A systematic review of the use of magnetic resonance imaging in non-conditional pacemakers and implantable defibrillators

Abstract Background Cardiac implantable electronic devices (CIEDs) were long considered a contraindication for magnetic resonance imaging (MRI). Modern devices are now MRI conditional, but still the majority of CIEDs in the population are legacy devices and are classified as unsafe for MRI. There is growing consensus that MRI is also safe in these patients. Purpose The purpose of this study was to perform an up to date systematic review of the evidence evaluating the use of MRI in patients with non-conditional CIEDs. Methods Searches of the PubMed, CINAHL and Embase databases were performed. Studies that assessed the rate of adverse outcomes after MRI in patients with non-conditional CIEDs were included. Studies were excluded if they did not disclose the conditionality of patients CIEDs. Case reports or case series were not included. Results 36 cohort studies were identified. No patient in these studies died during or immediately after MRI. Symptom associated with either torque or heating occurred in <1% of patients. Electrical resets occurred 1–2% of patients. There were no cases of non-conditional lead or generator failure. Inappropriate pacing occurred in <1% of patients. No ICD shocks occurred during MRI. Changes in CIED parameters occurred in 1–4% of patients. Conclusions This systematic review highlights the relative safety of the use of MRI in patients with non-conditional CIEDs. Demonstrated be the fact that no deaths or device shocks have been suffered as a consequence of MRI in any of these studies, and the extremely low incidence of device or lead related complications. Still strict selection and monitoring protocol should be used when imaging these patients. FUNDunding Acknowledgement Type of funding sources: None.

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Posterior epidural migration of a lumbar disc fragment: a series of 6 cases

Journal of Neurosurgery Spine ◽

10.3171/2011.3.spine10832 ◽

2011 ◽

Vol 15 (1) ◽

pp. 117-128 ◽

Cited By ~ 23

Author(s):

Ali Akhaddar ◽

Abad El-asri ◽

Mohammed Boucetta

Keyword(s):

Magnetic Resonance Imaging ◽

Systematic Review ◽

Magnetic Resonance ◽

Intervertebral Disc ◽

Lumbar Disc ◽

Cauda Equina ◽

Case Series ◽

Review Of The Literature ◽

Resonance Imaging ◽

Lumbar Intervertebral Disc

Object The migration of a lumbar intervertebral disc fragment to the posterior epidural space is a rare complication of lumbar disc herniation (LDH), mostly diagnosed intraoperatively. The authors describe a series of 6 patients with a posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) and provide a systematic review of the literature. Methods The authors undertook a retrospective case series of patients with PEMLIF who underwent surgery for LDH between February 2007 and June 2010. In 6 (1.04%) of 572 patients a diagnosis of PEMLIF was established. In addition, a systematic review of the literature produced 41 additional cases reported since 1973. The authors analyzed epidemiological, clinical, and imaging features, as well as surgical treatment and outcome of this infrequent form of LDH. Results This study represents the largest case series to analyze the distinguishing features of PEMLIF. Including the authors' cases, 37 male (78.72%) and 10 female (21.28%) patients (mean age 54.08 years) appear in the literature. Although the predominant clinical disturbance was related to cauda equina compression in 22 patients (46.80%), 19 patients (40.42%) presented with typical symptoms of sciatica or anterior thigh pain. In 27 patients (57.44%), PEMLIFs were localized at high lumbar levels. Magnetic resonance imaging was used in 36 cases. The PEMLIF appeared iso- to hypointense on T1-weighted imaging and had a variable intensity on T2-weighted imaging. After administration of Gd, 85.71% of lesions exhibited a peripheral ring. The preoperative diagnosis was never related to PEMLIF in 68% of cases. The PEMLIF was totally resected in all patients. An additional discectomy was performed in 31 patients (65.95%). Information was incomplete in 1 case. Of the remaining 46 patients, all improved postoperatively: total recovery was achieved in 33 cases (71.74%), subtotal recovery in 2 cases (4.35%), and improvement in 11 cases (23.91%). The postoperative outcome appeared not to depend on the duration or the degree of preoperative neurological deficits or the size of disc fragment. Conclusions The migration of a lumbar intervertebral disc fragment to the posterior epidural space is a rare event, occurring in an advanced working-age population. Clinical presentation is indistinguishable from the typical LDH, but overall cauda equina symptoms are far more common. High lumbar levels are more affected. Magnetic resonance imaging characteristics are difficult to differentiate from those of other entities. Ring enhancement after Gd administration is common. Outcomes in patients with cauda equina symptoms appear better than those in patients with standard ventral compression.

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Magnetic resonance imaging in non-conditional pacemakers and implantable cardioverter-defibrillators: a systematic review and meta-analysis

EP Europace ◽

10.1093/europace/euz343 ◽

2020 ◽

Vol 22 (2) ◽

pp. 288-298 ◽

Cited By ~ 1

Author(s):

Dian A Munawar ◽

Joel E Z Chan ◽

Mehrdad Emami ◽

Kadhim Kadhim ◽

Kashif Khokhar ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Case Reports ◽

Meta Analysis ◽

Implantable Defibrillator ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Number Of Patients

Abstract Aims There is growing evidence that magnetic resonance imaging (MRI) scanning in patients with non-conditional cardiac implantable electronic devices (CIEDs) can be performed safely. Here, we aim to assess the safety of MRI in patients with non-conditional CIEDs. Methods and results English scientific literature was searched using PubMed/Embase/CINAHL with keywords of ‘magnetic resonance imaging’, ‘pacemaker’, ‘implantable defibrillator’, and ‘cardiac resynchronization therapy’. Studies assessing outcomes of adverse events or significant changes in CIED parameters after MRI scanning in patients with non-conditional CIEDs were included. References were excluded if the MRI conditionality of the CIEDs was undisclosed; number of patients enrolled was <10; or studies were case reports/series. 35 cohort studies with a total of 5625 patients and 7196 MRI scans (0.5–3 T) in non-conditional CIEDs were included. The overall incidence of lead failure, electrical reset, arrhythmia, inappropriate pacing and symptoms related to pocket heating, or torque ranged between 0% and 1.43%. Increase in pacing lead threshold >0.5 V and impedance >50Ω was seen in 1.1% [95% confidence interval (CI) 0.7–1.8%] and 4.8% (95% CI 3.3–6.4%) respectively. The incidence of reduction in P- and R-wave sensing by >50% was 1.5% (95% CI 0.6–2.9%) and 0.4% (95% CI 0.06–1.1%), respectively. Battery voltage reduction of >0.04 V was reported in 2.2% (95% CI 0.2–6.1%). Conclusion This meta-analysis affirms the safety of MR imaging in non-conditional CIEDs with no death or implantable cardioverter-defibrillator shocks and extremely low incidence of lead or device-related complications.

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A Middle Cuneiform Stress Fracture in an Adolescent Athlete: A Case Report and Literature Review

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119878712 ◽

2019 ◽

Vol 12 ◽

pp. 117954411987871 ◽

Cited By ~ 1

Author(s):

Paul Krebs ◽

James Borchers

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Magnetic Resonance ◽

Literature Review ◽

Stress Fracture ◽

Sports Medicine ◽

Case Reports ◽

Case Series ◽

Resonance Imaging ◽

Adolescent Athlete

A 13-year-old female soccer and basketball athlete presented with pain in the arch of her foot. Magnetic resonance imaging confirmed the diagnosis of a middle cuneiform stress fracture. The patient’s stress fracture healed nonoperatively over a 10-week period complicated by nonadherence to a fracture boot, after which she was progressed back to full activity. Knowledge of these fractures and their treatment are important for sports medicine physicians, as they can often be overlooked, given their infrequent occurrence. There have been 8 previous case reports and 1 case series on cuneiform stress fractures, and these are summarized with this case report.

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Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging with Cardiac Implantable Electronic Devices

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.08.001 ◽

2014 ◽

Vol 65 (4) ◽

pp. 290-300 ◽

Cited By ~ 11

Author(s):

Atul Verma ◽

Andrew C.T. Ha ◽

Carole Dennie ◽

Vidal Essebag ◽

Derek V. Exner ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Electronic Devices ◽

Heart Rhythm ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Canadian Association ◽

Mri Environment ◽

Magnetic Resonance Imaging Mri ◽

Mri Conditional

Magnetic resonance imaging (MRI) has historically been considered contraindicated for individuals with cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable defibrillators. Magnetic resonance scanners produce magnetic fields that can interact negatively with the metallic components of CIEDs. However, as CIED technology has advanced, newer MRI conditional devices have been developed that are now in clinical use and these systems have had demonstrated safety in the MRI environment. Despite the supportive data of such CIED systems, physicians remain reluctant to perform MRI scanning of conditional devices. This joint statement by the Canadian Heart Rhythm Society and the Canadian Association of Radiologists describes a collaborative process by which CIED specialists and clinics can work with radiology departments and specialists to safely perform MRI in patients with MRI conditional CIED systems. The steps required for patient and scanning preparation and the roles and responsibilities of the CIED and radiology departments are outlined. We also briefly outline the risks and a process by which patients with nonconditional CIEDs might also receive MRI in highly specialized centres. This document supports MRI in patients with MRI conditional CIEDs and offers recommendations on how this can be implemented safely and effectively.

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Relevance and Clinical Significance of Magnetic Resonance Imaging of Neurological Manifestations in COVID-19: A Systematic Review of Case Reports and Case Series

Brain Sciences ◽

10.3390/brainsci10121017 ◽

2020 ◽

Vol 10 (12) ◽

pp. 1017

Author(s):

Anisa Chowdhary ◽

Roshan Subedi ◽

Medha Tandon ◽

Sijin Wen ◽

Jenil Patel ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Ischemic Stroke ◽

Magnetic Resonance ◽

Case Reports ◽

Case Series ◽

Neurological Complications ◽

Inflammatory Disorder ◽

Neurological Manifestations ◽

Resonance Imaging ◽

Mri Findings

We performed a systematic literature review of neuroimaging, predominantly focusing on magnetic resonance imaging (MRI) findings associated with neurological manifestations of coronavirus disease-2019 (COVID-19). We screened articles from PubMed, Google Scholar and Scopus, looking for reports that would potentially have neuroimaging findings in patients with COVID-19. Data analysis was performed with patient-based data based on the availability of clinical characteristics and outcomes for each individual patient from the studies. Chi square and Wilcoxon rank-sum tests were used to report COVID-19 severity and outcomes based on neurological imaging indicators and pathophysiology. A total of 171 patients with COVID-19 having neurological complications, from 134 studies, were identified in our review. The most common neuroimaging finding was ischemic stroke (62, 36.2%) cases, followed by CNS inflammatory disorder (44, 25.7%), and hemorrhagic stroke (41, 24.0%). Around 51% of all the fatal COVID-19 cases had an ischemic stroke. Among patients with ischemic stroke, the mean age of those who suffered from COVID-19 infection was 57.5 years (SD = 15.4) whereas it was 50.7 years (SD = 15.1) among those without stroke/other diagnosis. Fatality was more common in patients with ischemic stroke compared to those with other diagnosis (40% vs. 22%, p = 0.011). The most frequently published neuroimaging findings in patients with COVID-19 were ischemic stroke, CNS inflammatory disorder, and hemorrhagic disorder. In those studies, ischemic stroke was associated with fatality, and was more frequently seen in older patients. Based on our findings, early usage of MRI in COVID-19 patients may be recommended.

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Hydroceles of the Canal of Nuck in Adults—Diagnostic, Treatment and Results of a Rare Condition in Females

Journal of Clinical Medicine ◽

10.3390/jcm9124026 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4026

Author(s):

Panagiotis Fikatas ◽

Ioannis-Fivos Megas ◽

Kiriaki Mantouvalou ◽

Ibrahim Alkatout ◽

Sascha S. Chopra ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Inguinal Canal ◽

Case Reports ◽

Case Series ◽

Laparoscopic Approach ◽

Parietal Peritoneum ◽

Open Approach ◽

Resonance Imaging ◽

Invasive Treatment

Nuck’s hydroceles, which develop in a protruding part of the parietal peritoneum into the female inguinal canal, are rare abnormalities and a cause of inguinal swelling, mostly resulting in pain. They appear when this evagination of the parietal peritoneum into the inguinal canal fails to obliterate. Our review of the literature on this topic included several case reports and two case series that presented cases of Nuck hydroceles which underwent surgical therapy. We present six consecutive cases of symptomatic hydroceles of Nuck’s canal from September 2016 to January 2020 at the Department of Surgery of Charité Berlin. Several of these patients had a long history of pain and consecutive consultations to outpatient clinics without diagnosis. These patients underwent laparoscopic or conventional excision and if needed simultaneous hernioplasty in our institution. Ultrasonography and/or Magnetic Resonance Imaging were used to display the cystic lesion in the inguinal area, providing the diagnosis of Nuck’s hydrocele. This finding was confirmed intraoperatively and by histopathological review. Ultrasound and magnetic resonance imaging (MRI) captures, intraoperative pictures and video of minimal invasive treatment are provided. Nuck’s hydroceles should be included in the differential diagnosis of an inguinal swelling. We recommend an open approach to external Type 1 Nuck´s hydroceles and a laparoscopic approach to intra-abdominal Type 2 Nuck hydroceles. Complex hydroceles like Type 3 have to be evaluated individually, as they are challenging and the surgical outcome is dependent on the surgeon’s skills. If inguinal channel has been widened by the presence of a Nuck’s hydrocele, a mesh plasty, as performed in hernia surgery, should be considered.

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Is diversity harmful?—Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01924-w ◽

2021 ◽

Author(s):

Christoph Alexander König ◽

Florian Tinhofer ◽

Thomas Puntus ◽

Achim Leo Burger ◽

Nikolaus Neubauer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Electronic Devices ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Primary Endpoints ◽

Increased Risk ◽

Secondary Endpoints ◽

Magnetic Resonance Imaging Mri ◽

Mri Conditional

Summary Background Many patients with cardiac implantable electronic devices (CIED) undergo magnetic resonance imaging (MRI); however, a relevant proportion have a CIED system that has not been classified as MRI-conditional because of generators and leads from different brands (mixed-brand group). The available data concerning the outcome of these mixed patients undergoing MRI is limited. Methods A retrospective single center study, including all patients with CIEDs undergoing MRI between January 2013 until May 2020, was performed. Primary endpoints were defined as death or any adverse event necessitating hospitalization or CIED revision. Secondary endpoints were the occurrence of any sign for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with 1–9 MRIs per patient. Of the patients 38 underwent 54 procedures in the mixed-brand group and 89 patients underwent 134 MRIs in the MRI-conditional group. Of the patients 31 were excluded since the MRI conditionality could not be determined. No primary endpoints occurred within the mixed-brand group but in 2.2% of the MRI-conditional group (p = 1.000), with 2 patients developing new atrial fibrillation during MRI, of whom one additionally had a transient CIED dysfunction. No secondary endpoints were met in the mixed-brand group compared to 3.4% in the MRI-conditional group (p = 0.554). No complications occurred in the excluded patients. Conclusion The complication rate of CIED patients undergoing MRI was low. Patients with a mixed CIED system showed no signs of increased risk of adverse events compared to patients with MRI-conditional CIED systems.

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The Management of the Cotyledonoid Leiomyoma of the Uterus: A Narrative Review of the Literature

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168521 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8521

Author(s):

Francesca Buonomo ◽

Sofia Bussolaro ◽

Clarice de Almeida Fiorillo ◽

Giorgio Giorda ◽

Federico Romano ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Frozen Section ◽

Case Reports ◽

Malignant Lesion ◽

Ultrasound Image ◽

Case Series ◽

Conservative Surgery ◽

Resonance Imaging

Cotyledonoid leiomyoma is an unusual uterine myoma due to some ultrasound features that mimic a malignant lesion facilitating the choice of radical surgery. This study aims to summarize the ultrasound and the magnetic resonance imaging aspects of this atypical lesion, and also discuss surgical treatment and pathological exam. It included all English case reports or case series until August 2021 found through PubMed, Google Scholar, and Scopus. A total of 94 cotyledonoid leiomyomas were reported, with a median tumor size of 12 cm. The typical ultrasound image is characterized by a large solid heterogeneous mass, with high vascularity, no shadowing, and indistinct margins within the myometrium. Magnetic resonance imaging shows the presence of merging isointense nodules to the myometrium in T1-weighted images, hyperintense in T2-weighted images, and contrast agent enhancement. Surgical treatment consists of hysterectomy (75 cases, 80%) or myomectomy (19 cases, 20%), without evidence of recurrence if complete. The placenta-like appearance observed during surgery supports this rare fibroid hypothesis. The intraoperative frozen section can be considered. Microscopically, no atypical cells, signs of mitotic activity or cell necrosis are found. To conclude, some preoperative and intraoperative aspects of this lesion are distinctive and may lead surgeons to opt for conservative surgery.

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Is diversity harmful? - Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging

EP Europace ◽

10.1093/europace/euab116.480 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

C Koenig ◽

P Hellebart ◽

J Koch ◽

F Egger ◽

T Puntus ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Primary Endpoint ◽

Complication Rate ◽

Electronic Devices ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Increased Risk ◽

Secondary Endpoints ◽

Mri Conditional

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Many patients with cardiac implantable electronic devices (CIED) need to undergo magnetic resonance imaging (MRI). However, a significant proportion has a CIED system in place that has not been classified "MRI-conditional" because of generators and leads from different brands ("mixed-brand" group), although the individual components per se are MRI-conditional. There is only limited data available concerning the outcome of these patients with "mixed-brand" CIED systems undergoing MRI. Purpose To analyse complications or adverse effects in "mixed-brand" CIED patients undergoing MRI, compared to patients with a fully "MRI-conditional" CIED system. Methods A retrospective single-centre study was performed, including patients undergoing MRI between January 2013 until May 2020. Short- and long-term outcomes were compared between both groups. We defined the primary endpoint as death or any adverse event necessitating hospitalization or CIED revision in association with the MRI examination. Secondary endpoints were the occurrence of any surrogate for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with a range of 1-9 MRIs per patient. Mean age was 73 years and 52 (32.9%) patients were female. We identified 38 patients undergoing 54 procedures in the "mixed-brand" group and 89 patients undergoing 134 MRI procedures in the "MRI-conditional" group. In 31 patients undergoing 39 MRI examinations the MRI-conditionality could not be determined. "Mixed-brand" patients were older than MRI-conditional patients (mean 77 vs. 72 years, p = 0.003). The primary endpoint occurred in 0% in the "mixed-brand" group and in 2.2% in the "MRI conditional" group (p = 1.000). Complications were as follows: Two patients had first diagnosed atrial fibrillation directly associated with the procedure, of whom one additionally had a transient CIED dysfunction. No patient in the "mixed-brand" group and three patients (3.4%) in the "MRI conditional" group met the secondary endpoints (p = 0.554). In patients with undeterminable MRI conditionality the complication rate was similar (0% for both the primary and secondary endpoints). Conclusion The complication rate of CIED patients undergoing MRI was low. There was no signal for increased risk of adverse events in patients with a CIED without MRI certification due to mixed brands systems compared to patients with "MRI-conditional" CIED systems.

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Abstract 17012: Safety of Magnetic Resonance Imaging in Patients With Non-Transvenous Epicardial and Abandoned Cardiac Implantable Electronic Device Leads

Circulation ◽

10.1161/circ.142.suppl_3.17012 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nicholas O Palmeri ◽

Linda R York ◽

Wacks Emily ◽

Daniel B Kramer

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Adverse Events ◽

Electronic Device ◽

Medical Center ◽

Academic Medical Center ◽

Clinical Information ◽

Resonance Imaging ◽

Cardiac Implantable Electronic Devices ◽

Mri Conditional

Background: Patients with cardiac implantable electronic devices (CIEDs) commonly require magnetic resonance imaging (MRI). Pivotal studies establishing MRI safety in non-MRI-conditional CIEDs excluded patients with nontransvenous epicardial and abandoned leads, which may be higher risk for pro-arrhythmia. Patients with these systems are therefore excluded from national reimbursement coverage and guideline recommendations, and are sparsely reported in the literature. Objective: To describe outcomes of CIED-MRI in patients with epicardial and/or abandoned leads. Methods: We reviewed a prospective registry of CIED-MRIs at a single academic medical center for patients with nontransvenous epicardial leads or abandoned leads, including lead fragments from partial extractions. All patients were scanned on a 1.5T magnet with a standardized protocol including deactivation of tachytherapies (for ICDs), change of pacing mode to asynchronous pacing (if dependent) or off/inhibited (if not dependent), and observation with ECG telemetry and pulse oximetry. The primary outcome was adverse events, defined as any clinical arrhythmia or CIED system malfunction requiring revision procedures. Secondary outcomes included whether the MRI was interpretable and clinically useful. Results: Among 540 CIED-MRIs performed on non-MRI-conditional systems from 6/2014 to 5/2020, 21 MRIs were performed in 15 patients with epicardial or abandoned leads. The Table describes MRI indications and characteristics of CIED systems scanned (most commonly abandoned RA leads, N=10, and abandoned RV leads, N=5). MRIs were predominantly (86%) of the central nervous system. No adverse events were observed during any of the MRI scans, and no CIED systems required revision. All MRIs were found to be interpretable and provided clinically meaningful results. Conclusions: CIED-MRI in patients with epicardial or abandoned leads is safe and provides useful clinical information.

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