MRI contraindications
MR Contraindications[1]
Cardiovascular Devices
| Device | MR Category | Comments |
|---|---|---|
| Aortic stent grafts | Most MR Safe | Zenith AAA and TAA endovascular grafts (Cook) = MR Conditional |
| Cardiac closure and occluder devices | Most MR Safe (some MR Conditional) | |
| Coronary artery stents | Most MR Safe (some MR Conditional) | Check individual type |
| Embolization coils | Most MR Safe (some MR Conditional) | |
| Loop recorder (Event monitor) | MR Conditional? | Stored data may be affected |
| Mechanical cardiac valves | Most MR Safe (some MR Conditional) | Ie. prosthetic heart valves and annuloplasty rings |
| Sternal wires | Generally considered MR safe | |
| Hemodynamic monitoring and temporary pacing devices | MR Unsafe | |
| Hemodynamic support devices | MR Unsafe | I.e. Intraaortic balloon pump and ventricular assist devices |
| IVC filters | Most MR Safe (some MR Conditional) | Weakly ferromagnetic devices [e.g. Gianturco bird nest IVC filter (Cook), stainless steel Greenfield vena cava filter (Boston Scientific)]: after six weeks as long as no reason to suspect improper positioning or movement |
| Permanent pacemakers and ICDs | Strong relative contraindication vs. MR Unsafe | Absolute contraindication: pacemakers or ICDs with known lead fractures |
| Peripheral vascular stents | Most MR Safe (some MR Conditional) | Check individual type |
| Pulmonary artery monitoring/thermodilution catheters | MR Unsafe (unless otherwise specified) | I.e. Swan-Ganz catheter and similar catheters |
| Temporary pacemaker | MR Unsafe | I.e. External pulse generators or temporary pacing leads |
| Retained transvenous pacemaker and defibrillator leads | Strong relative contraindication vs. MR Unsafe | Approached same as those with pacemakers or ICDs (see above) |
Permanent pacemakers and implantable ICDs
- Only if no alternative diagnostic test is available and the potential benefit to the patient clearly outweighs the potential risks
- If performed, the pacemaker/ICD should be interrogated before and after the procedure
- Registry of non-MRI conditional pacemakers in NEJM article with nonthoracic MRI at field strength of 1.5 teslas suggested that lead or device failure does not occur[2]
- 1000 cases of pacemakers and 500 cases of ICD in study
- No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI
- Industry funded study, with strict criteria for inclusion
- Risks:
- Pacemaker/ICD dysfunction
- Pacemaker/ICD damage
- Arrhythmia
- Death
Non-Cardiovascular
| Device | MR Category | Comments |
|---|---|---|
| Nerve stimulators | MR Unsafe | |
| Cochlear implants | MR Unsafe | |
| Aneurysm clips | Ferromagnetic: MR Unsafe; Non/weakly-ferromagnetic: MR Safe | Requires specific information about clip material |
| Dental materials (alloys, wires, splints, and prostheses) | MR Safe | |
| Neurosurgical halo pins | MR unsafe? | |
| Transdermal patches | If contain aluminum or other metals (in non-adhesive backing): MR Unsafe | Remove before MR. Examples include certain clonidine, nicotine, scopolamine, testosterone, or fentanyl patches |
| Unstable patient | MR Conditional | Probably should avoid unless an urgent clinical indication without acceptable alternative |
Other
- Pregnancy: Unknown (if any, probably low)
- Gadolinium-based contrast not recommended unless benefit justifies risk (crosses the placenta)
- Claustrophobia
- Agitated
- Very Obese (depending on system)
MR (Gadolinium-Based) Contrast[3]
Background
- Unlike iodinated contrast, MR contrast has few side effects and rarely cause anaphylaxis
- It does cross the placenta
Specific Groups
- Pregnancy (see above)
- Gadolinium-based contrast not recommended unless benefit justifies risk
- Moderate to severe chronic kidney disease:
- Contrast nephropathy can occur (contraindicated)
- Dialysis and hepatorenal patients in the perioperative liver transplant period
- Associated Nephrogenic Systemic Fibrosis (contraindicated)
Key
- MR Safe: Generally safe
- MR Conditional: Weigh risk/benefit (relative contraindication)
- MR Unsafe: Generally contraindicated (absolute contraindication)
See Also
References
<references>
- 25.Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance. Circulation 2007; 116:2878.
- Russo RJ et al. Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator. N Engl J Med 2017; 376:755-764. February 23, 2017.
- 25.Levine GN, Gomes AS, Arai AE, et al. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance. Circulation 2007; 116:2878.
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