Department of Rhythmology, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany.
Department of Cardiac Surgery, HELIOS Heart Center-University of Leipzig, Struempellstr 39, Leipzig, Germany.
Eur Heart J Cardiovasc Imaging. 2018 Sep 1;19(9):1051-1061. doi: 10.1093/ehjci/jex243.
To prospectively determine evaluability of routine cardiovascular magnetic resonance (CMR) diagnostic modules in a referral population of implanted rhythm device all-comers, and to establish a device-dependent CMR imaging strategy to achieve optimal image quality.
One hundred and twenty-eight patients with cardiac implantable electronic devices [insertable cardiac monitoring system, n = 14; implantable loop-recorder, n = 21; pacemaker, n = 31; implantable cardioverter-defibrillator (ICD), n = 50; and cardiac resynchronization therapy defibrillator (CRT-D), n = 12] underwent clinically indicated CMR at 1.5 T. CMR protocols were tailored to the clinical indication and consisted of cine, perfusion, T1-/T2-weighted, late-gadolinium enhancement (LGE), 3D angiographic, and post-contrast cine spoiled gradient echo (SGE) scans. Image quality was determined using a 4-grade visual score per myocardial segment. Segmental evaluability was strongly influenced by device type and location with the highest proportion of non-diagnostic images encountered in the presence of ICD/CRT-D systems. Cine steady-state free-precession (SSFP) imaging was found to be mostly non-diagnostic in ICD/CRT-D patients, but a significant improvement of image quality was demonstrated when using SGE sequences with a further incremental improvement post-contrast resulting in an overall four-fold higher likelihood of achieving good image quality. LGE scans were found to be non-diagnostic in about one-third of left-ventricular segments of ICD/CRT-D patients but were artefact-free in > 94% for all other device types.
Device type and location constitute the main independent predictors of CMR image quality and thus, need to be considered during protocol adaptation. Most notably, post-contrast SGE cine imaging proved superior to conventionally used SSFP sequences. Thus, following the proposed device-dependent CMR imaging strategy, diagnostic image quality can be achieved in the majority of device patients.
前瞻性地评估植入式心律转复除颤器（ICD）患者的常规心血管磁共振（CMR）诊断模块的可评估性，并建立一种依赖设备的 CMR 成像策略，以获得最佳的图像质量。
128 例植入式心脏电子设备患者（植入式心脏监测系统，n=14；植入式环记录仪，n=21；起搏器，n=31；ICD，n=50；和心脏再同步治疗除颤器，n=12）在 1.5T 进行了临床推荐的 CMR。CMR 方案根据临床指征进行调整，包括电影、灌注、T1-/T2 加权、晚期钆增强（LGE）、3D 血管造影和对比后电影失相位梯度回波（SGE）扫描。使用每段心肌的 4 级视觉评分来确定图像质量。节段可评估性强烈受设备类型和位置的影响，在存在 ICD/CRT-D 系统的情况下，遇到的非诊断图像比例最高。在 ICD/CRT-D 患者中，稳态自由进动（SSFP）电影成像大多不可诊断，但使用 SGE 序列可显著提高图像质量，进一步增强对比后可显著提高图像质量，整体上可提高四倍的获得良好图像质量的可能性。在 ICD/CRT-D 患者的约三分之一的左心室节段中，LGE 扫描不可诊断，但对于所有其他设备类型，>94%的节段均无伪影。
设备类型和位置是 CMR 图像质量的主要独立预测因素，因此，在方案适应过程中需要考虑这些因素。值得注意的是，对比后 SGE 电影成像优于传统使用的 SSFP 序列。因此，按照提出的依赖设备的 CMR 成像策略，可以在大多数设备患者中获得诊断图像质量。
