Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland.
Heart and Lung Center, University of Helsinki and Helsinki University Hospital, P.O. Box 340, HUS, 00029, Helsinki, Finland.
Eur Radiol. 2023 Feb;33(2):1229-1242. doi: 10.1007/s00330-022-09059-w. Epub 2022 Aug 27.
Cardiac implantable electronic device (CIED)-induced metal artefacts possibly significantly diminish the diagnostic value of magnetic resonance imaging (MRI), particularly cardiac MR (CMR). Right-sided generator implantation, wideband late-gadolinium enhancement (LGE) technique and raising the ipsilateral arm to the generator during CMR scanning may reduce the CIED-induced image artefacts. We assessed the impact of generator location and the arm-raised imaging position on the CIED-induced artefacts in CMR.
We included all clinically indicated CMRs performed on patients with normal cardiac anatomy and a permanent CIED with endocardial pacing leads between November 2011 and October 2019 in our institution (n = 171). We analysed cine and LGE sequences using the American Heart Association 17-segment model for the presence of artefacts.
Right-sided generator implantation and arm-raised imaging associated with a significantly increased number of artefact-free segments. In patients with a right-sided pacemaker, the median percentage of artefact-free segments in short-axis balanced steady-state free precession LGE was 93.8% (IQR 9.4%, n = 53) compared with 78.1% (IQR 20.3%, n = 58) for left-sided pacemaker (p < 0.001). In patients with a left-sided implantable cardioverter-defibrillator, the median percentage of artefact-free segments reached 87.5% (IQR 6.3%, n = 9) using arm-raised imaging, which fell to 62.5% (IQR 34.4%, n = 9) using arm-down imaging in spoiled gradient echo short-axis cine (p = 0.02).
Arm-raised imaging represents a straightforward method to reduce CMR artefacts in patients with left-sided generators and can be used alongside other image quality improvement methods. Right-sided generator implantation could be considered in CIED patients requiring subsequent CMR imaging to ensure sufficient image quality.
• Cardiac implantable electronic device (CIED)-induced metal artefacts may significantly diminish the diagnostic value of an MRI, particularly in cardiac MRIs. • Raising the ipsilateral arm relative to the CIED generator is a cost-free, straightforward method to significantly reduce CIED-induced artefacts on cardiac MRIs in patients with a left-sided generator. • Right-sided generator implantation reduces artefacts compared with left-sided implantation and could be considered in CIED patients requiring subsequent cardiac MRIs to ensure adequate image quality in the future.
心脏植入式电子设备（CIED）引起的金属伪影可能显著降低磁共振成像（MRI）的诊断价值，尤其是心脏 MRI（CMR）。右侧发生器植入、宽带晚期钆增强（LGE）技术以及在 CMR 扫描期间将同侧手臂举至发生器上方可能会减少 CIED 引起的图像伪影。我们评估了发生器位置和举起手臂的成像位置对 CMR 中 CIED 引起的伪影的影响。
我们纳入了 2011 年 11 月至 2019 年 10 月期间在我院接受临床指征明确的 CMR 检查且具有心内膜起搏导线的正常心脏解剖结构和永久性 CIED 的所有患者（n=171）。我们使用美国心脏协会 17 节段模型分析电影和 LGE 序列中伪影的存在。
右侧发生器植入和举起手臂成像与更多无伪影节段显著相关。在右侧起搏器患者中，短轴平衡稳态自由进动 LGE 的无伪影节段中位数百分比为 93.8%（IQR 9.4%，n=53），而左侧起搏器患者为 78.1%（IQR 20.3%，n=58）（p<0.001）。在左侧植入式心律转复除颤器患者中，使用举起手臂成像时无伪影节段中位数百分比达到 87.5%（IQR 6.3%，n=9），而使用spoiled 梯度回波短轴电影时降至 62.5%（IQR 34.4%，n=9）（p=0.02）。
举起手臂成像代表了一种减少左侧发生器患者 CMR 伪影的简单方法，并且可以与其他提高图像质量的方法一起使用。对于需要后续 CMR 成像的 CIED 患者，可以考虑右侧发生器植入，以确保足够的图像质量。
CIED 引起的金属伪影可能显著降低 MRI 的诊断价值，尤其是在心脏 MRI 中。
相对于 CIED 发生器举起同侧手臂是一种经济有效的简单方法，可以显著减少左侧发生器患者 CMR 上的 CIED 引起的伪影。
与左侧植入相比，右侧发生器植入可减少伪影，对于需要后续心脏 MRI 的 CIED 患者，可考虑在未来确保足够的图像质量。
