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

• Published in: European radiology Vol. 30; no. 5; pp. 2571 - 2582
• Main Authors: Lunden, Laura, Wolff, Stephan, Peters, Sönke, Drews, Catharina, Gierloff, Christine, Jensen-Kondering, Ulf, Langguth, Patrick, Madjidyar, Jawid, Piesch, Tim-Christian, Jansen, Olav
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2020; Springer Nature B.V
• Subjects: Brain - diagnostic imaging; Constraining; Diagnostic Radiology; Diagnostic systems; Healthy Volunteers; Humans; Image quality; Image transmission; Imaging; Internal Medicine; Interventional Radiology; Knee; Liver - diagnostic imaging; Lumbar Vertebrae - diagnostic imaging; Magnetic Resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Medical imaging; Medicine; Medicine & Public Health; Neuroimaging; Neuroradiology; Phantoms, Imaging; Prostheses and Implants; Quality; Radio frequency; Radio Waves; Radiology; Scanners; Signal to noise ratio; Spine; Spine (cervical); Spine (lumbar); Ultrasound; Magnetic resonance imaging; Patient safety; Active devices
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06599-6

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 B 1+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 B 1+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 B 1+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 B 1+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 B 1+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.