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Segeroth M, Winkel DJ, Vosshenrich J, Breit HC, Giese D, Haaf P, Zellweger MJ, Bremerich J, Santini F, Pradella M. Cardiac Cine MRI Using a Commercially Available 0.55-T Scanner. Radiol Cardiothorac Imaging 2024; 6:e230331. [PMID: 38990132 DOI: 10.1148/ryct.230331] [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] [Indexed: 07/12/2024]
Abstract
Purpose To compare parameters of left ventricular (LV) and right ventricular (RV) volume and function between a commercially available 0.55-T low-field-strength cardiac cine MRI scanner and a 1.5-T scanner. Materials and Methods In this prospective study, healthy volunteers (May 2022 to July 2022) underwent same-day cine imaging using both scanners (0.55 T, 1.5 T). Volumetric and functional parameters were assessed by two experts. After analyzing the results of a blinded crossover reader study of the healthy volunteers, 20 participants with clinically indicated cardiac MRI were prospectively included (November 2022 to February 2023). In a second blinded expert reading, parameters from clinical 1.5-T scans in these participants were compared with those same-day 0.55-T scans. Results are displayed as Bland-Altman plots. Results Eleven healthy volunteers (mean age: 33 years [95% CI: 27, 40]; four of 11 [36%] female, seven of 11 [64%] male) were included. Very strong mean correlation was observed (r = 0.98 [95% CI: 0.97, 0.98]). Average deviation between MRI systems was 1.6% (95% CI: 0.3, 2.9) for both readers. Twenty participants with clinically indicated cardiac MRI were included (mean age: 55 years [95% CI: 48, 62], six of 20 [30%] female, 14 of 20 [70%] male). Mean correlation was very strong (r = 0.98 [95% CI: 0.97, 0.98]). LV and RV parameters demonstrated an average deviation of 1.1% (95% CI: 0.1, 2.1) between MRI systems. Conclusion Cardiac cine MRI at 0.55 T yielded comparable results for quantitative biventricular volumetric and functional parameters compared with routine imaging at 1.5 T, if acquisition time is doubled. Keywords: Cardiac, Comparative Studies, Heart, Cardiovascular MRI, Cine, Myocardium Supplemental material is available for this article. ©RSNA, 2024.
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Affiliation(s)
- Martin Segeroth
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - David J Winkel
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Jan Vosshenrich
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Hanns-Christian Breit
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Daniel Giese
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Philip Haaf
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Michael J Zellweger
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Jens Bremerich
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Francesco Santini
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
| | - Maurice Pradella
- From the Department of Radiology (M.S., D.J.W., J.V., H.C.B., J.B., F.S., M.P.) and Clinic of Cardiology (P.H., M.J.Z.), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; and Magnetic Resonance, Siemens Healthcare, Erlangen, Germany (D.G.)
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Festa P, Lovato L, Bianco F, Alaimo A, Angeli E, Baccano G, Barbi E, Bennati E, Bonhoeffer P, Bucciarelli V, Curione D, Ciliberti P, Clemente A, Di Salvo G, Esposito A, Ferroni F, Gaeta A, Giovagnoni A, Inserra MC, Leonardi B, Marcora S, Marrone C, Peritore G, Pergola V, Pluchinotta F, Puppini G, Stagnaro N, Raimondi F, Sandrini C, Spaziani G, Tchana B, Trocchio G, Ait-Ali L, Secinaro A. Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (Part II). J Cardiovasc Med (Hagerstown) 2024; 25:473-487. [PMID: 38829936 DOI: 10.2459/jcm.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. This is the second of two complementary documents, endorsed by experts from the Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, aimed at giving updated indications on the appropriate use of CMR and CCT in different clinical CHD settings, in both pediatrics and adults. In this article, support is also given to radiologists, pediatricians, cardiologists, and cardiac surgeons for indications and appropriateness criteria for CMR and CCT in the most referred CHD, following the proposed new criteria presented and discussed in the first document. This second document also examines the impact of devices and prostheses for CMR and CCT in CHD and additionally presents some indications for CMR and CCT exams when sedation or narcosis is needed.
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Affiliation(s)
- Pierluigi Festa
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Bologna
| | - Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Annalisa Alaimo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- U.O.C. di Cardiologia Pediatrica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Emanuela Angeli
- Pediatric & Grown-up Congenital Cardiac Surgery Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna
| | - Giovanna Baccano
- Department of Pediatric Cardiology - Centro Cardiologico Pediatrico Mediterraneo, Taormina
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo'
- Department of Pediatrics, University of Trieste, Trieste
| | - Elena Bennati
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | | | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital
| | - Paolo Ciliberti
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Alberto Clemente
- UOC Imaging Multimodale Cardiovascolare e Neuroradiologico - Dipartimento Immagini, Fondazione Toscana 'Gabriele Monasterio'/CNR - Pisa
| | - Giovanni Di Salvo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Women's and Children's Health, University of Padua, Padua
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center IRCCS Ospedale San Raffaele, Milan
| | | | - Alberto Gaeta
- Radiology Unit, Pediatric Hospital Giovanni XXIII, Bari
| | - Andrea Giovagnoni
- Radiology department, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
| | - Maria Cristina Inserra
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Radiologia 2 - Centro Alta Specialità e Trapianti (C.A.S.T.), Azienda Ospedaliero Universitaria Policlinico San Marco. Catania
| | - Benedetta Leonardi
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Simona Marcora
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- USSD Cardiologia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Giuseppe Peritore
- U.O.C. di Radiodiagnostica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua
| | - Francesca Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan
| | | | | | - Francesca Raimondi
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Gaia Spaziani
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Bertrand Tchana
- Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma
| | | | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
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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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4
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Fogante M, Volpato G, Esposto Pirani P, Cela F, Compagnucci P, Valeri Y, Selimi A, Alfieri M, Brugiatelli L, Belleggia S, Coraducci F, Argalia G, Casella M, Dello Russo A, Schicchi N. Cardiac Magnetic Resonance and Cardiac Implantable Electronic Devices: Are They Truly Still "Enemies"? MEDICINA (KAUNAS, LITHUANIA) 2024; 60:522. [PMID: 38674168 PMCID: PMC11051994 DOI: 10.3390/medicina60040522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
The application of cardiac magnetic resonance (CMR) imaging in clinical practice has grown due to technological advancements and expanded clinical indications, highlighting its superior capabilities when compared to echocardiography for the assessment of myocardial tissue. Similarly, the utilization of implantable cardiac electronic devices (CIEDs) has significantly increased in cardiac arrhythmia management, and the requirements of CMR examinations in patients with CIEDs has become more common. However, this type of exam often presents challenges due to safety concerns and image artifacts. Until a few years ago, the presence of CIED was considered an absolute contraindication to CMR. To address these challenges, various technical improvements in CIED technology, like the reduction of the ferromagnetic components, and in CMR examinations, such as the introduction of new sequences, have been developed. Moreover, a rigorous protocol involving multidisciplinary collaboration is recommended for safe CMR examinations in patients with CIEDs, emphasizing risk assessment, careful monitoring during CMR, and post-scan device evaluation. Alternative methods to CMR, such as computed tomography coronary angiography with tissue characterization techniques like dual-energy and photon-counting, offer alternative potential solutions, although their diagnostic accuracy and availability do limit their use. Despite technological advancements, close collaboration and specialized staff training remain crucial for obtaining safe diagnostic CMR images in patients with CIEDs, thus justifying the presence of specialized centers that are equipped to handle these type of exams.
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Affiliation(s)
- Marco Fogante
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Paolo Esposto Pirani
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Fatjon Cela
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Michele Alfieri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Leonardo Brugiatelli
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Sara Belleggia
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Francesca Coraducci
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
| | - Giulio Argalia
- Maternal-Child, Senological, Cardiological Radiology and Outpatient Ultrasound, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy; (P.E.P.); (F.C.); (G.A.)
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, 60126 Ancona, Italy; (G.V.); (P.C.); (Y.V.); (A.S.); (M.A.); (L.B.); (S.B.); (F.C.); (M.C.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital of Marche, 60126 Ancona, Italy;
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Campbell-Washburn AE, Varghese J, Nayak KS, Ramasawmy R, Simonetti OP. Cardiac MRI at Low Field Strengths. J Magn Reson Imaging 2024; 59:412-430. [PMID: 37530545 PMCID: PMC10834858 DOI: 10.1002/jmri.28890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiac MR imaging is well established for assessment of cardiovascular structure and function, myocardial scar, quantitative flow, parametric mapping, and myocardial perfusion. Despite the clear evidence supporting the use of cardiac MRI for a wide range of indications, it is underutilized clinically. Recent developments in low-field MRI technology, including modern data acquisition and image reconstruction methods, are enabling high-quality low-field imaging that may improve the cost-benefit ratio for cardiac MRI. Studies to-date confirm that low-field MRI offers high measurement concordance and consistent interpretation with clinical imaging for several routine sequences. Moreover, low-field MRI may enable specific new clinical opportunities for cardiac imaging such as imaging near metal implants, MRI-guided interventions, combined cardiopulmonary assessment, and imaging of patients with severe obesity. In this review, we discuss the recent progress in low-field cardiac MRI with a focus on technical developments and early clinical validation studies. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Juliet Varghese
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
- Alfred Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD USA
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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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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7
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Barison A, Ricci F, Pavon AG, Muscogiuri G, Bisaccia G, Camastra G, De Lazzari M, Lanzillo C, Raguso M, Monti L, Vargiu S, Pedrotti P, Piacenti M, Todiere G, Pontone G, Indolfi C, Dellegrottaglie S, Lombardi M, Schwitter J, Aquaro GD. Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study. J Clin Med 2023; 12:6673. [PMID: 37892813 PMCID: PMC10607654 DOI: 10.3390/jcm12206673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Most recent cardiac implantable electronic devices (CIEDs) can safely undergo a cardiovascular magnetic resonance (CMR) scan under certain conditions, but metal artifacts may degrade image quality. The aim of this study was to assess the overall diagnostic yield of CMR and the extent of metal artifacts in a multicenter, multivendor study on CIED patients referred for CMR. METHODS We analyzed 309 CMR scans from 292 patients (age 57 ± 16 years, 219 male) with an MR-conditional pacemaker (n = 122), defibrillator (n = 149), or loop recorder (n = 38); CMR scans were performed in 10 centers from 2012 to 2020; MR-unsafe implants were excluded. Clinical and device parameters were recorded before and after the CMR scan. A visual analysis of metal artifacts was performed for each sequence on a segmental basis, based on a 5-point artifact score. RESULTS The vast majority of CMR scans (n = 255, 83%) were completely performed, while only 32 (10%) were interrupted soon after the first sequences and 22 (7%) were only partly acquired; CMR quality was non-diagnostic in 34 (11%) scans, poor (<1/3 sequences were diagnostic) in 25 (8%), or acceptable (1/3 to 2/3 sequences were diagnostic) in 40 (13%), while most scans (n = 201, 68%) were of overall good quality. No adverse event or device malfunctioning occurred, and only nonsignificant changes in device parameters were recorded. The most affected sequences were SSFP (median score 0.32 [interquartile range 0.07-0.91]), followed by GRE (0.18 [0.02-0.59]) and LGE (0.14 [0.02-0.55]). ICDs induced more artifacts (median score in SSFP images 0.87 [0.50-1.46]) than PMs (0.11 [0.03-0.28]) or ILRs (0.11 [0.00-0.56]). Moreover, most artifacts were located in the anterior, anteroseptal, anterolateral, and apical segments of the LV and in the outflow tract of the RV. CONCLUSIONS CMR is a versatile imaging technique, with a high safety profile and overall good image quality even in patients with MR-conditional CIEDs. Several strategies are now available to optimize image quality, substantially enhancing overall diagnostic yield.
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Affiliation(s)
- Andrea Barison
- Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
- Life Science Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Giuseppe Muscogiuri
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
| | | | - Mario Raguso
- Ospedale Policlinico Casilino, 00169 Roma, Italy
| | - Lorenzo Monti
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Sara Vargiu
- Cardiologia 3, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Patrizia Pedrotti
- Cardiac Magnetic Resonance Laboratory, Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Ciro Indolfi
- Division of Cardiology, Magna Graecia University, 88100 Catanzaro, Italy
- Center for Cardiovascular Research, Magna Graecia University, 88100 Catanzaro, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Santo Dellegrottaglie
- Advanced Cardiovascular Imaging Unit, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, University Hospital Lausanne—CHUV, 1011 Lausanne, Switzerland
- CMR Center, University Hospital Lausanne—CHUV, 1011 Lausanne, Switzerland
- Faculty of Biology & Medicine, University of Lausanne—UniL, 1015 Lausanne, Switzerland
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
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Rogers T, Campbell-Washburn AE, Ramasawmy R, Yildirim DK, Bruce CG, Grant LP, Stine AM, Kolandaivelu A, Herzka DA, Ratnayaka K, Lederman RJ. Interventional cardiovascular magnetic resonance: state-of-the-art. J Cardiovasc Magn Reson 2023; 25:48. [PMID: 37574552 PMCID: PMC10424337 DOI: 10.1186/s12968-023-00956-7] [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: 02/11/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Laurie P Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
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9
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. RADIOLOGIA 2023; 65:269-284. [PMID: 37268369 DOI: 10.1016/j.rxeng.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 06/04/2023]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- M Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - B Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - D Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - J L Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - T Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - E Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - A M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - S Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - R J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - G Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - C Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - J F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J M Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J A Hidalgo Pérez
- Servicio de Radiología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - V Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - H Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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10
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:183-196. [PMID: 36539182 DOI: 10.1016/j.rec.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/21/2022] [Indexed: 12/23/2022]
Abstract
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Affiliation(s)
- Manuel Barreiro-Pérez
- Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
| | - Beatriz Cabeza
- Servicio de Diagnóstico por Imagen, Hospital Clínico San Carlos, Madrid, Spain; Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - David Calvo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José Luis Reyes-Juárez
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomás Datino
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirónsalud Madrid, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Departamento de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Eliseo Vañó Galván
- Servicio de Tomografía Computarizada y Resonancia Magnética, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - Alicia M Maceira González
- Unidad Cardiovascular, Grupo Biomético Ascires, Valencia, Spain; Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | | | - Susanna Prat-González
- Servicio de Cardiología, Instituto Clínic Cardiovascular (ICCV), Hospital Clínic, Barcelona, Spain
| | - Rosario J Perea
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | - Gorka Bastarrika
- Servicio de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Marcelo Sánchez
- Servicio de Radiología, Centro de Diagnóstico por la Imagen (CDI), Hospital Clínic, Barcelona, Spain
| | | | - Covadonga Fernández-Golfín Lobán
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - José F Rodríguez Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - José María Tolosana
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Esther Pérez-David
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Vicente Bertomeu-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Hug Cuéllar
- Área de Imagen Cardiovascular, Servicio de Radiodiagnóstico, Instituto de Diagnóstico por la Imagen (IDI), Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Vuorinen AM, Lehmonen L, Karvonen J, Holmström M, Kivistö S, Kaasalainen T. Reducing cardiac implantable electronic device-induced artefacts in cardiac magnetic resonance imaging. Eur Radiol 2023; 33:1229-1242. [PMID: 36029346 PMCID: PMC9889467 DOI: 10.1007/s00330-022-09059-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Cardiac implantable electronic device (CIED)-induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. METHODS We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. RESULTS Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). CONCLUSIONS Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. KEY POINTS • Cardiac implantable electronic device (CIED)-induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future.
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Affiliation(s)
- Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Lauri Lehmonen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Jarkko Karvonen
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Sari Kivistö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
| | - Touko Kaasalainen
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029 Helsinki, Finland
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12
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Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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13
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Barreiro-Pérez M, Cabeza B, Calvo D, Reyes-Juárez JL, Datino T, Vañó Galván E, Maceira González AM, Delgado Sánchez-Gracián C, Prat-González S, Perea RJ, Bastarrika G, Sánchez M, Jiménez-Borreguero LJ, Fernández-Golfín Lobán C, Rodríguez Palomares JF, Tolosana JM, Hidalgo Pérez JA, Pérez-David E, Bertomeu-González V, Cuéllar H. Resonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Reiter T, Weiss I, Weber OM, Bauer WR. Signal voids of active cardiac implants at 3.0 T CMR. Sci Rep 2022; 12:6285. [PMID: 35428775 PMCID: PMC9014817 DOI: 10.1038/s41598-022-09690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
Recent technical advancements allow cardiac MRI (CMR) examinations in the presence of so-called MRI conditional active cardiac implants at 3.0 T. However, the artifact burden caused by susceptibility effects remain an obstacle. All measurements were obtained at a clinical 3.0 T scanner using an in-house designed cubic phantom and optimized sequences for artifact evaluation (3D gradient echo sequence, multi-slice 2D turbo spin echo sequence). Reference sequences according to the American Society for Testing and Materials (ASTM) were additionally applied. Four representative active cardiac devices and a generic setup were analyzed regarding volume and shape of the signal void. For analysis, a threshold operation was applied to the grey value profile of each data set. The presented approach allows the evaluation of the signal void and shape even for larger implants such as ICDs. The void shape is influenced by the orientation of the B0-field and by the chosen sequence type. The distribution of ferromagnetic material within the implants also matters. The void volume depends both on the device itself, and on the sequence type. Disturbances in the B0 and B1 fields exceed the visual signal void. This work presents a reproducible and highly defined approach to characterize both signal void artifacts at 3.0 T and their influencing factors.
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Affiliation(s)
- Theresa Reiter
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany.
| | | | | | - Wolfgang R Bauer
- Department of Internal Medicine I, Cardiology, University Hospital Wuerzburg, Oberduerbacher Strasse 6a, 97080, Wuerzburg, Germany
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Suinesiaputra A, Mauger CA, Ambale-Venkatesh B, Bluemke DA, Dam Gade J, Gilbert K, Janse MHA, Hald LS, Werkhoven C, Wu CO, Lima JAC, Young AA. Deep Learning Analysis of Cardiac MRI in Legacy Datasets: Multi-Ethnic Study of Atherosclerosis. Front Cardiovasc Med 2022; 8:807728. [PMID: 35127868 PMCID: PMC8813768 DOI: 10.3389/fcvm.2021.807728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
The Multi-Ethnic Study of Atherosclerosis (MESA), begun in 2000, was the first large cohort study to incorporate cardiovascular magnetic resonance (CMR) to study the mechanisms of cardiovascular disease in over 5,000 initially asymptomatic participants, and there is now a wealth of follow-up data over 20 years. However, the imaging technology used to generate the CMR images is no longer in routine use, and methods trained on modern data fail when applied to such legacy datasets. This study aimed to develop a fully automated CMR analysis pipeline that leverages the ability of machine learning algorithms to enable extraction of additional information from such a large-scale legacy dataset, expanding on the original manual analyses. We combined the original study analyses with new annotations to develop a set of automated methods for customizing 3D left ventricular (LV) shape models to each CMR exam and build a statistical shape atlas. We trained VGGNet convolutional neural networks using a transfer learning sequence between two-chamber, four-chamber, and short-axis MRI views to detect landmarks. A U-Net architecture was used to detect the endocardial and epicardial boundaries in short-axis images. The landmark detection network accurately predicted mitral valve and right ventricular insertion points with average error distance <2.5 mm. The agreement of the network with two observers was excellent (intraclass correlation coefficient >0.9). The segmentation network produced average Dice score of 0.9 for both myocardium and LV cavity. Differences between the manual and automated analyses were small, i.e., <1.0 ± 2.6 mL/m2 for indexed LV volume, 3.0 ± 6.4 g/m2 for indexed LV mass, and 0.6 ± 3.3% for ejection fraction. In an independent atlas validation dataset, the LV atlas built from the fully automated pipeline showed similar statistical relationships to an atlas built from the manual analysis. Hence, the proposed pipeline is not only a promising framework to automatically assess additional measures of ventricular function, but also to study relationships between cardiac morphologies and future cardiac events, in a large-scale population study.
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Affiliation(s)
- Avan Suinesiaputra
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Charlène A. Mauger
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | | | - David A. Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Josefine Dam Gade
- Department of Biomedical Engineering and Informatics, School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Kathleen Gilbert
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Markus H. A. Janse
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Line Sofie Hald
- Department of Biomedical Engineering and Informatics, School of Medicine and Health, Aalborg University, Aalborg, Denmark
| | - Conrad Werkhoven
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Colin O. Wu
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Baltimore, MD, United States
| | | | - Alistair A. Young
- Faculty of Life Sciences & Medicine, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- *Correspondence: Alistair A. Young
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16
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Pavon AG, Porretta AP, Arangalage D, Domenichini G, Rutz T, Hugelshofer S, Pruvot E, Monney P, Pascale P, Schwitter J. Feasibility of adenosine stress cardiovascular magnetic resonance perfusion imaging in patients with MR-conditional transvenous permanent pacemakers and defibrillators. J Cardiovasc Magn Reson 2022; 24:9. [PMID: 35022037 PMCID: PMC8756706 DOI: 10.1186/s12968-021-00842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of stress perfusion-cardiovascular magnetic resonance (CMR) imaging remains limited in patients with implantable devices. The primary goal of the study was to assess the safety, image quality, and the diagnostic value of stress perfusion-CMR in patients with MR-conditional transvenous permanent pacemakers (PPM) or implantable cardioverter-defibrillators (ICD). METHODS Consecutive patients with a transvenous PPM or ICD referred for adenosine stress-CMR were enrolled in this single-center longitudinal study. The CMR protocol was performed using a 1.5 T system according to current guidelines while all devices were put in MR-mode. Quality of cine, late-gadolinium-enhancement (LGE), and stress perfusion sequences were assessed. An ischemia burden of ≥ 1.5 segments was considered significant. We assessed the safety, image quality and the occurrence of interference of the magnetic field with the implantable device. In case of ischemia, we also assessed the correlation with the presence of significant coronary lesions on coronary angiography. RESULTS Among 3743 perfusion-CMR examinations, 66 patients had implantable devices (1.7%). Image quality proved diagnostic in 98% of cases. No device damage or malfunction was reported immediately and at 1 year. Fifty patients were continuously paced during CMR. Heart rate and systolic blood pressure remained unchanged during adenosine stress, while diastolic blood pressure decreased (p = 0.007). Six patients (9%) had an ischemia-positive stress CMR and significant coronary stenoses were confirmed by coronary angiography in all cases. CONCLUSION Stress perfusion-CMR is safe, allows reliable ischemia detection, and provides good diagnostic value.
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Affiliation(s)
- Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Alessandra Pia Porretta
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dimitri Arangalage
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiology Department, AP-HP, Bichat Hospital and Université de Paris, Paris, France
| | - Giulia Domenichini
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Tobias Rutz
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Sarah Hugelshofer
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
| | - Etienne Pruvot
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Pierre Monney
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Patrizio Pascale
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
| | - Juerg Schwitter
- Cardiovascular Department, Division of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Cardiac Magnetic Resonance Center of the CHUV (CRMC), Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UniL), Lausanne, Switzerland
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17
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Roca-Luque I, Van Breukelen A, Alarcon F, Garre P, Tolosana JM, Borras R, Sanchez P, Zaraket F, Doltra A, Ortiz-Perez JT, Prat-Gonzalez S, Perea RJ, Guasch E, Arbelo E, Berruezo A, Sitges M, Brugada J, Mont L. Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators. Europace 2021; 22:598-606. [PMID: 32101605 DOI: 10.1093/europace/euaa021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular tachycardia (VT) substrate-based ablation has become a standard procedure. Electroanatomical mapping (EAM) detects scar tissue heterogeneity and define conduction channels (CCs) that are the ablation target. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is able to depict CCs and increase ablation success. Most patients undergoing VT ablation have an implantable cardioverter-defibrillator (ICD) that can cause image artefacts in LGE-CMR. Recently wideband (WB) LGE-CMR sequence has demonstrated to decrease these artefacts. The aim of this study is to analyse accuracy of WB-LGE-CMR in identifying the CC entrances. METHODS AND RESULTS Thirteen consecutive ICD-patients who underwent VT ablation after WB-LGE-CMR were included. Number and location of CC entrances in three-dimensional EAM and in WB-LGE-CMR reconstruction were compared. Concordance was compared with a historical cohort matched by cardiomyopathy, scar location, and age (26 patients) with LGE-CMR prior to ICD and VT ablation. In WB-CMR group, 101 and 93 CC entrances were identified in EAM and WB-LGE-CMR, respectively. In historical cohort, 179 CC entrances were identified in both EAM and LGE-CMR. The EAM/CMR concordance was 85.1% and 92.2% in the WB and historical group, respectively (P = 0.66). There were no differences in false-positive rate (CC entrances detected in CMR and absent in EAM: 7.5% vs 7.8% in WB vs. conventional CMR, P = 0.92) nor in false-negative rate (CC entrances present in EAM not detected in CMR: 14.9% vs.7.8% in WB vs. conventional CMR, P = 0.23). Epicardial CCs was predictor of poor CMR/EAM concordance (OR 2.15, P = 0.031). CONCLUSION Use of WB-LGE-CMR sequence in ICD-patients allows adequate VT substrate characterization to guide VT ablation with similar accuracy than conventional LGE-CMR in patients without an ICD.
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Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Ana Van Breukelen
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Francisco Alarcon
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Paz Garre
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Jose M Tolosana
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Roger Borras
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Paula Sanchez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Fatima Zaraket
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Adelina Doltra
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Jose T Ortiz-Perez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Susanna Prat-Gonzalez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Rosario J Perea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Radiology Department, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Elena Arbelo
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Antonio Berruezo
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Marta Sitges
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Josep Brugada
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Lluis Mont
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
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18
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Ian Paterson D, White JA, Butler CR, Connelly KA, Guerra PG, Hill MD, James MT, Kirpalani A, Lydell CP, Roifman I, Sarak B, Sterns LD, Verma A, Wan D, Crean AM, Grosse-Wortmann L, Hanneman K, Leipsic J, Manlucu J, Nguyen ET, Sandhu RK, Villemaire C, Wald RM, Windram J. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society. Can J Cardiol 2021; 37:835-847. [PMID: 34154798 DOI: 10.1016/j.cjca.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.
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Affiliation(s)
| | - D Ian Paterson
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - James A White
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Craig R Butler
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kim A Connelly
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Guerra
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Michael D Hill
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Anish Kirpalani
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carmen P Lydell
- Calgary Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Idan Roifman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley Sarak
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Laurence D Sterns
- Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Douglas Wan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Andrew M Crean
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grosse-Wortmann
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Kate Hanneman
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon Leipsic
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie Manlucu
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Elsie T Nguyen
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, USA
| | - Roopinder K Sandhu
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Villemaire
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Rachel M Wald
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Windram
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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19
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Hála P, Neužil P, Keller J, Moučka P, Mudroch M, Dujka L, Janotka M, Žáček R, Vymazal J, Reddy V. Quantification of artifacts during cardiac magnetic resonance in patients with leadless Micra pacemakers. J Cardiovasc Electrophysiol 2021; 32:1367-1375. [PMID: 33682228 DOI: 10.1111/jce.14988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION When cardiac magnetic resonance (MR) is performed after previous leadless transcatheter pacemaker implantation, an image distortion has to be expected in the heart region and evaluation of myocardial tissue can be affected. In this clinical prospective study, we aim to assess the extent and impact of this artifact on individual ventricular segments and compare it to conventional pacing devices. METHODS Total of 20 patients with leadless pacemaker placed in the right ventricle underwent cardiac MR imaging in a 1.5 Tesla scanner. A multiplanar segmentation was used to demarcate the left and right ventricular myocardium as well as the pacemaker-caused image artifact in systolic and diastolic time frames. Artifact size and its relative influence on myocardial segments were quantitatively assessed and expressed in AHA-17 model. RESULTS Implanted leadless pacemaker caused an image artifact with a volume of 48 ± 5 ml. Most distorted were the apical septal (53 ± 23%), apical inferior (30 ± 18%), and midventricular inferoseptal (30 ± 20%) segments. The artifact intersection with basal and lateral segments was none or negligible (up to 2%). The portion of left ventricular (LV) myocardium affected by the artifact was significantly higher in systole (8 ± 4%) compared to diastole (10 ± 3%; p < .001). CONCLUSION Implantation of leadless pacemaker represents no obstacle for cardiac MR imaging but causes an image artifact located mostly in septal, inferoseptal, and anteroseptal segments of apical and midventricular LV myocardium. With the exception of the apex, diastolic timing reduces the image distortion of all segments and improves global ventricular assessment.
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Affiliation(s)
- Pavel Hála
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Petr Neužil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Petr Moučka
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Martin Mudroch
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Libor Dujka
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Marek Janotka
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Radovan Žáček
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Vivek Reddy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.,Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, USA
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20
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Myocardial motion-corrected phase-sensitive inversion recovery late gadolinium enhancement in free breathing paediatric patients: a comparison with single-shot coherent gradient echo ("TrueFISP") phase-sensitive inversion recovery. Clin Radiol 2021; 76:471.e17-471.e25. [PMID: 33663913 DOI: 10.1016/j.crad.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/26/2021] [Indexed: 11/23/2022]
Abstract
AIM To investigate the value of motion-corrected (MOCO) phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) compared with single-shot balanced steady-state gradient echo ("TrueFISP", Siemens) PSIR in free breathing paediatric patients. MATERIALS AND METHODS In this retrospective study, 238 paediatric patients underwent clinical contrast-enhanced cardiovascular magnetic resonance imaging (CMRI). Both the single-shot TrueFISP PSIR and MOCO PSIR sequences were performed on each child. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists rated the quality of the images on a scale of 1-5 (1 = poor, 5 = very good). Bland-Altman, linear regression, and intraclass correlation coefficient were used to compared the extent of LGE of the single-shot TrueFISP PSIR and MOCO PSIR. Imaging artefacts were described and compared. RESULTS Children ranged in age from 60 days to 17 years with an average age of 8.1 ± 3.8 years. MOCO PSIR had higher SNR and CNR than the single-shot TrueFISP PSIR (p<0.001). Mean quality ratings for short-axis imaging were 4 (interquartile range, 3-4) for single-shot TrueFISP PSIR and 4 (interquartile range, 4-5) for MOCO PSIR (p<0.001). The scan time was faster for single-shot TrueFISP PSIR than for MOCO PSIR. The myocardial LGE results were similar with high agreement between the single-shot TrueFISP PSIR and MOCO PSIR (ICC = 0.955-0.986). CONCLUSION The MOCO PSIR sequence is feasible in children. MOCO PSIR is robust at high heart rates and can be performed without breath-holding with higher image-quality ratings than the single-shot TrueFISP PSIR.
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21
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Bhuva AN, Treibel TA, Seraphim A, Scully P, Knott KD, Augusto JB, Torlasco C, Menacho K, Lau C, Patel K, Moon JC, Kellman P, Manisty CH. Measurement of T1 Mapping in Patients With Cardiac Devices: Off-Resonance Error Extends Beyond Visual Artifact but Can Be Quantified and Corrected. Front Cardiovasc Med 2021; 8:631366. [PMID: 33585589 PMCID: PMC7878555 DOI: 10.3389/fcvm.2021.631366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Measurement of myocardial T1 is increasingly incorporated into standard cardiovascular magnetic resonance (CMR) protocols, however accuracy may be reduced in patients with metallic cardiovascular implants. Measurement is feasible in segments free from visual artifact, but there may still be off-resonance induced error. Aim: To quantify off-resonance induced T1 error in patients with metallic cardiovascular implants, and validate a method for error correction for a conventional MOLLI pulse sequence. Methods: Twenty-four patients with cardiac implantable electronic devices (CIEDs: 46% permanent pacemakers, PPMs; 33% implantable loop recorders, ILRs; and 21% implantable cardioverter-defibrillators, ICDs); and 31 patients with aortic valve replacement (AVR) (45% metallic) were studied. Paired mid-myocardial short-axis MOLLI and single breath-hold off-resonance field maps were acquired at 1.5 T. T1 values were measured by AHA segment, and segments with visual artifact were excluded. T1 correction was applied using a published relationship between off-resonance and T1. The accuracy of the correction was assessed in 10 healthy volunteers by measuring T1 before and after external placement of an ICD generator next to the chest to generate off-resonance. Results: T1 values in healthy volunteers with an ICD were underestimated compared to without (967 ± 52 vs. 997 ± 26 ms respectively, p = 0.0001), but were similar after correction (p = 0.57, residual difference 2 ± 27 ms). Artifact was visible in 4 ± 12, 42 ± 31, and 53 ± 27% of AHA segments in patients with ILRs, PPMs, and ICDs, respectively. In segments without artifact, T1 was underestimated by 63 ms (interquartile range: 7–143) per patient. The greatest error for patients with ILRs, PPMs and ICDs were 79, 146, and 191 ms, respectively. The presence of an AVR did not generate T1 error. Conclusion: Even when there is no visual artifact, there is error in T1 in patients with CIEDs, but not AVRs. Off-resonance field map acquisition can detect error in measured T1, and a correction can be applied to quantify T1 MOLLI accurately.
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Affiliation(s)
- Anish N Bhuva
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Thomas A Treibel
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Andreas Seraphim
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Paul Scully
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Kristopher D Knott
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - João B Augusto
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Camilla Torlasco
- Istituto Auxologico Italiano (IRCCS), Istituto Auxologico Italiano, Milan, Italy
| | - Katia Menacho
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Clement Lau
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Kush Patel
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - James C Moon
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Peter Kellman
- National Institutes of Health, Bethesda, MD, United States
| | - Charlotte H Manisty
- Institute for Cardiovascular Science, University College London, London, United Kingdom.,Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
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22
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Koshy AO, Swoboda PPP, Gierula J, Witte KK. Cardiac magnetic resonance in patients with cardiac resynchronization therapy: is it time to scan with resynchronization on? Europace 2020; 21:554-562. [PMID: 30608530 DOI: 10.1093/europace/euy299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/20/2018] [Indexed: 12/28/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is recommended in international guidelines for patients with heart failure due to important left ventricular systolic dysfunction (or heart failure with reduced ejection fraction) and ventricular conduction tissue disease. Cardiac magnetic resonance (CMR) represents the most powerful imaging tool for dynamic assessment of the volumes and function of cardiac chambers but is rarely utilized in patients with CRT due to limitations on the device, programming and scanning. In this review, we explore the known utility of CMR in this cohort with discussion of the risks and potential benefits of scanning whilst CRT is active, including a practical strategy for conducting high quality scans safely. Our contention is that imaging in patients with CRT could be improved further by keeping resynchronization therapy active with resultant benefits on research and also patient outcomes.
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Affiliation(s)
- Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - Peter P P Swoboda
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, Light Laboratories, University of Leeds and Leeds Teaching Hospitals NHS Trust, Clarendon Way, Leeds, UK
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23
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Löbe S, Paetsch I, Hilbert S, Spampinato R, Oebel S, Richter S, Döring M, Sommer P, Bollmann A, Hindricks G, Jahnke C. Evaluation of the right heart using cardiovascular magnetic resonance imaging in patients with cardiac devices. Int J Cardiol 2020; 316:266-271. [PMID: 32389768 DOI: 10.1016/j.ijcard.2020.05.021] [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: 10/16/2019] [Revised: 03/08/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with cardiac implantable electronic devices (CIED) necessitate comprehensive cardiovascular magnetic resonance (CMR) examinations. The aim of this study was to provide data on CMR image quality and feasibility of functional assessment of the right heart in patients with CIED depending on the device type and imaging sequence used. METHODS 120 CIED carriers (Insertable cardiac monitoring system, n = 13; implantable loop-recorder, n = 22; pacemaker, n = 30; implantable cardioverter-defibrillator (ICD), n = 43; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12) underwent clinically indicated CMR imaging using a 1.5 T. CMR protocols consisted of cine imaging and myocardial tissue characterization including T1-and T2-weighted blackblood imaging and late gadolinium enhancement (LGE) imaging. Image quality was evaluated with regard to device-related imaging artifacts per right-ventricular (RV) segment. RESULTS RV segmental evaluability was influenced by the device type and CMR imaging sequence: Cine steady-state-free-precision (SSFP) imaging was found to be non-diagnostic in patients with ICD/CRT-D and implantable loop recorders; a significant improvement of image quality was achieved when using cine turbo-field-echo (TFE) sequences with a further improvement on post-contrast TFE imaging. LGE scans were artifact-free in at least 91% of RV segments with best results in patients with a pacemaker or an insertable cardiac monitoring system. CONCLUSIONS In patients with CIED, artifact-free CMR imaging of the right ventricle was performed in the majority of patients and resulted in highly reproducible evaluability of RV functional parameters. This finding is of particular importance for the diagnosis and follow-up of right-ventricular diseases.
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Affiliation(s)
- S Löbe
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany.
| | - I Paetsch
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Hilbert
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - R Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Oebel
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - S Richter
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - M Döring
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - P Sommer
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
| | - A Bollmann
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - G Hindricks
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - C Jahnke
- Department of Electrophysiology, HELIOS Heart Center Leipzig, University of Leipzig, Germany
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Cardiac Magnetic Resonance in Patients With Cardiac Implantable Electronic Devices: Challenges and Solutions. J Thorac Imaging 2020; 35:W1-W17. [PMID: 31855948 DOI: 10.1097/rti.0000000000000462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Until recently, cardiac implantable electronic devices (CIEDs) were an absolute contraindication to magnetic resonance imaging (MRI), due to concerns about their adverse interaction in the MRI environment. The increasing clinical need to perform MRI examinations in these patients was an impetus to the development of MR-Conditional CIEDs. Secure performance of MRI in these patients requires scanning under specified MR conditions as well as operating the device in MR-scanning mode. This requires robust institutional protocols and a well-trained multidisciplinary team of radiologists, cardiologists, device applications specialists, physicists, nurses, and MRI technologists. MRI can also be performed in patients with non-MRI Conditional or "legacy" CIEDs by following safety precautions and continuous monitoring. Cardiac magnetic resonance (CMR) is additionally challenging due to expected susceptibility artifacts generated by the CIEDs, which are either near or in the heart. As the most common indication for CMR in these patients is the evaluation of myocardial scar/fibrosis, acquiring a high-quality late gadolinium enhancement image is of the utmost importance. This sequence is hampered by artifactual high signal due to inadequate myocardial nulling. Several solutions are available to reduce these artifacts, including reducing inhomogeneity, technical adjustments, and use of sequences that are more resilient to artifacts. In this article, we review the precautions for CMR in patients with CIEDs, provide guidelines for secure performance of CMR in these patients, and discuss techniques for obtaining high quality CMR images with minimized artifacts.
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25
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Nakamori S, Ngo LH, Rodriguez J, Neisius U, Manning WJ, Nezafat R. T 1 Mapping Tissue Heterogeneity Provides Improved Risk Stratification for ICDs Without Needing Gadolinium in Patients With Dilated Cardiomyopathy. JACC Cardiovasc Imaging 2020; 13:1917-1930. [PMID: 32653543 DOI: 10.1016/j.jcmg.2020.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/27/2020] [Accepted: 03/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study sought to determine whether myocardial tissue heterogeneity scanned by native T1 mapping could improve risk stratification in patients with nonischemic dilated cardiomyopathy (NICM) evaluated for primary prevention by ICD. BACKGROUND The benefit of insertable cardiac-defibrillator (ICD) as primary prevention ICD in patients with NICM remains to be fully clarified. METHODS A total of 115 NICM candidates for primary prevention and 55 healthy controls with similar distributions of age and sex were prospectively enrolled. Imaging was performed at 1.5-T using a protocol that included cine magnetic resonance for left ventricular function, late gadolinium enhancement (LGE) for focal scarring, and 5-slice native T1 mapping for diffuse fibrosis and heterogeneity. The last method was assessed by mean absolute deviation of the segmental pixel-SD from the average pixel-SD (Mad-SD). The primary endpoint was a composite of appropriate ICD therapy and sudden cardiac death. RESULTS During a median follow-up of 24 months, 13 patients (11%) experienced the primary endpoint. Dichotomized Mad-SD >0.24 provided a comparable outcome to the presence of LGE for the primary endpoint (annual event rate: 9.8% vs. 10.9%). The integration of Mad-SD to global native T1 showed excellent arrhythmic event-free survival (annual event rate: 0%), and high sensitivity of 85% (95% confidence interval [CI]: 55% to 98%) and moderate specificity of 72% (95% CI: 62% to 80%), with a C-statistic of 0.76 (95% CI: 0.64 to 0.87), which was comparable to the presence, location, or extent of LGE in its ability to predict arrhythmic events. CONCLUSIONS Combined myocardium tissue heterogeneity and interstitial fibrosis assessment by native T1 mapping is an important predictor of ventricular tachycardia and ventricular fibrillation and provides additive risk stratification for primary prevention ICD in NICM patients without the need for gadolinium contrast.
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Affiliation(s)
- Shiro Nakamori
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Long H Ngo
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Rodriguez
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Ulf Neisius
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Warren J Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Reza Nezafat
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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26
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Gakenheimer‐Smith L, Etheridge SP, Niu MC, Ou Z, Presson AP, Whitaker P, Su J, Puchalski MD, Asaki SY, Pilcher T. MRI in pediatric and congenital heart disease patients with CIEDs and epicardial or abandoned leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:797-804. [DOI: 10.1111/pace.13984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Susan P. Etheridge
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Mary C. Niu
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Zhining Ou
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | - Angela P. Presson
- Department of Pediatrics University of Utah Salt Lake City Utah
- Division of Epidemiology, Department of Internal Medicine University of Utah Salt Lake City Utah
| | | | - Jason Su
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Michael D. Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Sarah Yukiko Asaki
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
| | - Thomas Pilcher
- Division of Pediatric Cardiology, Department of Pediatrics University of Utah Salt Lake City Utah
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27
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Piccini D, Demesmaeker R, Heerfordt J, Yerly J, Di Sopra L, Masci PG, Schwitter J, Van De Ville D, Richiardi J, Kober T, Stuber M. Deep Learning to Automate Reference-Free Image Quality Assessment of Whole-Heart MR Images. Radiol Artif Intell 2020; 2:e190123. [PMID: 33937825 DOI: 10.1148/ryai.2020190123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 11/11/2022]
Abstract
Purpose To develop and characterize an algorithm that mimics human expert visual assessment to quantitatively determine the quality of three-dimensional (3D) whole-heart MR images. Materials and Methods In this study, 3D whole-heart cardiac MRI scans from 424 participants (average age, 57 years ± 18 [standard deviation]; 66.5% men) were used to generate an image quality assessment algorithm. A deep convolutional neural network for image quality assessment (IQ-DCNN) was designed, trained, optimized, and cross-validated on a clinical database of 324 (training set) scans. On a separate test set (100 scans), two hypotheses were tested: (a) that the algorithm can assess image quality in concordance with human expert assessment as assessed by human-machine correlation and intra- and interobserver agreement and (b) that the IQ-DCNN algorithm may be used to monitor a compressed sensing reconstruction process where image quality progressively improves. Weighted κ values, agreement and disagreement counts, and Krippendorff α reliability coefficients were reported. Results Regression performance of the IQ-DCNN was within the range of human intra- and interobserver agreement and in very good agreement with the human expert (R 2 = 0.78, κ = 0.67). The image quality assessment during compressed sensing reconstruction correlated with the cost function at each iteration and was successfully applied to rank the results in very good agreement with the human expert. Conclusion The proposed IQ-DCNN was trained to mimic expert visual image quality assessment of 3D whole-heart MR images. The results from the IQ-DCNN were in good agreement with human expert reading, and the network was capable of automatically comparing different reconstructed volumes.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Davide Piccini
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Robin Demesmaeker
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - John Heerfordt
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Jérôme Yerly
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Lorenzo Di Sopra
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Pier Giorgio Masci
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Juerg Schwitter
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Dimitri Van De Ville
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Jonas Richiardi
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
| | - Matthias Stuber
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (D.P., R.D., J.H., J.R., T.K.); Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue de Bugnon 46, BH 8.80, 1011 Lausanne, Switzerland (D.P., J.H., J.Y., L.D.S., J.R., T.K., M.S.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (D.P., J.R., T.K.); Institute of Electrical Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D.); Institute of Bioengineering/Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (R.D., D.V.D.V.); Center for Biomedical Imaging (CIBM), Lausanne, Switzerland (J.Y., M.S.); Division of Cardiology and Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (P.G.M., J.S.); and Department of Radiology and Medical Informatics, University Hospital of Geneva (HUG), Geneva, Switzerland (D.V.D.V.)
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Holtstiege V, Meier C, Bietenbeck M, Chatzantonis G, Florian A, Köbe J, Reinke F, Eckardt L, Yilmaz A. Clinical experience regarding safety and diagnostic value of cardiovascular magnetic resonance in patients with a subcutaneous implanted cardioverter/defibrillator (S-ICD) at 1.5 T. J Cardiovasc Magn Reson 2020; 22:35. [PMID: 32418537 PMCID: PMC7232845 DOI: 10.1186/s12968-020-00626-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) studies in patients with implanted cardioverter/defibrillators (ICD) are increasingly required in daily clinical practice. However, the clinical experience regarding the feasibility as well as clinical value of CMR studies in patients with subcutaneous ICD (S-ICD) is still limited. Besides safety issues, image quality and analysis can be impaired primarily due the presence of image artefacts associated with the generator. METHODS Twenty-three patients with an implanted S-ICD (EMBLEM, Boston Scientific, Marlborough, Massachusetts, USA; MR-conditional) with suspected cardiomyopathy and/or myocarditis underwent multi-parametric CMR imaging. Studies were performed on a 1.5 T CMR scanner after device interrogation and comprised standard a) balanced steady state free precession cine, b) T2 weighted-edema, c) velocity-encoded cine flow, d) myocardial perfusion, e) late-gadolinium-enhancement (LGE)-imaging and f) 3D-CMR angiography of the aorta. In case of substantial artefacts, alternative CMR techniques such as spoiled gradient-echo cine-sequences and wide-band inversion-recovery LGE (wb-LGE) sequences were applied. RESULTS Successful CMR studies could be performed in all patients without any case of unexpected early termination or relevant technical complication other than permanent loss of the S-ICD system beeper volume in 52% of our patients. Assessment of cine-CMR images was predominantly impaired in the left ventricular (LV) anterior, lateral and inferior wall segments and a switch to spoiled gradient echo-based cine-CMR allowed an accurate assessment of cine-images in N = 17 (74%) patients with only limited artefacts. Hyperintensity artefacts in conventional LGE-images were predominantly observed in the LV anterior, lateral and inferior wall segments and image optimisation by use of the wb-LGE was helpful in 15 (65%) cases. Aortic flow measurements and 3D-CMR angiography were assessable in all patients Perfusion imaging artefacts precluded a meaningful assessment in at least one half of the patients. A benefit in clinical-decision making was documented in 17 (74%) patients in the present study. CONCLUSION Safe 1.5 T CMR imaging was possible in all patients with an S-ICD, though the majority had permanent loss of the S-ICD beeper volume. Achieving good image quality may be challenging in some patients - particularly for perfusion imaging. Using spoiled gradient echo-based cine-sequences and wb-LGE sequences may help to reduce the extent of artefacts, thereby allowing accurate cardiac assessment. Thus, 1.5 T CMR studies should not be withhold in patients with S-ICD for safety concerns and/or fear of extensive imaging artefacts precluding successful image analysis.
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Affiliation(s)
- Viktoria Holtstiege
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Claudia Meier
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Michael Bietenbeck
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Grigorios Chatzantonis
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Anca Florian
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II – Electrophysiology, University Hospital Münster, Münster, Germany
| | - Ali Yilmaz
- Department of Cardiology I, Division of Cardiovascular Imaging, University Hospital Münster, Münster, Germany
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Lindemann F, Oebel S, Paetsch I, Arya A, Dagres N, Richter S, Dinov B, Hilbert S, Loebe S, Stegmann C, Doering M, Bollmann A, Hindricks G, Jahnke C. Clinical utility of cardiovascular magnetic resonance imaging in patients with implantable cardioverter defibrillators presenting with electrical instability or worsening heart failure symptoms. J Cardiovasc Magn Reson 2020; 22:32. [PMID: 32389126 PMCID: PMC7212569 DOI: 10.1186/s12968-020-00609-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Data on the usefulness of cardiovascular magnetic resonance (CMR) imaging for clinical decision making in patients with an implanted cardioverter defibrillator (ICD) are scarce. The present study determined the impact of CMR imaging on diagnostic stratification and treatment decisions in ICD patients presenting with electrical instability or progressive heart failure symptoms. METHODS 212 consecutive ICD patients underwent 1.5 T CMR combining diagnostic imaging modules tailored to the individual clinical indication (ventricular function assessment, myocardial tissue characterization, adenosine stress-perfusion, 3D-contrast-enhanced angiography); four CMR examinations (4/212, 2%) were excluded due to non-diagnostic CMR image quality. The resultant change in diagnosis or clinical management was determined in the overall population and compared between ICD patients for primary (115/208, 55%) or secondary prevention (93/208, 45%). Referral indication consisted of documented ventricular tachycardia, inadequate device therapy or progressive heart failure symptoms. RESULTS Overall, CMR imaging data changed diagnosis in 40% (83/208) with a significant difference between primary versus secondary prevention ICD patients (37/115, 32% versus 46/93, 49%, respectively; p = 0.01). The information gain from CMR led to an overall change in treatment in 21% (43/208) with a similar distribution in primary versus secondary prevention ICD patients (25/115,22% versus 18/93,19%, p = 0.67). The effect on treatment change was highest in patients initially scheduled for ventricular tachycardia ablation procedure (18/141, 13%) with revision of the treatment plan to medical therapy or coronary revascularization. CONCLUSIONS CMR imaging in ICD patients presenting with electrical instability or worsening heart failure symptoms provided diagnostic or management-changing information in a considerable proportion (40% and 21%, respectively).
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Affiliation(s)
- Frank Lindemann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sabrina Oebel
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Ingo Paetsch
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Susanne Loebe
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Clara Stegmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany
| | - Cosima Jahnke
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289, Leipzig, Germany.
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Technological Advances in Arrhythmia Management Applied to Adults With Congenital Heart Disease. Can J Cardiol 2019; 35:1708-1722. [DOI: 10.1016/j.cjca.2019.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022] Open
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Mukherjee RK, Whitaker J, Williams SE, Razavi R, O'Neill MD. Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation. Europace 2019; 20:1721-1732. [PMID: 29584897 PMCID: PMC6212773 DOI: 10.1093/europace/euy040] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/19/2018] [Indexed: 01/02/2023] Open
Abstract
Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.
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Affiliation(s)
- Rahul K Mukherjee
- School of Biomedical Engineering and Imaging Sciences, 4th Floor, North Wing, St Thomas' Hospital, King's College London, London, UK
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, 4th Floor, North Wing, St Thomas' Hospital, King's College London, London, UK
| | - Steven E Williams
- School of Biomedical Engineering and Imaging Sciences, 4th Floor, North Wing, St Thomas' Hospital, King's College London, London, UK.,Department of Cardiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, 4th Floor, North Wing, St Thomas' Hospital, King's College London, London, UK
| | - Mark D O'Neill
- School of Biomedical Engineering and Imaging Sciences, 4th Floor, North Wing, St Thomas' Hospital, King's College London, London, UK.,Department of Cardiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Koshy A, Witte K. Uses and potential for cardiac magnetic resonance imaging in patients with cardiac resynchronisation pacemakers. Expert Rev Med Devices 2019; 16:445-450. [DOI: 10.1080/17434440.2019.1618706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Aaron Koshy
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
| | - Klaus Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine LIGHT building, University of Leeds, Leeds, UK
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von Knobelsdorff-Brenkenhoff F, Bauer WR, Deneke T, Fleck E, Rolf A, Schulz-Menger J, Sommer P, Tillmanns C, Eitel I. Empfehlungen zu kardialen MRT-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren. DER KARDIOLOGE 2019. [DOI: 10.1007/s12181-019-0301-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wright GA, Krahn PRP, Glover BM. Magnetic Resonance Imaging: A New Gold Standard for Radiofrequency Ablation Assessment in Ventricular Arrhythmia Treatments? JACC Clin Electrophysiol 2019; 5:101-103. [PMID: 30678773 DOI: 10.1016/j.jacep.2018.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Graham A Wright
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
| | - Philippa R P Krahn
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Benedict M Glover
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A. MRI in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 289:281-292. [DOI: 10.1148/radiol.2018180285] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Muthalaly
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Yin Ge
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Raymond Y. Kwong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Arthur Nasis
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
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Performing Cardiac Magnetic Resonance Imaging in Patients With Cardiac Implantable Electronic Devices: A Contemporary Review. Can J Cardiol 2018; 34:1682-1686. [PMID: 30527159 DOI: 10.1016/j.cjca.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Abstract
There are expanding indications for cardiac magnetic resonance imaging (CMR) in patients with cardiac implantable electronic devices (CIEDs). The presence of a CIED had been regarded as a contraindication to CMR due to concerns of arrhythmias, significant changes to lead parameters, and detrimental changes to device programming. The risk of these potential adverse events is theoretically higher in patients undergoing CMR as compared with other anatomic sites. Recent studies have observed low rates of adverse events in patients undergoing CMR (< 1% to 2%), prompting a shift in the recommendations on CMR in patients with CIEDs. The 2017 Heart Rhythm Society Expert Consensus Statement now states that CMR can be performed in patients with both conditional and nonconditional CIEDs at a magnetic strength of 1.5 T, provided there are no fractured, abandoned, or epicardial leads and modifications to MRI parameters are made. The purpose of this review is to (a) outline the potential concerns of performing CMR in patients with CIEDs, (b) define categories of CIEDs as they pertain to MRI safety, (c) summarize the emerging data on adverse events, and (d) provide a practical approach, integrating the key modifications required to perform CMR in patients with CIEDs.
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MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator. Eur Radiol 2018; 28:2406-2416. [PMID: 29318430 DOI: 10.1007/s00330-017-5098-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/07/2017] [Accepted: 09/25/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). METHODS We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted <6 weeks before enrolment or prior to 01/01/2000, with cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). RESULTS 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three-12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. CONCLUSIONS A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. KEY POINTS • Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers. • No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers. • Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic. • All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic. • Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.
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Hilbert S, Jahnke C, Loebe S, Oebel S, Weber A, Spampinato R, Richter S, Doering M, Bollmann A, Sommer P, Hindricks G, Paetsch I. Cardiovascular magnetic resonance imaging in patients with cardiac implantable electronic devices: a device-dependent imaging strategy for improved image quality. Eur Heart J Cardiovasc Imaging 2017; 19:1051-1061. [DOI: 10.1093/ehjci/jex243] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/23/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sebastian Hilbert
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Cosima Jahnke
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Susanne Loebe
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sabrina Oebel
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Alexander Weber
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ricardo Spampinato
- Department of Cardiac Surgery, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Sergio Richter
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Michael Doering
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
| | - Ingo Paetsch
- Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany
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Indik JH, Gimbel JR, Abe H, Alkmim-Teixeira R, Birgersdotter-Green U, Clarke GD, Dickfeld TML, Froelich JW, Grant J, Hayes DL, Heidbuchel H, Idriss SF, Kanal E, Lampert R, Machado CE, Mandrola JM, Nazarian S, Patton KK, Rozner MA, Russo RJ, Shen WK, Shinbane JS, Teo WS, Uribe W, Verma A, Wilkoff BL, Woodard PK. 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices. Heart Rhythm 2017; 14:e97-e153. [DOI: 10.1016/j.hrthm.2017.04.025] [Citation(s) in RCA: 238] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 11/16/2022]
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Mavrogeni SI, Schwitter J, Gargani L, Pepe A, Monti L, Allanore Y, Matucci-Cerinic M. Cardiovascular magnetic resonance in systemic sclerosis: "Pearls and pitfalls". Semin Arthritis Rheum 2017; 47:79-85. [PMID: 28522072 DOI: 10.1016/j.semarthrit.2017.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular dysfunction and excessive fibrosis, involving internal organs including the heart. The estimated prevalence of cardiac involvement in SSc is high and remains subclinical until the late stages. It is either primary, related to myocardial inflammation and fibrosis, or secondary, due to pulmonary arterial hypertension (SSc-PAH) or systemic hypertension, in those patients with renal involvement. Cardiovascular magnetic resonance (CMR) is a useful tool for the early assessment of cardiac involvement in SSc. It is the gold standard technique to assess ventricular volumes,ejection fraction, and in particular is very useful to reliably and non-invasively detect myocardial inflammation, early perfusion defects, and myocardial fibrosis. However, the CMR evaluation in SSc may be problematic, because of cardiac and respiratory artefacts, commonly found in these patients. Therefore, a high level of expertise is necessary for both acquisition and interpretation of CMR images in SSc.
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Affiliation(s)
- Sophie I Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, 50 Esperou St, 175-61, P. Faliro, Athens, Greece.
| | - Juerg Schwitter
- Cardiovascular Department, Cardiac MR Center of the CHUV, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland
| | - Luna Gargani
- National Research Council, Institute of Clinical Physiology, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R., Pisa, Italy
| | - Lorenzo Monti
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, AOUC, Florence, Italy
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42
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Masuda A, Takeishi Y. Current Status and Future Direction of PET/MR in Cardiology. ACTA ACUST UNITED AC 2017. [DOI: 10.17996/anc.17-00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Atsuro Masuda
- Department of Cardiovascular Medicine, Fukushima Medical University
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Abstract
Expanding implantable cardioverter-defibrillator (ICD) indications and significant morbidity and mortality reduction benefits have resulted in a large number of routine ICD implants with appropriate ICD shocks for ventricular arrhythmias. The side-effects and lack of long-term efficacy of antiarrhythmics have made ventricular tachycardia (VT) ablation an increasingly attractive treatment option. Although cardiac magnetic resonance imaging (CMR) is considered the gold standard technique for imaging of myocardial fibrosis to diagnose and guide VT ablation targets in patients with cardiac arrhythmia, safety concerns and significant artifacts from the devices significantly limit the application of CMR. We discuss how to decrease artifact from cardiac devices and the role of a modified inversion pulse late gadolinium enhancement (LGE) CMR sequence as a useful tool in this setting, and we review techniques, safety protocols and limitations from the perspective of our institution’s experience.
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El Hajj SC, Gold MR. Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator: Expanding Access and Safety During Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005573. [PMID: 27729367 DOI: 10.1161/circimaging.116.005573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephanie C El Hajj
- From the Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Michael R Gold
- From the Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston.
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45
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Affiliation(s)
- Juerg Schwitter
- From the Division of Cardiology, Cardiovascular Department, University Hospital Lausanne, CHUV, and Cardiac MR Center of the University Hospital Lausanne, Switzerland
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Simonetti OP, Gross DC. Cardiovascular Magnetic Resonance in Patients With Magnetic Resonance–Conditional Cardiac Implantable Electronic Devices. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004970. [DOI: 10.1161/circimaging.116.004970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orlando P. Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine (O.P.S.), Department of Radiology (O.P.S.), Dorothy M. Davis Heart and Lung Research Institute (O.P.S., D.C.G.), and Department of Biomedical Engineering (D.C.G.), The Ohio State University, Columbus, OH
| | - David C. Gross
- Division of Cardiovascular Medicine, Department of Internal Medicine (O.P.S.), Department of Radiology (O.P.S.), Dorothy M. Davis Heart and Lung Research Institute (O.P.S., D.C.G.), and Department of Biomedical Engineering (D.C.G.), The Ohio State University, Columbus, OH
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