Fast-gradient-echo sequences yielded better cardiac MRI image quality than steady-state-free-precession sequences in patients with an MRI-conditional ICD (OR 3.5; 95% CI 2.5-4.8; P<0.0001).
RCT (n=275)
Randomized
Yes
Does fast-gradient-echo (FGE) sequence improve cardiac MRI image quality compared to steady-state-free-precession (SSFP) sequence in patients with an MR-conditional ICD?
In patients with MR-conditional ICDs, fast-gradient-echo sequences yield better cardiac MRI image quality and smaller artifacts compared to steady-state-free-precession sequences.
Effect estimate: OR 3.5 (95% CI 2.5-4.8)
Absolute Event Rate: 74% vs 53%
p-value: p=<0.0001
BACKGROUND: Recently, magnetic resonance (MR)-conditional implantable cardioverter defibrillator (ICD) systems have become available. However, associated cardiac MR image (MRI) quality is unknown. The goal was to evaluate the image quality performance of various cardiac MR sequences in a multicenter trial of patients implanted with an MR-conditional ICD system. METHODS AND RESULTS: The Evera-MRI trial enrolled 275 patients in 42 centers worldwide. There were 263 patients implanted with an Evera-MRI single- or dual-chamber ICD and randomized to controls (n=88) and MRI (n=175), 156 of whom underwent a protocol-required MRI (9-12 weeks post implant). Steady-state-free-precession (SSFP) and fast-gradient-echo (FGE) sequences were acquired in short-axis and horizontal long-axis orientations. Qualitative and quantitative assessment of image quality was performed by using a 7-point scale (grades 1-3: good quality, grades 6-7: nondiagnostic) and measuring ICD- and lead-related artifact size. Good to moderate image quality (grades 1-5) was obtained in 53% and 74% of SSFP and FGE acquisitions, respectively, covering the left ventricle, and in 69% and 84%, respectively, covering the right ventricle. Odds for better image quality were greater for right ventricle versus left ventricle (odds ratio, 1.8; 95% confidence interval, 1.5-2.2; P<0.0001) and greater for FGE versus SSFP (odds ratio, 3.5; 95% confidence interval, 2.5-4.8; P<0.0001). Compared with SSFP, ICD-related artifacts on FGE were smaller (141±65 versus 75±57 mm, respectively; P<0.0001). Lead artifacts were much smaller than ICD artifacts (P<0.0001). CONCLUSIONS: FGE yields good to moderate quality in 74% of left ventricle and 84% of right ventricle acquisitions and performs better than SSFP in patients with an MRI-conditional ICD system. In these patients, cardiac MRI can offer diagnostic information in most cases. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02117414.
Schwitter et al. (Sun,) conducted a rct in Implantable cardioverter defibrillator (n=275). Fast-gradient-echo (FGE) sequence vs. Steady-state-free-precession (SSFP) sequence was evaluated on Good to moderate image quality covering the left ventricle (OR 3.5, 95% CI 2.5-4.8, p=<0.0001). Fast-gradient-echo sequences yielded better cardiac MRI image quality than steady-state-free-precession sequences in patients with an MRI-conditional ICD (OR 3.5; 95% CI 2.5-4.8; P<0.0001).
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