The current European Society of Cardiology Guidelines on cardiac pacing approve magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED), such as pacemakers (PMs), implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices. The clinical impact of CMR imaging is significant also in CIED patients. 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.Ĭardiac magnetic resonance (CMR) imaging is often the preferred imaging method for the advanced evaluation of the heart, allowing for the non-invasive assessment of cardiac function, structure, myocardial scars and hemodynamics.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.Cardiac implantable electronic device (CIED)–induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs.Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. ConclusionsĪrm-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. 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). 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). Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. 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 assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in 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. ![]() Cardiac implantable electronic device (CIED)–induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR).
0 Comments
Leave a Reply. |