Quality and diagnostic capacity of the 1.5 Tesla magnetic resonance imaging in patients with conditional implantable cardioverter defibrillator.

Wednesday, February 4, 2026

1:40 PM - 1:50 PM

Location: Americas I and Hall 3 (2nd Lower Level)

Presenting Author(s)

Luciene Ferreira Mota, MD

Cardiologista
Heart Institute, University of São Paulo
Itajuba, Minas Gerais, Brazil

Primary Author(s)

VA

Veridiana Andrade, PhD

Cardiologyst
Heart Institute, University of São Paulo
São Paulo, Sao Paulo, Brazil

Co-Author(s)

MM

Martino Martinelli Filho, PhD

department head
Heart Institute, University of São Paulo, Sao Paulo, Brazil
Carlos Rochitte, MD, PhD, FSCMR

Associate Professor of Cardiology, Academic Coordinator of Cardiovascular Magnetic Resonance and Computed Tomography sector, and Medical Director of the Research Center at Heart Institute, InCor, University of São Paulo Medical School Cardiovascular Magnetic Resonance and Computed Tomography Director at HCOR Senior Medical Leader at Alta Excelência Diagnóstica, DASA, São Paulo
InCor - Univ. of São Paulo / HCOR - Heart Hospital
InCor - Univ. of São Paulo
São Paulo, Sao Paulo, Brazil

Background: Magnetic resonance imaging (MRI), which is classically contraindicated in patients with cardiac implantable electronic device (CIED),
became feasible with the introduction of the recent MRI conditional devices.These have been proven to be safer, but little is known about the quality and diagnostic capacity of the acquired images, which can be distorted by the presence of CIED, especially with regard to the implantable cardioverter defibrillator (ICD), whose quantity of ferromagnetic material is relevant. Our study was designed to evaluate the quality and diagnostic value of the images acquired by cardiac MR in patients with conditional ICD.

Methods: Pilot study of patients with MR conditional ICD who were submitted to previous CMR (CMR1). All patients underwent an another CMR after ICD implantation (CMR2), under specific protocol of pulse sequences used for cine-resonance, late enhancement, myocardial perfusion, T1 mapping, anatomic and myocardial edema evaluation, and flow map. All patients underwent ICD electronic
interrogations, immediate pre and post CMR2 measurements of battery voltage, capture thresholds, sensing, lead and shock impedance. Three specialists evaluated the quality of CMR images, pre and post implantation of ICD, which
were scored by the Likert Scale. This graded measure from 1 to 5 the impact of the imaging artifact and the diagnostic ability of the examination. For the images acquired by multiple slices the same score was used for each left ventricule(LV) segment (American Heart Association - AHA criteria).

Results: We studied 22 patients submitted to MR conditional ICD implantation. CMR1 had a high score (3 to 5, m = 4.7) on the Likert scale. On the other hand, in all CMR2 exams, there were artifacts of susceptibility, and the anterior and lateral LV walls were more affected. The mean segmental score and respective diagnostic image rates were: 3.1 points and 82.32% for Cine SSFP; 1.74 and 27.80% for
LGE; 2.08 and 30,4% for myocardial perfusion. The rates of diagnostic images obtained in the single slice acquisition were 0% for T1 mapping; 77.3% for anatomical evaluation (double and triple anatomic); 68.2% for flow map and 9.0% for myocardial edema evaluation.

Conclusion: In patients with MR conditional ICD, the quality of the images and the diagnostic capacity of the CMR examination are compromised by susceptibility artifacts, present mainly in the anterior and lateral LV walls. These findings suggest that further research is needed to optimize image quality and diagnostic capacity of CMR in patients with MR conditional ICD.

Average CINE SSFP Score per Segment (CMR1 vr. CMR2) with Likert Scale

Average Late Enhancement Score per Segment (CMR1 vr. CMR2) with Likert Scale

Diagnostic Rate of single acquisitions in RMC 2