Safety assessment of magnetic resonance imaging in patients with retained cardiac leads

保留心脏导线患者的磁共振成像安全性评估

• 批准号: 9762904
• 负责人: Laleh Golestani Rad
• 金额: $ 7.84万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-13 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762904
• 关键词: 3-Dimensional; Anatomy; Arthritis; Benefits and Risks; Cardiac; Cardiovascular system; Characteristics; Clinical; Clinical Protocols; Coiled Bodies; Comorbidity; Computer Simulation; Computing Methodologies; Couples; Data; Databases; Defibrillators; Dependence; Deposition; Development; Devices; Diagnostic; Disease; Electromagnetic Energy; Electromagnetics; Electronics; Elements; Equation; Female; Frequencies; Future; Generations; Geometry; Goals; Growth; Guidelines; Head; Heart Transplantation; Heating; Human body; Image; Imaging Device; Implant; In Situ; In Vitro; Individual; Injury; Investigation; Label; Lead; Left; Length; Location; Magnetic Resonance Imaging; Malignant Neoplasms; Methodology; Modeling; Obesity; Pacemakers; Patient imaging; Patients; Physiologic pulse; Postoperative Period; Probability; Procedures; Property; Protocols documentation; RF coil; Reporting; Resolution; Risk; Safety; Somatotype; Stroke; Structure; Supercomputing; Surface; Temperature; Thoracic Radiography; Time; Tissues; United States; Variant; Ventricular Function; Work; X-Ray Computed Tomography; absorption; base; clinical imaging; clinical practice; cohort; computational platform; electric field; evidence base; experimental study; hazard; human model; imaging modality; in vivo; magnetic field; male; models and simulation; non-invasive imaging; operation; patient population; phenomenological models; radio frequency; repository; risk minimization; safety assessment; safety study; side effect; simulation; soft tissue

Project Summary/Abstract The number of patients with a cardiovascular implanted electronic device (CIED) is rapidly and constantly growing, now comprising several million patients worldwide. It is estimated that up to 75% of all patients with CIED will have the future need for a magnetic resonance imaging (MRI) investigation due to the high probability of comorbidities such as stroke, lumbar disease, arthritis, or cancer in this patient population. A few studies have assessed the safety of endocardial leads connected to working devices, but many patients require additional procedures which lead to “lead extraction”, leaving fractions of the device left in situ, in which case the original safety studies of the device/lead combination are not applicable. Magnetic resonance imaging (MRI) is considered the imaging tool of choice in a wide range of diagnostic tasks, however, MRI is currently a contraindication for patients with abandoned or retained cardiac leads. This is particularly alarming, considering that 50% of patients undergoing heart transplantation who significantly benefit from MRI in assessment of rejection and ventricular function have already abandoned or retained leads from a previously implanted CIED. The major safety concern is due to the so-called “antenna effect”, where the electric field of the MRI transmit coil couples with conductive implanted leads and amplifies energy deposition in the tissue which leads to excessive heating and potential tissue damage. Phantom experiments have highlighted the significant effect of lead geometry, location, and trajectory on MR-induced RF heating, yet almost nothing is known about the actual temperature rise in the tissue in a realistic patient population. A significant challenge is that the problem has a very large parameter space with many interacting factors that preclude the application of a systematic experimental approach to estimate heating in the worst case scenario. This proposal aims to develop, optimize, and validate computational methodologies that consistently and reliably predict tissue heating in patients with retained leads during high-field MRI. As a first step, we will complete development of a repository of 30 patient-derived realistic models of abandoned/retained leads that incorporate detailed features of the lead structure and trajectory, co-registered in high-resolution anatomically detailed models of human body. We will then use these patient-derived lead and body models along with experimentally validated models of MRI transmit coils and perform full-wave electromagnetic simulations to calculate tissue heating during MRI at both 1.5 T and 3.0 T. Dependency and sensitivity of results on parameters such as RF coil’s frequency (64 MHz, vs. 127 MHz), mode of operation (linear vs. quadrature), body model characteristics (size, number of tissues, electric and thermal properties), and lead trajectory will be examined. Finally, we will use this information to devise an evidence-based, patient-specific, and easy-to-use clinical guideline to help clinicians better assess risks and benefits of performing MRI on these patients based on the particular imaging landmark and the pulse sequence in use.

项目摘要/摘要 心血管植入电子设备(CIED)的患者数量迅速且持续 不断增长，目前在全球拥有数百万名患者。据估计，高达75%的患者患有 CIED未来将需要进行磁共振成像(MRI)检查，因为 在该患者群体中发生中风、腰椎疾病、关节炎或癌症等合并症的可能性。几个 研究已经评估了连接到工作装置上的心内膜导线的安全性，但许多患者 需要额外的程序，以导致“铅提取”，留下设备的一小部分在原地，其中 情况：设备/引线组合的原始安全研究不适用。磁共振成像 (MRI)被认为是广泛诊断任务中的首选成像工具，然而，MRI目前是一种 心脏导联遗弃或保留患者的禁忌症。这尤其令人担忧， 考虑到50%的接受心脏移植的患者从磁共振中受益显著 对排斥反应和心功能的评估已经放弃或保留了以前 植入的CIED。主要的安全问题是由于所谓的“天线效应”，其中的电场 磁共振发射线圈与植入的导电导线相耦合，并放大组织中的能量沉积 这会导致过热和潜在的组织损伤。幻影实验突出了 导线几何形状、位置和轨迹对MR诱导的射频加热有显著影响，但几乎没有什么影响 已知现实患者群体中组织的实际温度升高。一个重大挑战是 这个问题有一个非常大的参数空间，有许多相互作用的因素，这排除了应用 一种系统的实验方法来估计最坏情况下的供暖。这项建议旨在 开发、优化和验证一致且可靠地预测组织的计算方法 高场磁共振期间导联滞留患者的加热。作为第一步，我们将完成一项 包含30个患者派生的放弃/保留导联的真实模型的存储库，其中包含详细特征 在人体高分辨率详细解剖模型中共同注册的导联结构和轨迹 尸体。然后，我们将使用这些患者衍生的铅和身体模型以及经过实验验证的模型 并执行全波电磁模拟以计算在MRI过程中的组织温度 在1.5T和3.0T下，结果对射频线圈频率等参数的依赖性和敏感性( MHz与127 MHz)、操作模式(线性与正交)、身体模型特征(大小、数量 组织、电学和热学性质)，以及引线轨迹。最后，我们将使用这个 设计循证的、针对患者的、易于使用的临床指南的信息，以帮助临床医生 根据特定的成像里程碑更好地评估对这些患者进行MRI检查的风险和好处 以及正在使用的脉冲序列。

项目成果

Safety of MRI in patients with retained cardiac leads.

• DOI: 10.1002/mrm.29116
• 发表时间: 2022-05
• 期刊: Magnetic resonance in medicine
• 影响因子: 3.3
• 作者: Nguyen BT;Bhusal B;Rahsepar AA;Fawcett K;Lin S;Marks DS;Passman R;Nieto D;Niemzcura R;Golestanirad L
• 通讯作者: Golestanirad L

The effect of simulation strategies on prediction of power deposition in the tissue around electronic implants during magnetic resonance imaging.

• DOI: 10.1088/1361-6560/abac9f
• 发表时间: 2020-09-16
• 期刊: Physics in medicine and biology
• 影响因子: 3.5
• 作者: Nguyen BT;Pilitsis J;Golestanirad L
• 通讯作者: Golestanirad L

Radiofrequency heating of retained cardiac leads during magnetic resonance imaging at 1.5 T and 3 T.

在 1.5 T 和 3 T 磁共振成像期间对保留的心脏引线进行射频加热。

• DOI: 10.1109/embc46164.2021.9629867
• 发表时间: 2021
• 期刊: Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
• 作者: Nguyen,BachT;Bhusal,Bhumi;Fawcett,Kate;Golestanirad,Laleh
• 通讯作者: Golestanirad,Laleh

Effect of Biophysical Model Complexity on Predictions of Volume of Tissue Activated (VTA) during Deep Brain Stimulation.

生物物理模型复杂性对深部脑刺激期间激活组织体积 (VTA) 预测的影响。

• DOI: 10.1109/embc44109.2020.9175300
• 发表时间: 2020
• 期刊: Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference
• 作者: Jiang,Fuchang;Nguyen,BachT;Elahi,Behzad;Pilitsis,Julie;Golestanirad,Laleh
• 通讯作者: Golestanirad,Laleh

Vertical open-bore MRI scanners generate significantly less radiofrequency heating around implanted leads: A study of deep brain stimulation implants in 1.2T OASIS scanners versus 1.5T horizontal systems.

• DOI: 10.1002/mrm.28818
• 发表时间: 2021-09
• 期刊: Magnetic resonance in medicine
• 影响因子: 3.3
• 作者: Kazemivalipour E;Bhusal B;Vu J;Lin S;Nguyen BT;Kirsch J;Nowac E;Pilitsis J;Rosenow J;Atalar E;Golestanirad L
• 通讯作者: Golestanirad L