Special article
Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus documentResonancia magnética para portadores de dispositivos cardiovasculares. Consenso SEC-GT CRMTC/SEC-Asociación del Ritmo Cardiaco/SERAM/SEICAT

https://doi.org/10.1016/j.rec.2022.12.002Get rights and content

Abstract

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Resumen

La resonancia magnética se ha convertido en técnica de imagen de primera línea en muchas situaciones clínicas. El número de pacientes portadores de dispositivos cardiovasculares, como los dispositivos cardiovasculares electrónicos implantables, ha crecido de modo exponencial. Aunque se han descrito complicaciones y efectos adversos cuando estos pacientes se someten a exploraciones de resonancia magnética, la evidencia clínica actual respalda la seguridad de realizar estos estudios cuando se cumplen unas normas y recomendaciones dirigidas a minimizar los posibles riesgos. El Grupo de Trabajo de Cardiorresonancia Magnética y Cardiotomografía Computarizadas de la Sociedad Española de Cardiología (SEC-GT CRMTC), la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (SEC-Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Imagen Cardiotorácica (SEICAT) han elaborado el presente documento, que revisa la evidencia disponible en este campo y establece las recomendaciones necesarias para que los pacientes portadores de dispositivos cardiovasculares electrónicos implantables y otros dispositivos puedan acceder con seguridad a este instrumento diagnóstico.

Section snippets

INTRODUCTION

In recent years, magnetic resonance (MR) has become an essential and first-line imaging technique in many clinical situations. At the same time, the number of patients with a cardiovascular device has grown exponentially. It is thus commonplace in clinical practice to encounter a recipient of one of these devices who requires an MR study.1, 2 The probability that a recipient of a cardiac implantable electronic device (CIED) will require an MR study in the first postimplantation year is

DEFINITIONS

The MR technique enables image capture due to the interaction between magnetic fields and the hydrogen nuclei of different tissues. Image generation involves application of 3 types of magnetic fields that have different effects on the human body and surrounding objects and influence the safety of the scans.4, 5

  • 1.

    The static magnetic field (B0). This is the magnetic field of the scanner; it is always active and its intensity is measured in teslas (T). The most commonly used systems are 1.5 and 3 T.

Influence of devices on the MR image (artifacts)

MR artifacts are relatively frequent. They are defined as any signal increase or loss that has no anatomical basis or is the consequence of information distortion, addition, or loss, generally that related to the presence of metallic or ferromagnetic material. Although some artifacts are obvious and easily recognizable, others are much more subtle and can lead to interpretation and diagnostic errors.

In general, there are 2 types of artifacts induced by ferromagnetic material:

  • 1.

    Magnetic

PROPOSED MR-RELATED WORKFLOW FOR PATIENTS WITH DEVICES

The workflow to consider for patients with cardiovascular devices who are undergoing an MR study will depend on the type of implanted device (figure 1).

IMPROVEMENT AND OPTIMIZATION OF THE CARDIOTHORACIC MR IMAGING OF PATIENTS WITH DEVICES

In an MR study, the type of device and its location constitute the main determinants of image quality. In cardiothoracic MR, ICDs and cardiac resynchronization therapy usually produce more artifacts due to their larger size and inclusion of ferromagnetic elements and can show image distortion up to 12 cm from the generator (figure 2). For this reason, devices implanted on the left side create more artifacts than right-sided devices,47 which generally do not affect cardiac imaging.48

The cardiac

CONCLUSIONS

MR studies can be performed in patients with a cardiovascular device with the appropriate precautions. The present document reviews the evidence and provides management guidelines to minimize interference of the magnetic field with the electronic device and to reduce the image artifacts generated with cardiovascular devices in the region of the cardiothoracic scan.

FUNDING

None.

AUTHORS’ CONTRIBUTIONS

All authors have participated equally in the drafting of this document. The present document has been reviewed before publication by experts not involved in its drafting: J.F. Rodríguez Palomares, J.M. Tolosana, J.A. Hidalgo Pérez, E. Pérez-David, Vicente Bertomeu-González, and H. Cuéllar.

CONFLICTS OF INTEREST

None.

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