Safety of magnetic resonance imaging in patients with retained cardiac leads

TL;DR

This study assesses the safety of MRI scans in patients with fragmented retained cardiac leads using simulations and phantom experiments, finding minimal heating and no stimulation risk at 1.5 T and 3 T.

Contribution

It provides the first comprehensive evaluation combining numerical simulation and experimental validation for MRI safety in patients with retained cardiac leads.

Findings

RF heating remains below safety thresholds at 1.5 T and 3 T.

Maximum temperature rise observed was 2.4°C at 3 T.

Electric fields did not reach stimulation thresholds.

Abstract

Purpose: To evaluate safety of MRI in patients with fragmented retained leads (FRLs) through numerical simulation and phantom experiments. Methods: Electromagnetic and thermal simulations were performed to determine the worst-case RF heating of 10 patient-derived FRL models during MRI at 1.5 T and 3 T and at imaging landmarks corresponding to head, chest and abdomen. RF heating measurements were performed in phantoms implanted with reconstructed FRL models that produced highest heating in numerical simulations. The potential for unintended tissue stimulation was assessed through a conservative estimation of the electric field induced in the tissue due to gradient-induced voltages developed along the length of FRLs. Results: In simulations under conservative approach, RF exposure at B1+<2 uT generated CEM43<40 at all imaging landmarks at both 1.5 T and 3 T indicating no thermal damage for acquisition times (TA) <10 minutes. In experiments, the maximum temperature rise when FRLs were positioned at the location of maximum electric field exposure was measured to be 2.4 degrees Celsius at 3 T and 2.1 degrees Celsius at 1.5 T. Electric fields induced in the tissue due to gradient-induced voltages remained below the threshold for cardiac tissue stimulation in all cases. Conclusions: Simulation and experimental results indicate that patients with FRLs can be scanned safely at both 1.5 T and 3 T with majority of clinical pulse sequences.