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Comparative Study
. 2011 Nov;4(6):662-70.
doi: 10.1161/CIRCIMAGING.111.965764. Epub 2011 Sep 23.

Quantitative assessment of artifacts on cardiac magnetic resonance imaging of patients with pacemakers and implantable cardioverter-defibrillators

Takeshi Sasaki  1 , Rozann Hansford, Menekhem M Zviman, Aravindan Kolandaivelu, David A Bluemke, Ronald D Berger, Hugh Calkins, Henry R Halperin, Saman Nazarian
Affiliations
Comparative Study

Quantitative assessment of artifacts on cardiac magnetic resonance imaging of patients with pacemakers and implantable cardioverter-defibrillators

Takeshi Sasaki et al. Circ Cardiovasc Imaging. 2011 Nov.

Abstract

Background: The safety and clinical utility of MRI at 1.5 T in patients with cardiac implantable devices such as pacemakers (PM) and implantable cardioverter-defibrillators (ICD) have been reported. This study aims to evaluate the extent of artifacts on cardiac magnetic resonance (CMR) in patients with PM and ICD (PM/ICD).

Methods and results: A total of 71 CMR studies were performed with an established safety protocol in patients with prepectoral PM/ICD. The artifact area around the PM/ICD generator was measured in all short-axis (SA), horizontal (HLA), and vertical long-axis (VLA) SSFP cine planes. The location and extent of artifacts were also assessed in all SA (20 sectors per plane), HLA, and VLA (6 sectors per plane) late gadolinium-enhanced CMR (LGE-CMR) planes. The artifact area on cine CMR was significantly larger with ICD versus PM generators in each plane (P<0.001, respectively). In patients with left-sided ICD or biventricular ICD systems, the percentages of sectors with any artifacts on LGE-CMR were 53.7%, 48.0%, and 49.2% in SA, HLA, and VLA planes, respectively. Patients with left-sided PM or right-sided PM/ICD had fewer artifacts. Anterior and apical regions were severely affected by artifact caused by left-sided PM/ICD generators.

Conclusions: In contrast to patients with right-sided PM/ICD and left-sided PM, the anterior and apical left ventricle can be affected by susceptibility artifacts in patients with left-sided ICD. Artifact reduction methodologies will be necessary to improve the performance of CMR in patients with left sided ICD systems.

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Figures

Figure 1
Figure 1. Methodology for Measurement of Artifacts on Cine CMR and LGE-CMR
Artifact size on SSFP cine and late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR) was measured in SA, HLA and VLA planes. (A) The artifact size on cine CMR due to the PM/ICD was measured. Percent sectors with any artifacts on cine CMR were also assessed in each plane. (B) The regional artifact effects on LGE-CMR due to the generator were quantitatively estimated in each plane (divided into 20 sectors in SA, 6 sectors in HLA, and 6 sectors in VLA planes, respectively). SSFP=steady state free precession; SA=short axis; HLA=horizontal long axis; VLA=vertical long axis; PM/ICD=pacemaker and implantable cardioverter defibrillator.
Figure 2
Figure 2. Artifacts Effects on LGE-CMR
Artifact effects in each plane of LGE-CMR due to the generator were quantitatively assessed in patients with left and right-sided ICD/BiV-ICD or PM systems. (A) The greatest artifact on LGE-CMR was observed in patients with left-sided ICD/BiV-ICD. About 50% of the sectors were affected by the artifact. (B) Details about the regional artifact effects on SA planes are demonstrated in patients with left-sided ICD/BiV-ICD and PM systems. The anterior and apical regions were severely affected by artifacts due to the generator in patients with ICD/BiV-ICD systems. Smaller artifacts were observed in patients with left-sided PM systems. (C) The regional artifact effects on HLA and VLA plane are shown in patients with left-sided ICD/BiV-ICD systems. The apical regions on HLA and VLA planes were severely affected by the artifact. BiV=biventricular; See abbreviations in Figure 1.
Figure 3
Figure 3. 17-Segment Model of Artifacts Effects on LGE-CMR
Artifact effects on LGE-CMR in patients with left-sided ICD/BiV-ICD are summarized using the 17-segment model. The percentages of sectors with artifact on LGE-CMR were divided into 4 groups (1–25, 26–50, 51–75, 76–100%).
Figure 4
Figure 4. Comparison of Artifact Effects on Cine, T2-weighted, Perfusion, and LGE-CMR
Comparison of artifact distribution and extent (asterisks) due to the ICD generator on (a) cine CMR, (b) LGE-CMR, (c) T2-weigthed and (d) perfusion CMR images. (e) The percentage of the sectors without any artifacts on short axis planes in each image sequence. Artifacts effects on LGE-CMR images were greater compared with the other images in all except the inferior myocardial regions (LGE-CMR vs. cine, T2-weighted and perfusion CMR in the septal, anterior and lateral myocardial regions; P<0.001, respectively). *P<0.001 vs. LGE-CMR, **P<0.01 vs. LGE-CMR, †P<0.001 vs. T2-weighted CMR; ††P<0.01 vs. T2-weighted CMR. See abbreviations in Figure 1.
Figure 5
Figure 5. Artifacts Effects on CMR due to PM/ICD Leads
Comparison of artifacts due to the ICD generator and lead in both CT (a, b) and MRI (c, d) in a patient with single chamber ICD. Artifacts due to the lead were smaller on MRI compared with CT. In contrast, artifacts due to the generator were larger with MRI. CT=computed tomography. See abbreviations in Figure 1.
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