Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists.

Pacemakers and implantable cardioverter defibrillators are commonly encountered in clinical practice, and entails special consideration when magnetic resonance imaging (MRI) is required. It is estimated that 50-75% of patients with cardiac implantable electronic devices (CIED) will have an indication for MRI during their lifetime. Radiologists may want to recommend MRI or may be consulted about the need to perform MRI in a patient with a CIED, at which point they may need to approve or at least provide guidance as to whether MRI may be performed safely. Even in situations where final clearance will not be provided by the radiologist, he or she can provide valuable information by reviewing radiographs and determining (a) whether a device is MRI-conditional and MRI may ultimately be permitted, (b) is not MRI-conditional and MRI using the standard workflow will therefore not be approved, or (c) when additional information will clearly be required. CIED identification and verification of leads can be accomplished through review of the medical record and/or evaluation of a chest radiograph. In patients with MRI-conditional CIEDs (as well as with legacy CIEDs in those institutions that perform MRI of these patients), specific imaging protocols must be adhered to in order to prevent death or injury to the patient or damage to the device. In this update, we provide details regarding the above topics and provide an algorithm for integrating this information into a clinical workflow to efficiently triage patients with CIEDs who are being considered for MRI.

A rare case of primary lung adenocarcinoma detected by routine liquid-based cervical cytology.

Cervical cytology is mainly used for the screening and detection of early cervical cancers and its precursors. Rarely, detection of malignant cells in cervical cytology specimens is the first manifestation of an extrauterine (EU) malignancy. We report a case of a 49-year-old female in which adenocarcinoma initially diagnosed on routine, liquid-based cervical cytology led to the detection of a primary lung cancer.

Needle localization in MR-guided biopsy and aspiration: effects of field strength, sequence design, and magnetic field orientation.

OBJECTIVE: The purpose of this investigation was to evaluate the accuracy of MR Imaging for needle depiction at 0.2 and 1.5 T with multiple pulse sequences and needle orientations. The goal was to provide a framework for biopsy approach and imaging technique parameter selection that will ensure the safety and accuracy of MR-guided procedures. MATERIALS AND METHODS: Eight titanium and stainless steel alloy MR-compatible biopsy devices were immersed in fluid phantoms and placed into 1.5- and 0.2-T MR systems used for clinical imaging. Spin-echo, turbo spin-echo, and gradient-echo images were obtained with the needle shafts of the biopsy devices placed parallel to, perpendicular to, and at angles of 30 degrees and 60 degrees relative to the static magnetic field of the scanner. All images were obtained with the frequency-encoding direction parallel to and perpendicular to the needle shaft. Needle width and tip position were measured from images on a freestanding workstation, and the apparent tip position was compared with that obtained by direct measurement. The difference between these values was calculated for each needle type, imaging sequence, frequency-encoding direction, and needle orientation. RESULTS: Artifactual widening was much more apparent at 1.5 T than at 0.2 T, as was error in determining needle tip position. Artifacts at both field strengths were most pronounced with gradient-echo sequences, less so with turbo spin-echo sequences, and least of all with spin-echo sequences. For spin-echo and turbo spin-echo sequences, when the frequency-encoding axis was perpendicular to the needle shaft, the apparent width of the needle was larger, but error in needle tip position was smaller. Artifacts were much less apparent, but error in tip position increased, as the orientation of the needle shaft became more parallel to the direction of the magnetic field. CONCLUSION: Specific measurements differed with field strength, but needle tip localization within 1 mm was obtained at both 0.2 and 1.5 T with the appropriate frequency-encoding direction, pulse sequence, and imaging parameters. Orientation of the needle parallel to the magnetic field significantly reduced the apparent width of the needle at both field strengths but also decreased the accuracy of needle tip position localization.