Ramirez-Suarez KI, Otero HJ, Biko DM, Dori Y, Smith CL, Feudtner C, White AM.Clin Imaging. 2022 Jun;86:43-52. doi: 10.1016/j.clinimag.2022.02.016. Epub 2022 Feb 23.PMID: 35334301
Take Home Points:
- The use of MRI, when no comparable alternative diagnostic imaging modality exist, as in the case of lymphatic system imaging, can be used with no major adverse effects in patients with previous epicardial lead
- Further studies are required in larger cohorts to elucidate safety measures more definitively
Commentary from Dr. Blanche Cupido (Cape Town, South Africa), chief section editor of ACHD Journal Watch:
MRI remains the diagnostic modality of choice for the diagnosis of complex lymphatic disorders. Though modern pacemakers are MRI conditional, older pacing devices and other implantable electronic devices have still pose a theoretical restriction to MRI. Epicardial leads, often used in pediatric patients, have traditionally been included in this group with a relative contraindication to MRI due to the theoretical risk of cardiac excitation or thermal injury. The potential harm is attributed to a potential interaction between static and time-varying magnetic fields and device components with the consequences (theoretical) of local tissue damage, ventricular arrhythmias and device malfunction. It is however noted that in clinical practice, the retained leads are short and do not usually form conducting loops.
This study gives the perspective of a single center of 5 patients with complex CHD (post-Fontan) with MRI ‘incompatible’ devices in whom a Dynamic Contrast Enhanced MR Lymphangiography (DCMRL) was performed. The patients underwent DCMRL of the chest, abdomen and pelvis on a 1.5 Tesla Siemens system, under general anaesthesia. All patients had been discussed in an MDT (which included the family and an ethics team) and the risks/benefits explained to the patients.
In all 5 patients, there were no MR safety related adverse events occurring during or following the imaging. This shows potential safety however larger studies would be needed to define the safe practice measures more definitively.
An example of a case is shown below: