title: Quantitative assessment of artifacts on cardiac magnetic resonance imaging of patients with pacemakers and implantable cardioverter-defibrillators.
abstract: BACKGROUND
  The safety and clinical utility of MRI at 1.5 T in patients with cardiac implantable devices such as pacemakers (PM) and implantable cardioverter-defibrillators (ICD) have been reported. This study aims to evaluate the extent of artifacts on cardiac magnetic resonance (CMR) in patients with PM and ICD (PM/ICD).
  
  
  RESULTS
  A total of 71 CMR studies were performed with an established safety protocol in patients with prepectoral PM/ICD. The artifact area around the PM/ICD generator was measured in all short-axis (SA), horizontal (HLA), and vertical long-axis (VLA) SSFP cine planes. The location and extent of artifacts were also assessed in all SA (20 sectors per plane), HLA, and VLA (6 sectors per plane) late gadolinium-enhanced CMR (LGE-CMR) planes. The artifact area on cine CMR was significantly larger with ICD versus PM generators in each plane (P<0.001, respectively). In patients with left-sided ICD or biventricular ICD systems, the percentages of sectors with any artifacts on LGE-CMR were 53.7%, 48.0%, and 49.2% in SA, HLA, and VLA planes, respectively. Patients with left-sided PM or right-sided PM/ICD had fewer artifacts. Anterior and apical regions were severely affected by artifact caused by left-sided PM/ICD generators.
  
  
  CONCLUSIONS
  In contrast to patients with right-sided PM/ICD and left-sided PM, the anterior and apical left ventricle can be affected by susceptibility artifacts in patients with left-sided ICD. Artifact reduction methodologies will be necessary to improve the performance of CMR in patients with left sided ICD systems.
authors.affiliation: Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tsasaki1@jhu.edu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sasaki
authors.forename: Rozann
authors.initials: R
authors.lastname: Hansford
authors.forename: Menekhem M
authors.initials: MM
authors.lastname: Zviman
authors.forename: Aravindan
authors.initials: A
authors.lastname: Kolandaivelu
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Henry R
authors.initials: HR
authors.lastname: Halperin
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000628:therapy; D016477:Artifacts; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index