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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

Abstract

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.

Keywords

Pacemaker MRI conditional Cardiac magnetic resonance CMR Image quality 

Notes

Acknowledgements

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.

References

  1. 1.
    Pennell DJ (2010) Cardiovascular magnetic resonance. Circulation 121:692–705CrossRefPubMedGoogle Scholar
  2. 2.
    von Knobelsdorff-Brenkenhoff F, Schulz-Menger J (2016) Role of cardiovascular magnetic resonance in the guidelines of the European Society of Cardiology. J Cardiovasc Magn Reson 18:6CrossRefGoogle Scholar
  3. 3.
    Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA et al (2010) ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 55:2614–2662CrossRefPubMedGoogle Scholar
  4. 4.
    Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: society for cardiovascular magnetic resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 15:35CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Taylor J (2012) ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J 33:2371–2372CrossRefPubMedGoogle Scholar
  6. 6.
    Nandalur KR, Dwamena BA, Choudhri AF, Nandalur MR, Carlos RC (2007) Diagnostic performance of stress cardiac magnetic resonance imaging in the detection of coronary artery disease: a meta-analysis. J Am Coll Cardiol 50:1343–1353CrossRefPubMedGoogle Scholar
  7. 7.
    Authors/Task FORCE m, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J et al (2014) ESC/EACTS Guidelines on myocardial revascularization: the TASK FORCE ON MYOCARDIAL REVASCULARIZATION OF THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–619. doi: 10.1093/eurheartj/ehu278 CrossRefGoogle Scholar
  8. 8.
    Li M, Zhou T, Yang LF, Peng ZH, Ding J, Sun G (2014) Diagnostic accuracy of myocardial magnetic resonance perfusion to diagnose ischemic stenosis with fractional flow reserve as reference: systematic review and meta-analysis. JACC Cardiovasc Imaging 7:1098–1105CrossRefPubMedGoogle Scholar
  9. 9.
    Hundley WG, Hamilton CA, Thomas MS, Herrington DM, Salido TB, Kitzman DW et al (1999) Utility of fast cine magnetic resonance imaging and display for the detection of myocardial ischemia in patients not well suited for second harmonic stress echocardiography. Circulation 100:1697–1702CrossRefPubMedGoogle Scholar
  10. 10.
    Shinbane JS, Colletti PM, Shellock FG (2011) Magnetic resonance imaging in patients with cardiac pacemakers: era of “MR Conditional” designs. J Cardiovasc Magn Reson 13:63CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wollmann CG, Thudt K, Kaiser B, Salomonowitz E, Mayr H, Globits S (2014) Safe performance of magnetic resonance of the heart in patients with magnetic resonance conditional pacemaker systems: the safety issue of the ESTIMATE study. J Cardiovasc Magn Reson 16:30CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Buendia F, Cano O, Sanchez-Gomez JM, Igual B, Osca J, Sancho-Tello MJ et al (2011) Cardiac magnetic resonance imaging at 1.5 T in patients with cardiac rhythm devices. Europace 13:533–538CrossRefPubMedGoogle Scholar
  13. 13.
    Klein-Wiele O, Garmer M, Urbien R, Busch M, Kara K, Mateiescu S et al (2015) Feasibility and safety of adenosine cardiovascular magnetic resonance in patients with MR conditional pacemaker systems at 1.5 T. J Cardiovasc Magn Reson 17:112CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Schwitter J, Kanal E, Schmitt M, Anselme F, Albert T, Hayes DL et al (2013) Impact of the Advisa MRI pacing system on the diagnostic quality of cardiac MR images and contraction patterns of cardiac muscle during scans: Advisa MRI randomized clinical multicenter study results. Heart Rhythm 10:864–872CrossRefPubMedGoogle Scholar
  15. 15.
    Kaasalainen T, Kivisto S, Holmstrom M, Peltonen J, Pakarinen S, Hanninen H et al (2016) Cardiac MRI in patients with cardiac pacemakers: practical methods for reducing susceptibility artifacts and optimizing image quality. Acta Radiol 57:178–187CrossRefPubMedGoogle Scholar
  16. 16.
    Naehle CP, Kreuz J, Strach K, Schwab JO, Pingel S, Luechinger R et al (2011) Safety, feasibility, and diagnostic value of cardiac magnetic resonance imaging in patients with cardiac pacemakers and implantable cardioverters/defibrillators at 1.5 T. Am Heart J 161:1096–1105CrossRefPubMedGoogle Scholar
  17. 17.
    Sasaki T, Hansford R, Zviman MM, Kolandaivelu A, Bluemke DA, Berger RD et al (2011) Quantitative assessment of artifacts on cardiac magnetic resonance imaging of patients with pacemakers and implantable cardioverter-defibrillators. Circ Cardiovasc Imaging 4:662–670CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Raphael CE, Vassiliou V, Alpendurada F, Prasad SK, Pennell DJ, Mohiaddin RH (2015) Clinical value of cardiovascular magnetic resonance in patients with MR-conditional pacemakers. Eur Heart J Cardiovasc ImagingGoogle Scholar
  19. 19.
    Alonso A, Jensen PN, Lopez FL, Chen LY, Psaty BM, Folsom AR et al (2014) Association of sick sinus syndrome with incident cardiovascular disease and mortality: the Atherosclerosis Risk in Communities study and Cardiovascular Health Study. PLoS One 9:e109662CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hsueh CW, Lee WL, Chen YT, Ting CT (2001) The incidence of coronary artery disease in patients with symptomatic bradyarrhythmias. Jpn Heart J 42:417–423CrossRefPubMedGoogle Scholar
  21. 21.
    Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA et al (2013) ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34:2281–2329. doi: 10.1093/eurheartj/eht150 CrossRefPubMedGoogle Scholar
  22. 22.
    Bruder O, Wagner A, Lombardi M, Schwitter J, van Rossum A, Pilz G et al (2013) European Cardiovascular Magnetic Resonance (EuroCMR) registry–multi national results from 57 centers in 15 countries. J Cardiovasc Magn Reson 15:9CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kellman P, Hansen MS (2014) T1-mapping in the heart: accuracy and precision. J Cardiovasc Magn Reson 16:2CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Stevens SM, Tung R, Rashid S, Gima J, Cote S, Pavez G et al (2014) Device artifact reduction for magnetic resonance imaging of patients with implantable cardioverter-defibrillators and ventricular tachycardia: late gadolinium enhancement correlation with electroanatomic mapping. Heart Rhythm 11:289–298CrossRefPubMedGoogle Scholar

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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