Department of Radiological Diagnostics, University Hospital of Cologne, Germany.
Dtsch Arztebl Int. 2012 Apr;109(15):270-5. doi: 10.3238/arztebl.2012.0270. Epub 2012 Apr 13.
Magnetic resonance imaging (MRI) is generally contraindicated for patients with a pacemaker (PM) or implantable cardiac defibrillator (ICD), because of the risk of life-threatening interference with the device. Nevertheless, the question whether to perform MRI despite the presence of these devices can still arise when MRI is vitally indicated. In some hospitals, special precautionary measures are taken so that MRI can be performed in such cases.
This review is based on the authors' experience in 42 patients who underwent MRI at our university hospital, on the pertinent literature, and on the recommendations of medical societies.
Because of its excellent image quality, MRI is often an indispensable diagnostic tool. Structured multidisciplinary management enables it to be performed safely even in patients with a PM or ICD. Pre- and post-MRI checks of the device are recommended, as well as extensive monitoring and the availability of the necessary personnel to deal with an emergency. In general, the pacing and defibrillator functions should be deactivated; for pacemaker-dependent patients, the asynchronous pacing mode should be activated. No serious incidents have occurred when these precautions have been observed, either among our own patients or in the literature. Newer PM systems have been approved for MRI scanning under certain conditions.
In patients with a PM or ICD, the benefit of MRI may far outweigh its risks if the indication has been established for the particular patient as an interdisciplinary decision and if the appropriate precautions are observed during scanning. Now that newer PM systems have been approved for MRI scanning, the problem seems close to being solved.
由于存在危及生命的设备干扰风险，磁共振成像（MRI）通常对装有起搏器（PM）或植入式心脏除颤器（ICD）的患者禁忌。然而，当 MRI 至关重要时，仍然可能会出现是否要在存在这些设备的情况下进行 MRI 的问题。在一些医院，会采取特殊的预防措施，以便在这种情况下进行 MRI。
本综述基于作者在我院 42 名接受 MRI 检查的患者的经验、相关文献和医学协会的建议。
由于其出色的图像质量，MRI 通常是不可或缺的诊断工具。结构化的多学科管理使即使在装有 PM 或 ICD 的患者中也能安全地进行 MRI。建议在 MRI 前后对设备进行检查，并进行广泛的监测，以及配备必要的人员以应对紧急情况。通常，应停用起搏和除颤器功能；对于依赖起搏器的患者，应激活异步起搏模式。如果这些预防措施得到遵守，无论是在我们自己的患者中还是在文献中，都没有发生严重事件。在某些条件下，新的 PM 系统已被批准用于 MRI 扫描。
如果特定患者的特定情况下已经确立了 MRI 的适应症，并且在扫描过程中采取了适当的预防措施，那么对于装有 PM 或 ICD 的患者，MRI 的益处可能远远超过其风险。现在，新的 PM 系统已被批准用于 MRI 扫描，这个问题似乎接近解决。
