Cardiovascular magnetic resonance in patients with magnetic resonance conditional pacemaker systems at 1.5 T: influence of pacemaker related artifacts on image quality including first pass perfusion, aortic and mitral valve assessment, flow measurement, short tau inversion recovery and T1-weighted imaging

  • Oliver Klein-Wiele
  • Marietta Garmer
  • Martin Busch
  • Serban Mateiescu
  • Rhyan Urbien
  • Gianluca Barbone
  • Kaffer Kara
  • Michael Schulte-Hermes
  • Frauke Metz
  • Birgit Hailer
  • Dietrich Grönemeyer
Review Paper


There are only limited data on the impact of device-related artifacts on image quality in cardiovascular magnetic resonance imaging (CMR) in patients with pacemakers (PM). Adenosine stress perfusion, T1-weighted imaging and flow measurement as well as valve characterization have not been evaluated previously concerning artifact burden. We aimed to assess image quality in all routinely used CMR sequences. We analyzed 2623 myocardial segments in CMR scans of 61 patients with MR conditional PM (mean age 72.1 ± 11.5 years), 23 (37.7%) with right sided, 38 (62.3%) with left-sided devices. There were no relevant artifacts in patients with right-sided devices irrespective of the imaging sequence. In left-sided implants no PM-induced artifacts were found in first pass perfusion sequence, flow analysis and T1 weighted imaging. Only few patients with left-sided devices showed significant PM-artifacts in aortic (3/38, 7.9%)/mitral (n = 2/38, 5.3%) valve imaging and STIR (n = 3/35, 8.6%). In STIR only 14/805 (1.7%) segments were involved. In left-sided PM SSFP cine sequences had more artifact burden than LGE with 377/1505 (25.0%) vs. 162/1505 (10.8%) myocardial segments involved by relevant artifacts respectively (p < 0.001). Apart from cine and LGE imaging in anterior myocardial segments with left-sided implants presence of MRI conditional pacemakers does not affect CMR image quality in multimodal CMR examinations to a significant extent. Our data supports evidence that reduced image quality does not need to be a major concern in PM patients undergoing CMR.


Pacemaker MRI conditional Cardiac magnetic resonance CMR Image quality 



We acknowledge Michael Pilz for editing the graphic content of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Oliver Klein-Wiele
    • 1
    • 2
  • Marietta Garmer
    • 3
  • Martin Busch
    • 3
  • Serban Mateiescu
    • 3
  • Rhyan Urbien
    • 2
  • Gianluca Barbone
    • 2
  • Kaffer Kara
    • 4
  • Michael Schulte-Hermes
    • 5
  • Frauke Metz
    • 3
  • Birgit Hailer
    • 2
  • Dietrich Grönemeyer
    • 3
  1. 1.Department of Cardiology, Grönemeyer Institut BochumUniversity of Witten/HerdeckeBochumGermany
  2. 2.Department of Cardiology, Katholisches Klinikum EssenUniversity of Witten/HerdeckeEssenGermany
  3. 3.Department of Radiology, Grönemeyer Institut BochumUniversity of Witten/HerdeckeBochumGermany
  4. 4.Cardiovascular Centre, Josef HospitalUniversity of BochumBochumGermany
  5. 5.Department of Cardiology, Prosper-Hospital RecklinghausenUniversity of Witten/HerdeckeRecklinghausenGermany

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