Arrhythmia Summit Basel

Transcription

1 Bildgebung bei ICD und Schrittmacher-Patienten: Wann/ wie kann ein MRI gemacht werden, Alternativen? Jens Bremerich Abteilung Cardiale und Thorakale Diagnostik Klinik für Radiologie & Nuklearmedizin Unispital Basel Schweiz

2 Overview Background Information Resources Practical Approach Outlook

3 Background Ideal support from Device Vendor Yes you can scan

4 Background Real support from Device Vendor Sommer T et al. German Roentgen Society Statement on MR Imaging of Patients with Cardiac Pacemakers. RöFo 2015; 187:

5 Background Help? Sommer T et al. German Roentgen Society Statement on MR Imaging of Patients with Cardiac Pacemakers. RöFo 2015; 187:

6 Background Legal aspects Radiologist: Responsible Device Vendor: Recommendations are complex and keep changing Cardiologist: Cooperation Radiology-Cardiology mandatory Technologist: Requests clear standard of procedure

7 Background Terminology Conditional: The term, MR conditional is used to describe an item that has been shown to pose no known hazards in a specified MR environment with specified conditions of use. In-Label MRI with conditional device; all specific procedure guidelines Off-Label MRI with conditional device; not-all specific procedure guidelines PM Colletti, JS Shinbane, FG Shellock: MR conditional pacemakers: The Radiologist s role in multidisciplinary management. AJR 197; 2011.

8 Background Issues SAR Upper limit of 2 W/kg (local head SAR value 3.4 W/kg) Coils Surface receive coils (all); Transmit/receive coils (few) Positioning Prone (all) / supine (most) Scan Range Some devices exclude imaging of chest

9 Overview Background Information Resources Practical Approach Outlook

10 Information Resources

11 Information Resources

12 Information Resources

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15 Overview Background Information Resources Practical Approach Outlook

16 Practical Approach Justify MRI & consider Alternative Modality Clinical Problem: Indication for MRI: MRI & Defibrillator: Recurrent left ventricular tachycardia To identify arryhthmogenic foci to guide ablation 1) Safety & 2) Artifacts

17 Practical Approach Justify MRI & consider Alternative Modality CE-Spectral CT Cine-CT

18 Practical Approach In-label (Conditional Pacer/Defibrillator; standard procedure) Sommer T et al. German Roentgen Society Statement on MR Imaging of Patients with Cardiac Pacemakers. RöFo 2015; 187:

19 Practical Approach Off-label (Conventional Pacer/Defibrillator; no standard procedure) Sommer T et al. German Roentgen Society Statement on MR Imaging of Patients with Cardiac Pacemakers. RöFo 2015; 187:

20 Practical Approach Scan parameters 1.5 T. Maximum slew rate 200 T/m/s per axis. Whole-body averaged SAR 2.0 W/kg, with head SAR at < 3.2 W/kg. Scan range restrictions apply in some pacers Coil restricitions apply in some pacers

21 Practical Approach Basel Workflow Scheduling Team Electrophysiologist Radiologist Technologist Electrophysiologist

22 Practical Approach SAR restrictions

23 Overview Background Information Resources Practical Approach Outlook

24 Outlook Defibrillator for whole body MRI with minor artifacts Gold MR et al. Full-Body MRI in Patients with an implantable Cardioverter-Defibrillator (ICD): Primary results of a randomized study. JACC 2015

25 Outlook Defibrillator for whole body MRI with minor artifacts

26 Outlook Defibrillator for whole body MRI with minor artifacts Gold MR et al. Full-Body MRI in Patients with an implantable Cardioverter-Defibrillator (ICD): Primary results of a randomized study. JACC 2015

27 Outlook Defibrillator for whole body MRI with minor artifacts Gold MR et al. Full-Body MRI in Patients with an implantable Cardioverter-Defibrillator (ICD): Primary results of a randomized study. JACC 2015

28 Outlook Defibrillator for whole body MRI with minor artifacts Gold MR et al. Full-Body MRI in Patients with an implantable Cardioverter-Defibrillator (ICD): Primary results of a randomized study. JACC 2015

29 Conclusion Scanning a patient with MR conditional PM is safe, when used appropriately. Defined workflow is helpful: Everybody knows what to do. Information resources: jens.bremerich@usb.ch