Background Implanted cardiac devices were previously considered unsuitable for CMR. With the development of MR-conditional devices, access to CMR has increased, despite concerns regarding image quality and diagnostic accuracy. We aimed to assess the clinical application of CMR in patients wearing MR-conditional devices.
Materials and methods We retrospectively enrolled patients wearing MR-conditional devices undergoing a comprehensive CMR protocol (cine, early and late gadolinium enhancement, LGE) in a 1.5T scanner (June 2012–November 2015). Every sequence was analysed by two independent observers and scored according to the effect of artefacts on image quality and interpretation (no, minor and major artefacts). Inter-observer agreement was assessed per sequence and as overall judgement on scan quality and interpretation. Clinical impact of CMR was defined as a change in diagnosis and in management. All devices were interrogated before and after CMR.
Results We enrolled 46 consecutive patients (28 male, mean age 56 ± 16 years) wearing MR-conditional pacemaker (22, 48%) and implantable loop recorder (24, 52%). All CMR scans were successfully completed and diagnostic: minor artefacts were recorded in 17 scans (37%), major artefacts in 7 (15%), and no artefacts in 22 (48%). Additional FLASH sequences were performed in 9 patients (20%) to overcome artefacts. Inter-observer agreement on image quality and interpretation was moderate, both overall (kappa 0.454, p < 0.0001) and per sequence, with the exception of long-axis LGE sequences, for which it was fair (kappa 0.284, p = 0.005) (Table 1). Cine sequences were most affected by artefacts, mainly in the mid-apical left ventricular anterior wall and anteroseptum (Figure 1). No change in device parameters was reported after the scan. CMR had a clinical impact in 26 patients (57%), determining a change in diagnosis in 16 (35%), in management in 5 (11%) and a change in both in 5 patients (11%).
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