摘要
目的:探讨植入磁共振兼容起搏器患者进行3.0 T磁共振成像(MRI)检查的安全性和有效性。方法:严格按照规范化检查流程,在电生理专科医师、起搏器工程师和影像科医师3方人员的配合下,2017年1月至2018年12月对中国医学科学院阜外医院14例植入磁共振兼容起搏器术后的患者进行3.0 T MRI检查。MRI检查前后进行起搏器程控,分析心房及心室的感知、阻抗和阈值等参数,记录MRI扫描相关不良事件,并评估MRI影像质量。结果:14例患者年龄(59±18)岁,年龄范围17~81岁,男6例,共接受16例次MRI检查(头颅8例次、颈椎2例次、腰椎3例次、心脏3例次)。4例患者在植入起搏器前接受过MRI检查。11例患者脉冲发生器置于左胸,3例置于右胸。MRI检查前后起搏器程控检查的感知[心房:(3.3±1.2)?mV对(2.6±1.5)?mV, P=0.29;心室:(9.1±3.7)?mV对(6.8±4.7)?mV, P=0.39]、阻抗[心房:(578±162)?Ω对(587±88)?Ω, P=0.41;心室:(584±200)?Ω对(578±66)?Ω, P=0.63]和阈值[心房:(0.6±0.2)?V/0.4 ms对(0.8±0.1)?V/0.4 ms, P=1.0;心室:(0.8±0.3)?V/0.4 ms对(0.8±0.3)?V/0.4 ms, P=0.76]等参数差异无统计学意义,无需程控调整。所有患者无心悸、灼热感、疼痛、晕厥等不适症状,亦无脉冲发生器故障、电重置、心律失常等不良事件发生。3例(2例右胸,1例左胸)心脏MRI检查存在导线和脉冲发生器相关的伪影,经影像科医生评估,MRI质量对病情诊断和评估无不良影响。 结论:磁共振兼容起搏器患者在规范化流程下进行3.0 T MRI检查具有良好的安全性和有效性,心脏MRI的脉冲发生器和导线伪影并未影响MRI检查结果的影像价值。
Objective This study aimed to evaluate the safety and practical concerns of 3.0 tesla(3.0 T)magnetic resonance imaging(MRI)scan for patients with magnetic resonance(MR)-conditional pacemakers.Methods Fourteen patients with MR-conditional pacemaker who were referred for medically necessary MRI scanning from January 2017 to December 2018 in Fuwai hospital were included.A rigorous standardized workflow was performed in collaboration with electrophysiologists,pacemaker engineers and radiologists.Pacemaker interrogation was performed immediately before and after MRI scan.Significant changes in parameters including sense,impedance and threshold were recorded.Scan related adverse events were documented and imaging qualities were evaluated by radiologists.Results Among the 14 patients,6 were men and the age was(59±18)years old(17-81 years old).Sixteen MRI examinations on different body regions(brain=8,cervical spine=2,lumbar spine=3,heart=3)were successfully completed.There were 11 patients who had their pacemakers implanted in the right chest wall and 3 patients in the left chest wall.Four patients had spine or cardiac MRI exams before pacemaker implantation.No significant changes in interrogation parameters such as sense[atrial:(3.3±1.2)mV vs.(2.6±1.5)mV,P=0.29;ventricular:(9.1±3.7)mV vs.(6.8±4.7)mV,P=0.39],impedance[atrial:(578±162)Ωvs.(587±88)Ω,P=0.41;ventricular:584±200Ωvs.(578±66)Ω,P=0.63]and threshold[atrial:(0.6±0.2)V/0.4 ms vs.(0.8±0.1)V/0.4 ms,P=1.0;ventricular:(0.8±0.3)V/0.4 ms vs.(0.8±0.3)V/0.4 ms,P=0.76]were noted during or after MRI scanning.None of the patients complained of palpitations,heating sensation,pain or syncope.No pacing inhibition,pacemaker reset or arrhythmia were detected.Artifacts related to pulse generator and leads were observed in 3 cardiac MRI reports,with 2 pacemakers in the right pectoral and 1 in the left pectoral,but quality of cardiac image adequately allowed interpretation of diagnostic value.Conclusion This study made an effective attempt to demonstrate that 3.0 T MRI scanning on different body regions for patients with MR-conditional pacemakers can be safely applied in the conditions of standardized workflow.The artifacts of pulse generators and leads in cardiac MRI scan had no adverse impact on diagnostic value.
作者
宁小晖
樊晓寒
陈柯萍
华伟
刘志敏
陈若菡
陈秀玉
陆敏杰
赵世华
张澍
Ning Xiaohui;Fan Xiaohan;Chen Keping;Hua Wei;Liu Zhimin;Chen Ruohan;Chen Xiuyu;Lu Minjie;Zhao Shihua;Zhang Shu(Center of Arrhythmia,Fuwai Hospital,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)
出处
《中华心律失常学杂志》
2020年第3期288-292,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
心脏起搏
人工
磁共振成像
3.0
T
Cardiac pacing,artificial
Magnetic resonance imaging
3.0 tesla
作者简介
通信作者:樊晓寒,Email:fanxiaohan@fuwaihospital.org。
