title: Image Quality of Cardiac Magnetic Resonance Imaging in Patients With an Implantable Cardioverter Defibrillator System Designed for the Magnetic Resonance Imaging Environment.
abstract: BACKGROUND
  Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system.
  
  
  RESULTS
  The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades 1-3: good quality, grades 6-7: nondiagnostic) and measuring ICD- and lead-related artifact size. Good to moderate image quality (grades 1-5) was obtained in 53% and 74% of SSFP and FGE acquisitions, respectively, covering the left ventricle, and in 69% and 84%, respectively, covering the right ventricle. Odds for better image quality were greater for right ventricle versus left ventricle (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P<0.0001) and greater for FGE versus SSFP (odds ratio, 3.5; 95% confidence interval, 2.5-4.8; P<0.0001). Compared with SSFP, ICD-related artifacts on FGE were smaller (141±65 versus 75±57 mm, respectively; P<0.0001). Lead artifacts were much smaller than ICD artifacts (P<0.0001).
  
  
  CONCLUSIONS
  FGE yields good to moderate quality in 74% of left ventricle and 84% of right ventricle acquisitions and performs better than SSFP in patients with an MRI-conditional ICD system. In these patients, cardiac MRI can offer diagnostic information in most cases.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02117414.
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.). Jurg.schwitter@chuv.ch.
authors.forename: Juerg
authors.initials: J
authors.lastname: Schwitter
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Michael R
authors.initials: MR
authors.lastname: Gold
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al Fagih
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Sung
authors.initials: S
authors.lastname: Lee
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Peterson
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Allen
authors.initials: A
authors.lastname: Ciuffo
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Nina
authors.initials: N
authors.lastname: Kristiansen
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Emanuel
authors.initials: E
authors.lastname: Kanal
authors.affiliation: From the Division of Cardiology and Director of the Cardiac Magnetic Resonance Center, University Hospital Lausanne, Switzerland (J.S.); Division of Cardiology, Medical University of South Carolina, Charleston (M.R.G.); Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia (A.A.F.); Departments of Cardiovascular Disease and Clinical Cardiac Electrophysiology, Washington Hospital Center, Washington, DC (S.L.); United Heart and Vascular Clinic, Minneapolis, MN (M.P.); Sentara Norfolk General Hospital, VA (A.C.); Cardiac Rhythm and Heart Failure Management, Medtronic, Minneapolis, MN (Y.Z.); Cardiac Rhythm and Heart Failure Management, Medtronic, Maastricht, The Netherlands (N.K.); Department of Radiology and Neuroradiology, University of Pittsburgh Medical Center, PA (E.K.); and Department of Diagnostic and Interventional Radiology and Nuclear Medicine, German Red Cross Hospital, Neuwied, Germany (T.S.).
authors.forename: Torsten
authors.initials: T
authors.lastname: Sommer
mesh_terms: D000368:Aged; D016477:Artifacts; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D015203:Reproducibility of Results; D012307:Risk Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Image Quality Enhancement and Cardiac Function Test; artifacts; heart ventricles; implantable cardioverter-defibrillator; magnetic resonance imaging