Sommer Torsten, Bauer Wolfgang, Fischbach Katharina, Kolb Christof, Luechinger Roger, Wiegand Uwe, Lotz Joachim, Eitel Ingo, Gutberlet Matthias, Thiele Holger, Schild Hans H, Kelm Malte, Quick Harald H, Schulz-Menger Jeanette, Barkhausen Jörg, Bänsch Dietmar
Klinik für Diagnostische und Interventionelle Radiologie, DRK Krankenhaus Neuwied - Department of Diagnostic and Interventional Radiology, German Red Cross Hospital Neuwied, Germany.
Med. Klinik und Poliklinik I Univ. Klinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz Univ. Würzburg - Department of Internal Medicine I, University Hospital Würzburg, Germany, Center for Heart Failure Research, University of Würzburg, Germany.
Rofo. 2017 Mar;189(3):204-217. doi: 10.1055/s-0043-102029. Epub 2017 Feb 15.
This joint consensus paper of the German Roentgen Society and the German Cardiac Society provides physical and electrophysiological background information and specific recommendations for the procedural management of patients with cardiac pacemakers (PM) and implantable cardioverter defibrillators (ICD) undergoing magnetic resonance (MR) imaging. The paper outlines the responsibilities of radiologists and cardiologists regarding patient education, indications, and monitoring with modification of MR sequences and PM/ICD reprogramming strategies being discussed in particular. The aim is to optimize patient safety and to improve legal clarity in order to facilitate the access of SM/ICD patients to MR imaging. · Conventional PM and ICD systems are no longer an absolute but rather a relative contraindication for performing an MR examination. Procedural management includes the assessment of the individual risk/benefit ratio, comprehensive patient informed consent about specific risks and "off label" use, extensive PM/ICD-related and MR-related safety precautions to reduce these risks to the greatest extent possible, as well as adequate monitoring techniques.. · MR conditional pacemaker and ICD systems have been tested and approved for MR examination under specific conditions ("in-label" use). Precise understanding of and compliance with the terms of use for the specific pacemaker system are essential for patient safety.. · The risk for an ICD patient during MR examinations is to be considered significantly higher compared to PM patients due to the higher vulnerability of the structurally damaged myocardium and the higher risk of irreversible damage to conventional ICD systems. The indication for a MR examination of an ICD patient should therefore be determined on a stricter basis and the expected risk/benefit ratio should be critically reviewed.. · This complex subject requires close collaboration between radiology and cardiology.. · Sommer T, Bauer W, Fischbach K et al. MR Imaging in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators. Fortschr Röntgenstr 2017; 189: 204 - 217.
德国放射学会和德国心脏病学会的这份联合共识文件提供了物理和电生理背景信息，并针对植入心脏起搏器（PM）和植入式心脏复律除颤器（ICD）的患者进行磁共振（MR）成像的程序管理给出了具体建议。该文件概述了放射科医生和心脏病专家在患者教育、适应症以及监测方面的职责，尤其讨论了MR序列的修改和PM/ICD重新编程策略。目的是优化患者安全并提高法律清晰度，以便于PM/ICD患者接受MR成像检查。· 传统的PM和ICD系统不再是进行MR检查的绝对禁忌症，而是相对禁忌症。程序管理包括评估个体风险/获益比、让患者全面知情同意特定风险及“非标签”使用情况、采取广泛的与PM/ICD相关以及与MR相关的安全预防措施以尽可能降低这些风险，以及采用适当的监测技术。· MR条件性起搏器和ICD系统已在特定条件下经过测试并获批用于MR检查（“标签内”使用）。准确理解并遵守特定起搏器系统的使用条款对患者安全至关重要。· 由于结构受损心肌的更高易损性以及传统ICD系统发生不可逆损害的更高风险，ICD患者在MR检查期间的风险被认为显著高于PM患者。因此，ICD患者进行MR检查的适应症应更严格地确定，并且应严格审查预期的风险/获益比。· 这个复杂的主题需要放射科和心脏病科密切合作。· 索默·T、鲍尔·W、菲施巴赫·K等。心脏起搏器和植入式心脏复律除颤器患者的MR成像。《德国放射学进展》2017年；189: 204 - 217。
