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MRI in patients with implanted active devices: how to combine safety and image quality using a limited transmission field?

  • Magnetic Resonance
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Abstract

Objectives

Radio frequency (RF) pulses in magnetic resonance imaging (MRI) can interact with implanted devices and cause tissue damage. However, there are new devices that can safely perform measurements with liberal MRI conditions such as an RF transmission field B1+rms ≤ 2.0 μT. We investigated whether MRI in this case is limited for these technical reasons.

Methods

We selected typical MRI protocols of six body regions (brain, cervical spine, lumbar spine, knee, liver, heart) using two typical 1.5T MRI scanners. Overall, we adapted 62 sequences to B1+rms conditions and evaluated their diagnostic quality. For this, we measured signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR), and geometric deviation (GD) as quality parameters, using phantom studies. For questionnaire studies, we selected pairs of original and adapted sequences in healthy volunteers. Blinded radiologists rated the images as single sequence rating and in direct comparison.

Results

Roughly one-third of the checked sequences were below the B1+rms limit. Here, 56 of the 62 adapted sequences showed at least the same image quality in single ratings. A reduction in SNR and/or CNR was found with 31 sequences and only one sequence with considerably increased GD. Especially, sequences with original high B1+rms values, PD sequences, and sequences of the Siemens knee and heart protocol were difficult to adapt, whereas most TSE and IR sequences had no clinical limitations.

Conclusion

By limiting the transmission field to B1+rms ≤ 2.0 μT, clinically relevant MR sequences can be adapted with nearly no reduction in image quality. Despite limiting the transmission field, high-quality MR imaging is possible. We could derive strategies for adaptation.

Key Points

• Despite limiting the transmission field, high-quality MRI is possible.

• We could derive strategies for adapting the sequences to B 1+rms ≤ 2.0 μT.

• This enables high-quality MRI of different body regions for patients with AD.

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Abbreviations

AD:

Active device

B1:

B1 field strange

Blade:

Periodically rotated overlapping parallel lines with enhanced reconstruction

CNR:

Contrast-to-noise-ratio

GD:

Geometric deviation

MRI:

Magnetic resonance imaging

PD:

Proton density weighted image

RF:

Radio frequency

SAR:

Specific absorption rate

SE:

Spin echo

SNR:

Signal-to-noise-ratio

Stir:

Short T1 inversion recovery

TSE:

Turbo spin echo

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Funding

This study has received funding from Medtronic.plc.

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Authors and Affiliations

  1. Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Straße 3, Haus 41, 24105, Kiel, Germany

    Laura Lunden, Stephan Wolff, Sönke Peters, Catharina Drews, Christine Gierloff, Ulf Jensen-Kondering, Patrick Langguth, Jawid Madjidyar, Tim-Christian Piesch & Olav Jansen

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  1. Laura Lunden
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  2. Stephan Wolff
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  3. Sönke Peters
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  4. Catharina Drews
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  5. Christine Gierloff
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  6. Ulf Jensen-Kondering
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  7. Patrick Langguth
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  10. Olav Jansen
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Corresponding author

Correspondence to Laura Lunden.

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Guarantor

The scientific guarantor of this publication is Prof. Dr. Med. Olav Jansen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Randomized controlled trial

• Performed at one institution

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Lunden, L., Wolff, S., Peters, S. et al. MRI in patients with implanted active devices: how to combine safety and image quality using a limited transmission field?. Eur Radiol 30, 2571–2582 (2020). https://doi.org/10.1007/s00330-019-06599-6

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  • DOI: https://doi.org/10.1007/s00330-019-06599-6

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