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Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging

OBJECTIVES: Cardiac implantable electronic device (CIED)–induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raisi...

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Autores principales: Vuorinen, Aino-Maija, Lehmonen, Lauri, Karvonen, Jarkko, Holmström, Miia, Kivistö, Sari, Kaasalainen, Touko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889467/
https://www.ncbi.nlm.nih.gov/pubmed/36029346
http://dx.doi.org/10.1007/s00330-022-09059-w
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author Vuorinen, Aino-Maija
Lehmonen, Lauri
Karvonen, Jarkko
Holmström, Miia
Kivistö, Sari
Kaasalainen, Touko
author_facet Vuorinen, Aino-Maija
Lehmonen, Lauri
Karvonen, Jarkko
Holmström, Miia
Kivistö, Sari
Kaasalainen, Touko
author_sort Vuorinen, Aino-Maija
collection PubMed
description OBJECTIVES: Cardiac implantable electronic device (CIED)–induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. METHODS: We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. RESULTS: Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). CONCLUSIONS: Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. KEY POINTS: • Cardiac implantable electronic device (CIED)–induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-09059-w.
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spelling pubmed-98894672023-02-02 Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging Vuorinen, Aino-Maija Lehmonen, Lauri Karvonen, Jarkko Holmström, Miia Kivistö, Sari Kaasalainen, Touko Eur Radiol Cardiac OBJECTIVES: Cardiac implantable electronic device (CIED)–induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR. METHODS: We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts. RESULTS: Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02). CONCLUSIONS: Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality. KEY POINTS: • Cardiac implantable electronic device (CIED)–induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00330-022-09059-w. Springer Berlin Heidelberg 2022-08-27 2023 /pmc/articles/PMC9889467/ /pubmed/36029346 http://dx.doi.org/10.1007/s00330-022-09059-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Cardiac
Vuorinen, Aino-Maija
Lehmonen, Lauri
Karvonen, Jarkko
Holmström, Miia
Kivistö, Sari
Kaasalainen, Touko
Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title_full Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title_fullStr Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title_full_unstemmed Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title_short Reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
title_sort reducing cardiac implantable electronic device–induced artefacts in cardiac magnetic resonance imaging
topic Cardiac
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889467/
https://www.ncbi.nlm.nih.gov/pubmed/36029346
http://dx.doi.org/10.1007/s00330-022-09059-w
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