Current Radiology Reports

, 6:41 | Cite as

MR Imaging of Patients with Cardiac Implantable Electronic Devices (CIEDs): Implementing a Program and Optimizing CMR

  • Avanti Gulhane
  • Harold LittEmail author
Cardiovascular Imaging (K Ordovas, Section Editor)
Part of the following topical collections:
  1. Cardiovascular Imaging


Purpose of review

How to implement a program for MRI in patients with conditional and non-conditional (“legacy”) CIED. How to optimize safety and image quality in CMR? What the radiologists need to know: device programming, pre- and post-MRI CIED parameters.

Recent findings

New Center for Medicare and Medicaid Services (CMS) guidelines have opened MRI to many patients with nonconditional devices. Newer pulse sequences for cardiac MRI (CMR) in device patients, including modified cine, late gadolinium enhancement and T1 mapping sequences, have resulted in improved image quality in device patients. We present several cases of CMR in device patients, including imaging of leadless pacemakers subcutaneous ICDs. Imaging pitfalls/artifacts in CMR interpretation are also presented.


An organized institutional workflow with an established protocol involving proper patient screening, device programming, scan monitoring, and pre- and post-ICD interrogation minimizes risk in patients with conditional and non-conditional CIEDs. Although rare, significant changes in lead performance, power-on/reset, inappropriate pacing or ICD discharges and battery voltage depletion should be documented. High-quality scans with accurate scar characterization in CIED patients require the use of wideband sequences. CMS has recently acknowledged MRI as a reasonable test necessary for the diagnosis and treatment of beneficiaries with implanted CIEDs, improving the financial prospects and encouraging future developments.


Cardiac implantable electronic device Safety concerns CMR protocol Device programming Wideband LGE Image quality 


Compliance with Ethical Guidelines

Conflict of interest

Avanti Gulhane and Harold Litt each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

40134_2018_301_MOESM1_ESM.avi (1.4 mb)
Video 1: Non conditional pacemaker cine 4ch. Supplementary material 1 (AVI 1391 kb)
40134_2018_301_MOESM2_ESM.avi (1.4 mb)
Video 2: Non conditional pacemaker cine SAX. Supplementary material 2 (AVI 1386 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiovascular Imaging Section, Department of RadiologyPerelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Cardiothoracic Imaging Division, Department of RadiologyPerelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA

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