Cardiovascular implantable electronic devices: a review of the dangers and difficulties in MR scanning and attempts to improve safety

ABSTRACT: An increasing number of patients are being treated with cardiovascular implantable electronic devices (CIEDs), many of which are MR conditional. There is a lack of literature on the safe scanning of MR conditional CIEDs. This review article discusses MR imaging safety in patients with implanted CIEDs. Guidelines on safe use and indications of imaging patients with MR conditional CIEDs are described, followed by a pictorial essay of the radiographic features of these devices. We also discuss the challenges of monitoring the patient in the MR environment, advances in MRI conditional imaging of devices, availability, limitations and workflow including vendor-specific and other collaborative efforts to simplify the scanning process. Radiologists must be able to facilitate the safe utilization of MR imaging in patients who have CIEDs. A thorough knowledge of the hazards of imaging non-MR compatible devices is required as well as knowing how to correctly identify and manage the imaging of patients with MR conditional CIEDs. Finally, we propose steps required to facilitate the safe scanning of patients with MR conditional CIEDs adopted in our institution and a contingency plan in the event that an inadvertent MR scan of a patient with a MRI unsafe CIED should occur. MAIN MESSAGES: • Risks of MR imaging in patients who have CIEDs have been worked around. • There are many technical limitations in enabling safe MR scanning of CIEDs. • Radiological identification of MRI-conditional status of CIEDs is useful. • Standardizing conditions for safe MRI scanning is important. • We offer example algorithms for facilitating safe MRI scanning of CIEDs.