The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices
The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices
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DOI：
10.1016/j.acra.2016.08.016
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发表时间：
2016-12-01
影响因子：
4.8
通讯作者：
Knight, Bradley P.
中科院分区：
文献类型：
--
作者：
Dandamudi, Sanjay;Collins, Jeremy D.;Knight, Bradley P.
理论基础和目的：关于使用心脏可植入电子设备(CIED)的患者进行磁共振成像(MRI)安全性的研究大多排除了在磁体等中心使用该设备进行检查。本研究的目的是描述心脏和胸椎MRI在CIED患者中的安全性。材料和方法：回顾2011年1月至2014年12月接受心脏或胸椎MRI检查的CIED患者的病历。对依赖起搏器的患者在成像前和成像后对设备进行询问，重新编程为异步起搏。结果：58例患者接受了51次心脏和11次胸椎MRI检查。29名患者安装了起搏器，29名患者安装了植入型心律转复除颤器。17%(n=10)依赖起搏器。51名患者(%)使用了非条件磁共振设备。在房室感觉、阻抗和阈值测量方面没有临床上显著的变化。没有发生设备模式改变、心律失常、治疗、电子重启或电池耗尽的情况。其中一项研究因患者主诉胸痛而提前终止，其病因尚未确定。在所有检查中，平均峰值SAR为2.0+/-0.85W/kg，平均SAR为0.35+/-0.37W/kg。33%的心脏MRI研究中存在明显限制临床解释的伪影。结论：当遵循全面的CIED磁共振安全方案时，在磁体等中心使用该设备进行1.5-T磁共振研究的风险很低，包括对起搏器依赖的患者。
Rationale and Objectives: Studies reporting the safety of magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED) have mostly excluded examinations with the device in the magnet isocenter. The purpose of this study was to describe the safety of cardiac and thoracic spine MRI in patients with a CIED.Materials and Methods: The medical records of patients with a CIED who underwent a cardiac or thoracic spine MRI between January 2011 and December 2014 were reviewed. Devices were interrogated before and after imaging with reprogramming to asynchronous pacing in pacemaker dependent patients. The clinical interpretability of the MRI and peak and average specific absorption rates (SARs, W/kg) achieved were determined.Results: Fifty-eight patients underwent 51 cardiac and 11 thoracic spine MRI exams. Twenty-nine patients had a pacemaker and 29 had an implantable cardioverter defibrillator. Seventeen percent (n = 10) were pacemaker dependent. Fifty-one patients (89%) had non-MRI-conditional devices. There were no clinically significant changes in atrial and ventricular sensing, impedance, and threshold measurements. There were no episodes of device mode changes, arrhythmias, therapies delivered, electrical reset, or battery depletion. One study was prematurely discontinued due to a patient complaint of chest pain of which the etiology was not determined. Across all examinations, the average peak SAR was 2.0 +/- 0.85 W/kg with an average SAR of 0.35 +/- 0.37 W/kg. Artifact significantly limiting the clinical interpretation of the study was present in 33% of cardiac MRI studies.Conclusions: When a comprehensive CIED magnetic resonance safety protocol is followed, the risk of performing 1.5-T magnetic resonance studies with the device in the magnet isocenter, including in patients who are pacemaker dependent, is low.