Image Quality of Cardiac Magnetic Resonance Imaging in Patients With an Implantable Cardioverter Defibrillator System Designed for the Magnetic Resonance Imaging Environment

Juerg Schwitter; Michael R Gold; Ahmed Al Fagih; Sung Lee; Michael Peterson; Allen Ciuffo; Yan Zhang; Nina Kristiansen; Emanuel Kanal; Torsten Sommer; Evera-MRI Study Investigators

doi:10.1161/CIRCIMAGING.115.004025

Image Quality of Cardiac Magnetic Resonance Imaging in Patients With an Implantable Cardioverter Defibrillator System Designed for the Magnetic Resonance Imaging Environment

Circ Cardiovasc Imaging. 2016 May;9(5):e004025. doi: 10.1161/CIRCIMAGING.115.004025.

Affiliations

¹ From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.). Jurg.schwitter@chuv.ch.
² From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).

PMID: 27151268
DOI: 10.1161/CIRCIMAGING.115.004025

Abstract

Background: Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system.

Methods and results: The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades 1-3: good quality, grades 6-7: nondiagnostic) and measuring ICD- and lead-related artifact size. Good to moderate image quality (grades 1-5) was obtained in 53% and 74% of SSFP and FGE acquisitions, respectively, covering the left ventricle, and in 69% and 84%, respectively, covering the right ventricle. Odds for better image quality were greater for right ventricle versus left ventricle (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P<0.0001) and greater for FGE versus SSFP (odds ratio, 3.5; 95% confidence interval, 2.5-4.8; P<0.0001). Compared with SSFP, ICD-related artifacts on FGE were smaller (141±65 versus 75±57 mm, respectively; P<0.0001). Lead artifacts were much smaller than ICD artifacts (P<0.0001).

Conclusions: FGE yields good to moderate quality in 74% of left ventricle and 84% of right ventricle acquisitions and performs better than SSFP in patients with an MRI-conditional ICD system. In these patients, cardiac MRI can offer diagnostic information in most cases.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02117414.

Keywords: Image Quality Enhancement and Cardiac Function Test; artifacts; heart ventricles; implantable cardioverter-defibrillator; magnetic resonance imaging.

Publication types

Comparative Study
Multicenter Study
Randomized Controlled Trial

MeSH terms

Aged
Artifacts
Defibrillators, Implantable* / adverse effects
Electric Countershock / adverse effects
Electric Countershock / instrumentation*
Female
Heart Diseases / diagnostic imaging*
Heart Diseases / physiopathology
Heart Diseases / therapy*
Humans
Image Interpretation, Computer-Assisted
Linear Models
Logistic Models
Magnetic Resonance Imaging* / methods
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Prosthesis Design
Reproducibility of Results
Risk Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Function, Right

Associated data

ClinicalTrials.gov/NCT02117414