Oral Abstract Session
SCMR 22nd Annual Scientific Sessions
Robert Biederman, MD
Director, Cardiac MRI
Allegheny General Hospital
Loretta Gevenosky, RN
Registered Nurse
Allegheny General Hospital
Huma Samar, MD
Cardiology
Loma Linda University Medical Center
June Yamrozik, BSc
MRI Tech
Allegheny General Hospital
Ronald Williams, RT
Cardiac MRI Technologist
Allegheny General Hospital
Richard Lombardi
MRI Technician
Allegheny General Hospital
Moneal Shah, MD
Co-Director, Cardiovascular MRI
Assistant Professor of Medicine
Temple University
Allegheny Health Network
Allegheny General Hospital
Christopher Bonnet, MD
Physician
Allegheny General Hospital
Mark Doyle, PhD
PhD
Allegheny General Hospital
Background: MRI is infrequently performed on patients with conventional pacemakers and ICDs. While many studies have unequivocally documented MRI safety in pts with implanted devices, the clinical value has never been considered. Despite this, CMS-NCD recently supported more widespread considerations and adoption of non-conditional PM/ICDs in MRI scanners. Thus, as the disconnect between that which is CMS approved and the failure of our Society to endorse such a policy increases, we wondered what the 'Additive Value' beyond safety might offer. Moreover, such a strategy might serve to encourage via an alternative mechnism, the notion that PM/ICD scanning has substantial clinical yield in the MRI bore.
Hypothesis We propose that MRI in those with a PM/ICD is crucial to the existing diagnosis and in many instances, substantially alters diagnosis and consequently, subsequent management.
Methods: An evaluation of consecutive pts with PM/ICDs who underwent MRI in a dedicated Cardiac MRI Lab (GE 1.5T,WI) 95% over 10 yrs were performed in a prospective manner. A series of questions using a Boolean Logic Construct 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 33±20min and of the 750 pts, 535 (71%) were neurology/neurosurgery, 62 (12%) were musculoskeletal and 153 (20%) were cardiovascular cases. Upon reviewing the 535 neurology/neurosurgery MRIs, 467 (87%) provided additional information. The diagnoses changed in 346 (65%), while medical therapy changed in 343 (64%). In only 62 (12%) did MRI simply confirm original diagnosis. In 153 cardiac cases, MRI provided additional data. In 125 pts (82%), MRI changed the original diagnosis and in 90 (59%), pt care. MRI did not contribute in 21
(14%) as it was uninterpretable (ICD artifact), while in 30 patients the diagnosis did not change. In essence, 125 ( 82%) of the cardiac cases benefited by MRI. Finally, in 62 musculoskeletal cases, MRI provided additional information in 58 (94%) and in 51 (82%), changed pt care, and in one patient, simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety or device issues were encountered in any patient.
Conclusion:
MRI in patients with PM/ICDs adds substantial clinical value to diagnosis and subsequent management justifying inherent risk. To our knowledge, this is the first (and largest) study to focus solely on diagnostic value and efficacy under the assumption that safety can be routinely accomplished; a new pinnacle. We now believe yet another impediment to the advancement of CMR-PM/ICD strategies may now be operative; parallel not prohibitive with the CMS-NCD .