Ο ασθενής μου με εμφυτευμένο απινιδωτή έχει όγκο στον εγκέφαλο: Πρέπει να κάνει μαγνητική τομογραφία και μετά να χειρουργηθεί Tι θα κάνω; Γ. Κουργιαννίδης 251 Γενικό Νοσοκομείο Αεροπορίας
Ουδεμία Σύγκρουση Συμφερόντων
Static magnetic field (e.g., 1.5 Tesla) Bo Pulsed RF waves B1 align the protons with or against the magnetic field excite the nuclear spin of the proton causing an energy transition Magnetic field gradients Gx, Gy, Gz localize in space the signal that is emitted after the RF signal is turned off
ΒΛΑΒΕΣ ΤΟΥ ΜΑΓΝΗΤΙΚΟΥ ΠΕΔΙΟΥ ΣΤΙΣ ΣΥΣΚΕΥΕΣ ΔΙΑΧΕΙΡΙΣΗΣ ΡΥΘΜΟΥ Effects on reed switch activity Inappropriate function and therapies
Power-on Reset Parameters
ΚΑΤΑΣΤΡΟΦΙΚΑ ΣΕΝΑΡΙΑ PoR in PM depend. pt Asynch to VVI back up Inhibition/asystole PoR Detection on ICD Inappropriate shock or Battery Depletion Hemodynamically unstable ventricular arrhythmias while tachycardia detection is deactivated
STEP 1 Clinical Assessment STEP 2 MRI CONDITIONAL OR NOT STEP 3 PM dependent or not
CONDITIONAL 1/Patient Factors 2/CIED Factors 3/ MRI Scanner Factors
MRI CONDITIONAL DEVICES Leads and generators : tested together. Abandoned PM or ICD leads (capped or not) Lead remnants Extenders or adaptors Fractured lead(s) Surgically implanted epicardial leads Programming of the device
ΔΙΑΦΟΡΕΣ ΑΝΑΛΟΓΑ ΜΕ ΤΙΣ ΕΤΑΙΡΕΙΕΣ ΚΑΙ ΤΑ ΜΟΝΤΕΛΑ 1,5 Τ VS 3 Τ FBS EXZ ΠΑΡΟΥΣΙΑ ΠΥΡΕΤΟΥ ΘΕΣΗ ΤΟΥ ΑΣΘΕΝΟΥΣ ΔΙΑΡΚΕΙΑ ΤΗΣ ΕΞΕΤΑΣΗΣ ΑΠΑΙΤΗΣΕΙΣ ΑΠO MRI (SAR, slew rate etc)
Battery voltage is determined prior to MRI Power supply disruption Memory corruption Changes in programmable device variables Device reset
MRI NON- CONDITIONAL DEVICES
MRI nonconditional DEVICES Heart Rhythm, Vol 14, No 7, July 2017
The DDD mode X
PM DEPENDENCY
Keep in mind: Temporary decrease in measured battery voltage
Russo et al N Engl J Med 2017;376:755-64.
Russo et al N Engl J Med 2017;376:755-64. 1000 PM 500 ICD No deaths, lead failures, losses of capture, or ventricular arrhythmias 1 ICD required immediate replacement 6 Afib/AFl 6 cases of partial electrical reset. Changes in lead impedance, pacing threshold, battery voltage, and P-wave and R-wave amplitude exceeded prespecified thresholds in a small number of cases. Repeat MRI was not associated with an increase in adverse events
Magnetic Resonance Imaging Safety in Non-Conditional Pacemaker and Defibrillator Recipients: A Meta Analysis and Systematic Review Heart Rhythm 2018 3,692 pacemaker recipients and 1,440 ICD recipients 551 PM dependent
* * < 2006 CIED
80 pt 97 MRI with 90 abandoned leads in place during the scans. 1,5 T No clinical or electrical evidence of CIED dysfunction, arrhythmias or pain No Tn elevation Safety of Magnetic Resonance Imaging in Patients with Legacy Pacemakers and Defibrillators and Abandoned Leads February 2018Volume 15, Issue 2, Pages 228 233
ΣΥΜΠΕΡΑΣΜΑΤΑ ΤΟ ΠΕΡΙΒΑΛΛΟΝ ΤΗΣ MRI ΕΙΝΑΙ ΕΧΘΡΙΚΟ ΓΙΑ ΤΙΣ ΕΜΦΥΤΕΥΟΜΕΝΕΣ ΣΥΣΚΕΥΕΣ ΟΙ MRI-CONDITIONAL ΣΥΣΚΕΥΕΣ ΑΠΟΤΕΛΟΥΝ ΤΗΝ ΒΕΛΤΙΣΤΗ ΜΕΧΡΙ ΣΤΙΓΜΗΣ ΛΥΣΗ ΣΕ ΠΕΡΙΠΤΩΣΕΙΣ NON CONDITIONAL ΣΥΣΚΕΥΩΝ Η ΔΙΕΝΕΡΓΕΙΑ MRI ΜΕ ΕΙΔΙΚΗ ΠΡΟΕΤΟΙΜΑΣΙΑ ΜΠΟΡΕΙ ΝΑ ΠΡΑΓΜΑΤΟΠΟΙΗΘΕΙ ΟΤΑΝ ΥΠΑΡΧΟΥΝ ΚΛΙΝΙΚΕΣ ΑΠΑΙΤΗΣΕΙΣ
American College of Radiology Appropriateness Criteria Condition Chronic Neck Pain (Radiographs normal. Neurologic signs or symptoms present.) Low Back Pain (> 70 yrs old) Soft Tissue Masses (Clinically suspected soft tissue mass: general) MRI Rating* Stroke symptoms (New focal neurologic defect, fixed or worsening 3 to 24 hours) 8 Possible or probable Alzheimer s disease CT Rating* 9 5 8 6 Only if MRI contraindicated CT Radiation Level 9 5 Varies 8 MRI preferred if not unreasonably delayed 8 6