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==Contraindications==
==MR Contraindications==
 
===Cardiovascular Devices===
===Cardiovascular Devices===
*Coronary artery and peripheral vascular stents: most "MR safe" and "MR conditional" (check individual type)
{| class="wikitable"
*Aortic stent grafts:
|-
**Most "MR safe"
! Device !! MR Category !! Comments
**Zenith AAA and TAA endovascular grafts (Cook) = "MR conditional"
|-
*Mechanical cardiac valves:
| Aortic stent grafts || Most ''MR Safe'' || Zenith AAA and TAA endovascular grafts (Cook) = ''MR Conditional''
**most prosthetic heart valves and annuloplasty rings = "MR safe"
|-
**Others ="MR conditional"
| Cardiac closure and occluder devices  || Most ''MR Safe'' (some ''MR Conditional'') ||
*Sternal wires = generally considered MR safe
|-
*Cardiac closure and occluder devices
| Coronary artery stents || Most ''MR Safe'' (some ''MR Conditional'') || Check individual type
**Majority of cardiac closure and occluder devices = "MR safe"
|-
**Several tested devices have been labeled as "MR conditional"
| Embolization coils || Most ''MR Safe'' (some ''MR Conditional'')||
*Inferior vena cava filters:
|-
**Most "MR safe"
| Loop recorder (Event monitor) || ''MR Conditional''?  || Stored data may be affected
**The remainder = "MR conditional"
|-
**Weakly ferromagnetic devices: can be performed after six weeks if clinically indicated as long as there is no reason to suspect that the device is not positioned properly or that it is not firmly in place
| Mechanical cardiac valves || Most ''MR Safe'' (some ''MR Conditional'') || Ie. prosthetic heart valves and annuloplasty rings
***Gianturco bird nest IVC filter (Cook)
|-
***Stainless steel Greenfield vena cava filter (Boston Scientific)
| Sternal wires || Generally considered ''MR safe'' ||
*Embolization coils: most "MR safe"
|-
**The remainder = "MR conditional"
|Hemodynamic monitoring and temporary pacing devices || '''MR Unsafe''' ||
*Loop recorder (Event monitor) —
|-
**Reveal Plus ILR = "MR conditional."
|Hemodynamic support devices||'''MR Unsafe'''|| I.e. Intraaortic balloon pump and ventricular assist devices
**May undergo MRI any time after implantation if there is no reason to believe the device is not well implanted
|-
**Stored data may be affected
| 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
*Hemodynamic monitoring and temporary pacing devices
|-
**"MR unsafe"
|Permanent pacemakers and ICDs||Strong relative contraindication vs. '''MR Unsafe'''||Absolute contraindication: pacemakers or ICDs with known lead fractures
*Pulmonary artery hemodynamic monitoring/thermodilution catheters
|-
**Swan-Ganz catheter and similar catheters  
| Peripheral vascular stents || Most ''MR Safe'' (some ''MR Conditional'') || Check individual type
**Generally MR unsafe, unless otherwise specified
|-
*Temporary pacemaker (external pulse generators or temporary pacing leads)
|Pulmonary artery monitoring/thermodilution catheters|| '''MR Unsafe''' (unless otherwise specified) || I.e. Swan-Ganz catheter and similar catheters
**MR unsafe
|-
*Permanent pacemakers and implantable ICDs
|Temporary pacemaker||'''MR Unsafe'''|| I.e. External pulse generators or temporary pacing leads
**Generally considered a strong relative contraindication
|-
**Only if no alternative diagnostic test is available and the potential benefit to the patient clearly outweighs the potential risks  
|Retained transvenous pacemaker and defibrillator leads || Strong relative contraindication vs. '''MR Unsafe''' ||Approached same as those with pacemakers or ICDs (see above)
**If performed, the pacemaker/ICD should be interrogated before and after the procedure
|}
**Risks:
 
***pacemaker/ICD dysfunction
====Permanent pacemakers and implantable ICDs====
***pacemaker/ICD damage
*Only if no alternative diagnostic test is available and the potential benefit to the patient clearly outweighs the potential risks<ref>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.</ref>
***arrhythmia
*If performed, the pacemaker/ICD should be interrogated before and after the procedure
***death
*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<ref>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.</ref>
**Absolute contraindication (MR Unsafe): pacemakers or ICDs with known lead fractures
**1000 cases of pacemakers and 500 cases of ICD in study
*Retained transvenous pacemaker and defibrillator leads
**No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI
**Approached same as those with pacemakers or ICDs (see above)
**Industry funded study, with strict criteria for inclusion
*Hemodynamic support devices (intraaortic balloon pump and ventricular assist devices)
*Risks:
**Absolute contraindication (MR Unsafe)
**Pacemaker/ICD dysfunction
*Nerve stimulators: MR Unsafe
**Pacemaker/ICD damage
*Cochlear implants: MR Unsafe
**Arrhythmia
*Aneurysm clips
**Death
**Requires specific information about the clip, particularly its material
 
***Ferromagnetic: absolute contraindication
===Non-Cardiovascular===
***Nonferromagnetic or weakly ferromagnetic: MR safe
{| class="wikitable"
*Dental materials (alloys, wires, splints, and prostheses): MR Safe
|-
*Neurosurgical halo pins: MR unsafe?
! Device !! MR Category !! Comments
*Transdermal patches
|-
**If contain aluminum or other metals (in non-adhesive backing): MR Unsafe (remove before MR)
| Nerve stimulators || '''MR Unsafe''' ||
***Examples: certain clonidine, nicotine, scopolamine, testosterone, or fentanyl patches
|-
*Unstable patient: MR conditional (probably should not unless there is an urgent clinical indication without acceptable alternative)
| 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)
*Pregnancy: Unknown (if any, probably low)
**Gadolinium-based contrast not recommended unless benefit justifies risk (crosses the placenta)
**Gadolinium-based contrast not recommended unless benefit justifies risk (crosses the placenta)
*MR contrast agents and renal failure
**Unlike iodinated contrast, MR contrast has few side effects and rarely cause [[anaphylaxis]]
***Moderate to severe chronic kidney disease:
****Contrast nephropathy can occur
****Dialysis and hepatorenal patients in the perioperative liver transplant period
*****Associated nephrogenic systemic fibrosis (may be fatal)
*****MR Unsafe
===Other===
*Claustrophobia  
*Claustrophobia  
*Agitated
*Agitated
*Very Obese (depending on system)
*Very Obese (depending on system)


[[Category:Rads]]
==MR (Gadolinium-Based) Contrast==
===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==
*[[MRI (main)]]
*[[CT/MRI size limits]]
 
==References==
<references/>
 
[[Category:Radiology]]

Revisión actual - 22:02 1 mar 2023

MR Contraindications

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[1]
  • 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

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

Key

  • MR Safe: Generally safe
  • MR Conditional: Weigh risk/benefit (relative contraindication)
  • MR Unsafe: Generally contraindicated (absolute contraindication)

See Also

References

  1. ↑ 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.
  2. ↑ 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.
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