Feasibility of MRI in patients with non-Pacemaker/Defibrillator metallic devices and abandoned leads

Abstract

Objective: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/ Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads.

Background: Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI.

Methods: We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) < 4.0 W/kg and scan time < 60 minutes.

Results: The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190±475 days (median 13 days). No device malfunction reported during follow-up.

Conclusions: With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.

Keywords: Abandoned leads; Extra-cardiac devices; Implantable loop recorder; MRI Safety; Pacemaker.

Figure. 1.. Non-pacemaker / defibrillator metallic devices and abandoned leads in MRI environment.

Yellow arrows: Device/lead; White arrows: Pathology identified. A. MRI of left knee in a patient with implantable loop recorder, showing mild tricompartmental chondrosis. B. Cardiac MRI in a nonischemic cardiomyopathy patient with a Watchman device, showing delayed hyperenhancement in inferoseptal segment. C. Cardiac MRI in a heart transplant patient with retained leads, presenting with chronic rejection. D. MRI brain in a patient with coiled abandoned leads, showing a hypoenhancing lesion in pituitary gland and pituitary compression. E. MRI lumbar spine in a patient with spinal cord stimulator, showing disc herniation with spinal canal and foraminal stenosis. F. MRI Brain in a patient with vagal nerve stimulator, showing cystic lesion in sella turcica with suprasellar extension.