Abstract 14874: Efficacy vs. Safety; Or Can We have Both? A Focused Study of Devices in the MRI Environment
Background: MRI is infrequently performed on patients with conventional pacemakers/ICD’s. While many studies have unequivocally documented MRI safety in pts with implanted devices, the clinical value has never been considered.
Hypothesis: We propose that MRI in pts with a PM/ICD is crucial to the existing diagnosis and in many instances, substantially alters diagnosis and pt management.
Methods: An evaluation of 250 consecutive pts with PM/ICD’s who underwent MRI (GE 1.5T,WI) over 10 yrs (95% <5 yrs) was performed. The devices consisted of 222 PM, 4 BiV PM while 150 had PM/ICD and 8 BiV ICD. Specific criteria were followed to objectively determine if the diagnosis via MRI altered pt care. Accordingly, four questions were answered within 1 week of MRI by both MRI technologist and MRI physician(s): 1) Did the primary diagnosis change? 2) Did MRI provide additional information to existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did pt management change? If ’Yes’ was answered to any of the above questions, it was considered that MRI was of value to pt diagnosis and/or impending therapy.
Results: The average MRI was 21±45min. Of the 250 pts, 170(68%) were neurology/neurosurgery, 15 (6%) were musculoskeletal and 65 (26%) were cardiovascular cases. Upon reviewing the 170 neurology/neurosurgery MRI’s, 145 (85%) provided additional information. The diagnoses changed in 90 (62%), while medical therapy changed for 37(25%). In only 18(12%) did MRI simply confirm original diagnosis. In 65 cardiac cases, MRI provided additional data. In 55 pts(85%), MRI changed the original diagnosis and in 6(9%), pt care. MRI did not contribute in 4(6%) as it was uninterpretable (ICD artifact). In essence, 95% of the cardiac cases benefited by MRI. Finally, in 15 musculoskeletal cases, MRI provided additional information in 13(81%) and in 5(38%), changed pt care. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any pt.
Conclusion: MRI in pts with PM/ICD’s adds substantial clinical value to diagnosis and subsequent management justifying inherent risk. To our knowledge, this is the first study to focus solely on diagnostic value under the assumption that safety can be routinely accomplished.
Author Disclosures: H. Samar: None. L. Gevenosky: None. J. Yamrozik: None. R. Williams: None. R. Lombardi: None. M. Doyle: None. M. Shah: None. C. Bonnet: None. R.W. Biederman: None.
- © 2016 by American Heart Association, Inc.