The patient’s heart rhythm and vital signs should be monitored throughout the MR procedure. This site uses cookies. An item that has been demonstrated to pose no known hazards in a specified MR imaging environment with specified conditions of use.
Prescanning steps outside the MR environment: For non–pacemaker-dependent patients, pretest pacemaker functions, For pacemaker-dependent patients, pretest pacemaker functions and reprogram to asynchronous mode, For patients with ICDs, pretest ICD functions and disable therapy and detection for tachycardia/bradycardia modes. The writing committee emphasizes that efforts by industry to manufacture pacemakers and ICDs that are specifically designed to be acceptable for patients undergoing MR procedures should be intensified, an approach preferable to the current “ad hoc” methods described above. Contact Us.
Instruct the patient to alert the MR system operator to any unusual sensations or problems.
Most embolization coils that have been tested have been labeled as “MR safe”; the remainder that have been tested have been labeled as “MR conditional.”1 Patients who have been treated with nonferromagnetic embolization coils can undergo MR examination any time after coil implantation.
For weakly ferromagnetic devices for which there are not currently enough data and consensus to make the recommendation that scanning can be performed safely any time after implantation, the writing group recommends that the physician weigh the risks and benefits of scanning patients with such devices on a case-by-case basis and adopt the following approach: For cases that occur in the days to weeks after device implantation in which there is a clear potential clinical benefit of scanning the patient at that time (eg, acute back pain and lower-extremity weakness after trauma), the benefits of the MR examination will likely outweigh any risks of the examination, and MR examination should generally be performed. As a result of ferromagnetic interactions, a device may be moved, rotated, dislodged, or accelerated toward the magnet. Therefore, a careful assessment of these potential risks and the potential benefits to the patient should be completed before use of MR imaging.”46 The writing group agrees with this approach.
This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. Most of the stents currently used for carotid procedures are made of nitinol and are nonferromagnetic or only weakly ferromagnetic. Customer Service The majority of endovascular aortic stent grafts, but not all, are made from nonferromagnetic or weakly ferromagnetic materials. An item that is known to pose hazards in all MR environments. The timing of MR examination at 3 T or less in patients with aortic stent grafts that are weakly ferromagnetic should be weighed on a case-by-case basis.
This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 18, 2007.
identifier=4431. Scanning should only be performed at extremely experienced centers with expertise in MR imaging and electrophysiology. Furthermore, many of the reported cases of MR-related injuries and most of the few fatalities that have occurred have been the result of failure to follow established safety guidelines or the use of outdated information related to the safety aspects of biomedical implants and devices. In patients with chronic conditions in which it makes little difference whether the scan is performed at a given time or weeks later, it may be prudent to defer MR examination until ≈6 weeks after device implantation. Deaths associated with MR examination of patients with pacemakers/ICDs have been reported.91–95 As best as can be determined, all of these deaths occurred in the setting of MR examinations that were not supervised or monitored by a physician. Time-varying magnetic fields called gradients (dB/dt, measured in teslas per second) are used to encode for various aspects of the image acquisition.
An American Heart Association Scientific Statement From the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: © American Heart Association, Inc. All rights reserved.
Numerous clinical studies have demonstrated the safety of performing MR examinations in patients with prosthetic heart valves. Therefore, particularly in cases in which there is a relative contraindication to device examination and the examination location is distinct from the device location, consultation with a person with expertise in MR physics and MR safety is recommended.
In addition, a more general discussion of safety issues is also provided that uses the expertise of the writing group to synthesize the FDA labeling using the American Society for Testing and Materials terminology with the latest experimental and clinical data, as well as expert consensus opinion, to give guidance to as broad a target audience as possible for issues regarding MR safety and cardiovascular devices. Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB), Journal of the American Heart Association (JAHA), Customer Service and Ordering Information, October 20, 2020: Vol.
55,57,58 Of note, 28 patients recently underwent apparently uneventful cardiac MR imaging after percutaneous pulmonary valve implantation. On the other hand, some devices, such as many intravascular coils and stents that are firmly implanted into the vessel wall or adjacent tissues during the implantation process, may be further passively or actively anchored to the vessel wall or adjacent tissues and are subject to constant hemodynamically generated forces from the beating of the heart and resultant blood flow that are often much greater than the forces associated with the MR examination.
Due to the wide prevalence of cardiovascular diseases, a significant proportion of patients who would ideally be referred for MR examinations will have permanent cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Specific comments regarding such scanning of non–pacemaker-dependent patients, pacemaker-dependent patients, and patients with ICDs are given below and in Table 2, based in part on previous recommendations1,3,91,93,96,109 and on the general consensus of the present writing group. organization. Risks associated with MR imaging generally arise from 3 distinct mechanisms related to MR imaging: (1) the static main magnetic field; (2) RF energy; and (3) gradient magnetic fields.
Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association.
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