there has been a considerable research in the pathophysiology of PVC, several clinical presentations in different situations, new proposals of successful diagnostic methods, and treatment modalities. Finally, the American College of Cardiology Electrophysiology Council has published a special report that deals with all the aspects of PVC. We reviewed the important points from this report that can be reflected in our daily practice.
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Raptis DA, Woodard PK, Bhalla S. Keeping Pace: Our Experience With MR With Cardiac Devices. Can Assoc Radiol J 2021; 72:599-600. [PMID: 33563045 DOI: 10.1177/0846537121993080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Demetrios A Raptis
- Mallinckrodt Institute of Radiology, 7548Washington University School of Medicine, St. Louis, MO, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, 7548Washington University School of Medicine, St. Louis, MO, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, 7548Washington University School of Medicine, St. Louis, MO, USA
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Deshpande S, Kella D, Padmanabhan D. MRI in patients with cardiac implantable electronic devices: A comprehensive review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:360-372. [DOI: 10.1111/pace.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Danesh Kella
- Department of Cardiology Piedmont Heart Institute Atlanta Georgia USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
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Long Z, Kurup AN, Jensen NM, Hangiandreou NJ, Schueler BA, Yu L, Leng S, Wood CP, Felmlee JP. Initial testing of pegfilgrastim (Neulasta Onpro) on-body injector in multiple radiological imaging environments. J Appl Clin Med Phys 2021; 22:343-349. [PMID: 33395503 PMCID: PMC7856482 DOI: 10.1002/acm2.13156] [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: 06/03/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose An increasing number of implantable or external devices can impact whether patients can receive radiological imaging examinations. This study examines and tests the Neulasta (pegfilgrastim) Onpro on‐body injector in multiple imaging environments. Methods The injector was analyzed for four imaging modalities with testing protocols and strategies developed for each modality. In x‐ray and computed tomography (CT), scans with much higher exposure than clinical protocols were performed with the device attached to an anthropomorphic phantom. The device was monitored until the completion of drug delivery. For magnetic resonance imaging (MRI), the device was assessed using a hand‐held magnet and underwent the magnetically induced displacement testing in a 1.5T clinical MRI scanner room. For ultrasound, magnetic field changes were measured around an ultrasound scanner system with three transducers. Results For x‐ray and CT no sign of device error was identified during or after the high radiation exposure scans. Drug delivery was completed at expected timing with expected volume. For MRI the device showed significant attractive force towards the hand‐held magnet and a 50‐degree deflection angle at 50 cm from the opening of the scanner bore. No further assessment from the gradient or radiofrequency field was deemed necessary. For ultrasound the maximum magnetic field change from baseline was measured to be +11.7 μT in comparison to +74.2 μT at 4 inches from a working microwave. Conclusions No device performance issue was identified under the extreme test conditions in x‐ray or CT. The device was found to be MR Unsafe. Magnetic field changes around an ultrasound system met the limitation set by manufacture. Patient ultrasound scanning is considered safe as long as the transducers do not inadvertently loosen the device.
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Affiliation(s)
- Zaiyang Long
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Ikeya Y, Nakai T, Kogawa R, Kurokawa S, Nagashima K, Watanabe R, Arai M, Otsuka N, Kunimoto S, Okumura Y. Current Status and Issues Concerning Magnetic Resonance Imaging in Patients with a Magnetic Resonance Conditional Cardiac Implantable Electrical Device: A Single-center Study. Intern Med 2021; 60:1813-1818. [PMID: 34135267 PMCID: PMC8263183 DOI: 10.2169/internalmedicine.6517-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Following the introduction of magnetic resonance (MR)-conditional cardiac implantable electrical devices (CIEDs), patients with CIEDs have undergone MRI scanning more frequently. As the required settings of MRI equipment for scanning patients with a CIED vary by device, a number of precautions should be taken to allow safe examinations, including the confirmation of conditions and selection of MRI modes appropriate for pacing status in individual patients. In this study, we examined the current status and issues concerning the performance of MRI examinations in patients with an MRI-conditional CIED. Method and Results We reviewed a total of 262 MRI scans. The most common site of MRI scanning was the head, followed by the spine, abdomen, and heart in order. Regarding the MRI mode, DOO was most often used, followed by OFF, AOO, and finally VOO mode, to maintain atrioventricular synchrony. Although no obvious adverse events were observed related to MRI scanning, there were several cases encountered that might have been predisposed to a significant incident or in which the patient's intrinsic pulse rates or subjective symptoms changed before and during scanning. Conclusion As MRI is a very useful diagnostic tool for cerebrovascular diseases and orthopedic disorders, the demand for MRI scanning is high when treating these areas. Although MRI scanning in patients with MR-conditional devices was performed without any adverse events, there were incidents that could have potentially led to major harm. This highlights the importance of confirming the appropriate MRI mode is being used before scanning and monitoring patients during scanning.
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Affiliation(s)
- Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Satoshi Kunimoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Japan
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Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Almeida AG, António N, Saraiva C, Ferreira AM, Reis AH, Marques H, Ferreira ND, Oliveira M. Consensus document on magnetic resonance imaging in patients with cardiac implanted electronic devices. Rev Port Cardiol 2020; 40:41-52. [PMID: 33342713 DOI: 10.1016/j.repc.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/22/2022] Open
Abstract
Magnetic resonance imaging (MRI) is currently considered an essential complementary method for diagnosis in many conditions. Exponential growth in its use is expected due to the aging population and a broader spectrum of clinical indications. Growth in its use, coupled with an increasing number of pacemaker implants, implantable cardioverter-defibrillators and cardiac resynchronization therapy, has led to a frequent clinical need for this diagnostic modality in patients with cardiac implantable electronic devices (CIED). This clinical need has fueled the development of devices specifically designed and approved for use in a magnetic resonance (MR) environment under certain safety conditions (MR-conditional devices). More than a decade after the introduction of the first MR-conditional pacemaker, there are now several dozen MR-conditional devices with different safety specifications. In recent years, increasing evidence has indicated there is a low risk to MRI use in conventional (so-called non-MR-conditional) CIED patients in the right circumstances. The increasing number, as well as the greater diversity and complexity of implanted devices, justify the need to standardize procedures, by establishing institutional agreements that require close collaboration between cardiologists and radiologists. This consensus document, prepared jointly by the Portuguese Society of Cardiology and the Portuguese Society of Radiology and Nuclear Medicine, provides general guidelines for MRI in patients with CIED, ensuring the safety of patients, health professionals and equipment. In addition to briefly reviewing the potential risks of MRI in patients with CIED and major changes to MRI-conditional devices, this article provides specific recommendations on risk-benefit analysis, informed consent, scheduling, programming strategies, devices, monitoring and modification of MRI sequences. The main purpose of this document is to optimize patient safety and provide legal support to facilitate easy access by CIED patients to a potentially beneficial and irreplaceable diagnostic technique.
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Affiliation(s)
- Ana G Almeida
- Serviço de Cardiologia do Hospital Santa Maria, Centro Hospitalar e Universitário de Lisboa Norte, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
| | - Natália António
- Unidade de Pacing e Eletrofisiologia, Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carla Saraiva
- Serviço de Radiologia do Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - António Miguel Ferreira
- Serviço de Cardiologia do Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Unidade de Imagem Cardíaca Avançada, Hospital da Luz, Lisboa, Portugal
| | - António Hipólito Reis
- Laboratório de Pacing e Eletrofisiologia, Hospital Geral de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Hugo Marques
- Serviço de Radiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central; Unidade Imagem Cardíaca Avançada, Hospital da Luz Lisboa; Nova Medical School, Lisboa, Portugal
| | - Nuno Dias Ferreira
- Serviço de Cardiologia do Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Mário Oliveira
- Unidade de Arritmologia, Pacing e Eletrofisiologia, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Lebel K, Mondesert B, Robillard J, Pham M, Terrone D, Tan S. 2020 MR Safety for Cardiac Devices: An Update for Radiologists. Can Assoc Radiol J 2020; 72:814-830. [DOI: 10.1177/0846537120967701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a unique and powerful diagnostic tool that provides images without ionizing radiation and, at times, can be the only modality to properly assess and diagnose some pathologies. Although many patients will need an MRI in their lifetime, many of them are still being unjustly denied access to it due to what were once considered absolute contraindications, including MR nonconditional pacemakers and implantable cardioverter-defibrillators. However, there are a number of large studies that have recently demonstrated that MRI can safely be performed in these patients under certain conditions. In addition, there are an increasing number of novel cardiac devices implanted in patients who may require an MRI. Radiologists need to familiarize themselves with these devices, identify which patients with these devices can safely undergo MRI, and under which conditions. In this article, we will review the current literature on MR safety and cardiac devices, elaborate on how to safely image patients with cardiac devices, and share the expertise of our tertiary cardiac institute.
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Affiliation(s)
- Kiana Lebel
- The University of Sherbrooke, Montreal, Quebec, Canada
| | | | | | - Magali Pham
- Montreal Heart Institute, Montreal, Quebec, Canada
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Schwartz SM, Pathrose A, Serhal AM, Ragin AB, Charron J, Knight BP, Passman RS, Avery RJ, Kim D. Evaluation of image quality of wideband single-shot late gadolinium-enhancement MRI in patients with a cardiac implantable electronic device. J Cardiovasc Electrophysiol 2020; 32:138-147. [PMID: 33146422 DOI: 10.1111/jce.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION While wideband segmented, breath-hold late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) has been shown to suppress image artifacts associated with cardiac-implanted electronic devices (CIEDs), it may produce image artifacts in patients with arrhythmia and/or dyspnea. Single-shot LGE is capable of suppressing said artifacts. We sought to compare the performance of wideband single-shot free-breathing LGE against the standard and wideband-segmented LGEs in CIED patients. METHODS AND RESULTS We retrospectively identified all 54 consecutive patients (mean age: 61 ± 15 years; 31% females) with CIED who had undergone CMR with standard segmented, wideband segmented, and/or wideband single-shot LGE sequences as part of quality assurance for determining best clinical practice at 1.5 T. Two raters independently graded the conspicuity of myocardial scar or normal myocardium and the presence of device artifact level on a 5-point Likert scale (1: worst; 3: acceptable; 5: best). Summed visual score (SVS) was calculated as the sum of conspicuity and artifact scores (SVS ≥ 6 defined as diagnostically interpretable). Median conspicuity and artifact scores were significantly better for wideband single-shot LGE (F = 24.2, p < .001) and wideband-segmented LGE (F = 20.6, p < .001) compared to standard-segmented LGE. Among evaluated myocardial segments, 72% were deemed diagnostically interpretable-defined as SVS ≥ 6-for standard-segmented LGE, 89% were deemed diagnostically interpretable for wideband-segmented LGE, and 94% segments were deemed diagnostically interpretable for wideband single-shot LGE. CONCLUSIONS Wideband single-shot LGE and wideband-segmented LGE produced similarly improved image quality compared to standard LGE.
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Affiliation(s)
- Sarah M Schwartz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali M Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann B Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Charron
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley P Knight
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Department of Internal Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan J Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Kim SH, Litt HI. Surveillance Imaging following Endovascular Aneurysm Repair: State of the Art. Semin Intervent Radiol 2020; 37:356-364. [PMID: 33041481 DOI: 10.1055/s-0040-1715882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endovascular aneurysmal repair (EVAR) has become a prominent modality for the treatment of abdominal aortic aneurysm. Surveillance imaging is important for the detection of device-related complications, which include endoleak, structural abnormalities, and infection. Currently used modalities include ultrasound, X-ray, computed tomography, magnetic resonance imaging, and angiography. Understanding the advantages and drawbacks of each modality, as well available guidelines, can guide selection of the appropriate technique for individual patients. We review complications following EVAR and advances in surveillance imaging modalities.
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Affiliation(s)
- Stephanie H Kim
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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Ryan JW, Murray AS, Gilligan PJ, Bisset JM, Nolan C, Doyle A, Emerson B, Galvin JM, Murray JG. MRI safety management in patients with cardiac implantable electronic devices: Utilizing failure mode and effects analysis for risk optimization. Int J Qual Health Care 2020; 32:431-437. [PMID: 32578847 DOI: 10.1093/intqhc/mzaa067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/13/2020] [Accepted: 06/20/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Cardiac implantable electronic devices (CIEDs) are increasing in prevalence. Exposing patients with CIEDs to magnetic resonance imaging (MRI) can lead to adverse outcomes. This has led certain radiology departments to not accept MRI referrals related to patients with CIEDs. Patients with MR-conditional CIEDs can be safely scanned under specific conditions. Our institution has accepted such referrals since 2014. The aim of this study was to systematically identify and reduce risk in our CIED-MRI protocol using failure mode and effects analysis (FMEA). METHODS A multidisciplinary FMEA team was assembled and included senior stakeholders from the CIED-MRI protocol. A process map was constructed followed by risk analysis and scoring. Targeted interventions were formulated and implemented; high-risk failure modes were prioritized. A new process map and protocol were drafted and repeat risk analysis was performed. Monitoring and re-evaluation of the CIED-MRI pathway were instigated at departmental quality assurance (QA) meetings. RESULTS Interventions included direct CIED characterization using wireless technology pre-MRI, CIED programming and reprogramming in the MRI suite before and immediately after MRI reducing device downtime and continuous patient monitoring during MRI by a cardiac physiologist. The cumulative risk priority number (RPN) decreased from 1190 pre-FMEA to 492 post-FMEA. DISCUSSION Despite the risk of exposing CIEDs to the MR environment, patients with MR-conditional CIEDs can be safely scanned with an appropriate multidisciplinary support. We found FMEA an indispensable tool in identifying and minimizing risk with no adverse events recorded since FMEA recommendations were implemented.
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Affiliation(s)
- James W Ryan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | | | | | - Chris Nolan
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Audrey Doyle
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | - Barry Emerson
- Mater Private Hospital, Eccles Street, Dublin, Ireland
| | | | - John G Murray
- Mater Private Hospital, Eccles Street, Dublin, Ireland
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Cronin B, Dalia A, Nguyen QS, Sandoval K, Birgersdotter-Green U, Maus T, Essandoh MK. Perioperative Interrogation of Medtronic Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists. J Cardiothorac Vasc Anesth 2020; 34:2465-2475. [DOI: 10.1053/j.jvca.2019.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/11/2022]
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Ajala A, Zhang J, Pednekar A, Buko E, Wang L, Cheong BY, Hor PH, Muthupillai R. Mitral Valve Flow and Myocardial Motion Assessed with Dual-Echo Dual-Velocity Cardiac MRI. Radiol Cardiothorac Imaging 2020; 2:e190126. [PMID: 33778578 DOI: 10.1148/ryct.2020190126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Purpose To develop a dual-echo phase-contrast (DEPC) MRI approach with which each echo is acquired by using a different velocity sensitivity within one repetition time (TR) and demonstrate the feasibility of this approach to measure transmitral blood flow (E) and myocardial tissue (E m) velocities. Materials and Methods The flow across tubes of known diameter was measured by using the proposed DEPC method and compared with flowmeter measurements and theoretic predictions. Then, with both the DEPC MRI sequence and the conventional single-echo phase-contrast (SEPC) MRI sequence, E, E m, and E/E m were measured in six healthy volunteers (mean age, 49 years ± 13 [standard deviation]) and eight patients (mean age, 54 years ± 15) being evaluated for cardiac disease. Differences between the DEPC and conventional SEPC MRI methods were assessed by percent error, Pearson correlation, and Bland-Altman analyses. Results Velocities measured in vitro and in vivo by using the SEPC and DEPC MRI approaches were well correlated (r 2 > 0.97), with negligible bias (<0.5 cm/sec) and comparable velocity-to-noise ratios. Imaging times were approximately 19% shorter with the DEPC method (TR, 5.7 msec) than with the SEPC method (TR, 2.8 msec ± 4.2) (P < .05). Conclusion The proposed DEPC method was sensitive to two velocity regimes within a single TR, resulting in a shorter imaging time compared with the imaging time in conventional SEPC MRI. Preliminary human study results suggest the feasibility of using this approach to estimate E/E m.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Afis Ajala
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Jiming Zhang
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Amol Pednekar
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Erick Buko
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Luning Wang
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Benjamin Y Cheong
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Pei-Herng Hor
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
| | - Raja Muthupillai
- Department of Physics (A.A., E.B., P.H.H., R.M.) and Texas Center for Superconductivity (P.H.H.), University of Houston, Houston, Tex; Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.Z.); Department of Diagnostic and Interventional Radiology, CHI-St Luke's Health-Baylor St Luke's Medical Center, 6720 Bertner Ave, MC-2-270, Houston, TX 77030 (E.B., B.Y.C., R.M.); Department of Radiology, Texas Children's Hospital, Houston, Tex (A.P., L.W.); and Texas Heart Institute, Houston, Tex (B.Y.C., R.M.)
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Bonmassar G, Serano P. MRI-Induced Heating of Coils for Microscopic Magnetic Stimulation at 1.5 Tesla: An Initial Study. Front Hum Neurosci 2020; 14:53. [PMID: 32231526 PMCID: PMC7082860 DOI: 10.3389/fnhum.2020.00053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Deep brain stimulation (DBS) has proved to be effective in the treatment of movement disorders. However, the direct contact between the metal contacts of the DBS electrode and the brain can cause RF heating in magnetic resonance imaging (MRI) scanning, due to an increase of local specific absorption rate (SAR). Recently, micro coils (μMS) have demonstrated excitation of neuronal tissue through the electromagnetic induction both in vitro and in vivo experiments. In contrast to electrical stimulation, in μMS, there is no direct contact between the metal and the biological tissue. Methods We compared the heating of a μMS coil with a control case of a metal wire. The heating was induced by RF fields in a 1.5 T MRI head birdcage coil (often used for imaging patients with implants) at 64 MHz, and normalized results to 3.2 W/kg whole head average SAR. Results The μMS coil or wire implants were placed inside an anatomically accurate head saline-gel filled phantom inserted in the RF coil, and we observed approximately 1°C initial temperature rise at the μMS coil, while the wire exhibited a 10°C temperature rise in the proximity of the exposed end. The numerical simulations showed a 32-times increase of local SAR induced at the tips of the metal wire compared to the μMS. Conclusion In this work, we show with measurements and electromagnetic numerical simulations that the RF-induced increase in local SAR and induced heating during MRI scanning can be greatly reduced by using magnetic stimulation with the proposed μMS technology.
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Affiliation(s)
- Giorgio Bonmassar
- Athinoula A. Martinos Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Peter Serano
- Athinoula A. Martinos Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,ANSYS Inc., Canonsburg, PA, United States
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Premature ventricular complexes: diagnostic and therapeutic considerations in clinical practice : A state-of-the-art review by the American College of Cardiology Electrophysiology Council. J Interv Card Electrophysiol 2019; 57:5-26. [PMID: 31828560 DOI: 10.1007/s10840-019-00655-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in the clinical setting. PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death. High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy. Sometimes PVCs may be a marker of underlying pathophysiologic process such as myocarditis. Identification of PVC burden is important, since cardiomyopathy and LV dysfunction can reverse after catheter ablation or pharmacological suppression. This state-of-the-art review discusses pathophysiology, clinical manifestations, how to differentiate benign and malignant PVCs, PVCs in the structurally normal heart, underlying SHD, diagnostic procedures (physical examination, electrocardiogram, ambulatory monitoring, exercise testing, echocardiography, cardiac magnetic resonance imaging, coronary angiography, electrophysiology study), and treatment (lifestyle modification, electrolyte imbalance, medical, and catheter ablation).
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Bhuva AN, Moralee R, Moon JC, Manisty CH. Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change. Eur Radiol 2019; 30:1378-1384. [PMID: 31776746 PMCID: PMC7033076 DOI: 10.1007/s00330-019-06449-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022]
Abstract
Abstract More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this—newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.
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Affiliation(s)
- A N Bhuva
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK. .,Institute for Cardiovascular Science, University College London, London, UK.
| | - R Moralee
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK
| | - J C Moon
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
| | - C H Manisty
- Department of Cardiac Imaging, Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.,Institute for Cardiovascular Science, University College London, London, UK
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Mathew RP, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Cardiovascular implantable electronic devices, cardiac valve prostheses and Amplatzer occluder devices. SA J Radiol 2019; 23:1730. [PMID: 31754536 PMCID: PMC6837806 DOI: 10.4102/sajr.v23i1.1730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/05/2019] [Indexed: 11/25/2022] Open
Abstract
Several new innovative cardiac devices have been created over the last few decades. Chest radiographs (CXRs) are the most common imaging investigations undertaken because of their value in evaluating the cardiorespiratory system. It is important for the interpreting radiologist to not only identify these iatrogenic objects but also to assess for their accurate placement, as well as for any complications related to their placement, which may be seen either on the immediate post-procedural CXR or on a follow-up CXR.
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Affiliation(s)
- Rishi P Mathew
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy Alexander
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Pushparajah K, Duong P, Mathur S, Babu-Narayan SV. EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract 2019; 6:ERP-19-0048. [PMID: 31730044 PMCID: PMC6893312 DOI: 10.1530/erp-19-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular MRI and CT are useful imaging modalities complimentary to echocardiography. This review article describes the common indications and consideration for the use of MRI and CT in the management of congenital heart disease.
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Affiliation(s)
- Kuberan Pushparajah
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Evelina London Children’s Hospital, London, UK
| | | | - Sonya V Babu-Narayan
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
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Cunqueiro A, Lipton ML, Dym RJ, Jain VR, Sterman J, Scheinfeld MH. Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists. Clin Radiol 2019; 74:912-917. [PMID: 31431253 DOI: 10.1016/j.crad.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
Pacemakers and implantable cardioverter defibrillators are commonly encountered in clinical practice, and entails special consideration when magnetic resonance imaging (MRI) is required. It is estimated that 50-75% of patients with cardiac implantable electronic devices (CIED) will have an indication for MRI during their lifetime. Radiologists may want to recommend MRI or may be consulted about the need to perform MRI in a patient with a CIED, at which point they may need to approve or at least provide guidance as to whether MRI may be performed safely. Even in situations where final clearance will not be provided by the radiologist, he or she can provide valuable information by reviewing radiographs and determining (a) whether a device is MRI-conditional and MRI may ultimately be permitted, (b) is not MRI-conditional and MRI using the standard workflow will therefore not be approved, or (c) when additional information will clearly be required. CIED identification and verification of leads can be accomplished through review of the medical record and/or evaluation of a chest radiograph. In patients with MRI-conditional CIEDs (as well as with legacy CIEDs in those institutions that perform MRI of these patients), specific imaging protocols must be adhered to in order to prevent death or injury to the patient or damage to the device. In this update, we provide details regarding the above topics and provide an algorithm for integrating this information into a clinical workflow to efficiently triage patients with CIEDs who are being considered for MRI.
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Affiliation(s)
- A Cunqueiro
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M L Lipton
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neuroscience, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R J Dym
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - V R Jain
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - J Sterman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M H Scheinfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Okada DR, Wu KC. Applications of Cardiac MR Imaging in Electrophysiology. Magn Reson Imaging Clin N Am 2019; 27:465-473. [PMID: 31279450 DOI: 10.1016/j.mric.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nguyên UC, Cluitmans MJM, Strik M, Luermans JG, Gommers S, Wildberger JE, Bekkers SCAM, Volders PGA, Mihl C, Prinzen FW, Vernooy K. Integration of cardiac magnetic resonance imaging, electrocardiographic imaging, and coronary venous computed tomography angiography for guidance of left ventricular lead positioning. Europace 2018; 21:626-635. [DOI: 10.1093/europace/euy292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matthijs J M Cluitmans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Strik
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Justin G Luermans
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Suzanne Gommers
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul G A Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Casper Mihl
- Department of Radiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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