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Friday, May 11th 2012

MRI Safe

Neurosurgery loses a lot of MRI. It uses a lot of MRI in the urgent setting. Care of the central nervous system is where MR has altered care the most and where quick and efficient access to MR for acute issues has become widely available; rightly. Patients with symptoms of stroke, SCI, cauda equina injury, intracranial mass lesions with herniation syndromes. These are situations where stat access to MRI has proven invaluable and nowadays is essentially standard of care.

And so I am surprised by the number of patients I see who have symptoms that would dictate stat MR scans but who have contraindications to MRI. Patients with ICDs or pacemakers or SCS or other implants or who are claustrophobic or who are morbidly obese and won’t fit on the table. Running into this problem often, I’m excited about a prospective study looking at MRI use in patient’s with supposedly non-compatible pacemakers, the Magnasafe Registry.

This group gave an oral presentation of early results at the Heart Rhythm Society meeting. As the Medscape write up notes,

Among 500 patients undergoing scans, there were no deaths, device failures, generator-lead replacements, losses of capture, ventricular arrhythmias, or electrical resets, according to Debra Doud, MD, of the Scripps Clinic in La Jolla, Calif.

[...]

Current guidelines state that MRI is contraindicated in patients with cardiac devices, and Medicare has not reimbursed for MRI scans performed in patients who have a device in place. Doud noted that Medicare has since begun reimbursing for such scans as long as the patient is enrolled in the registry.

Considering the large number of patients with cardiac devices, the aging of the population, the increasing indications for cardiac devices, and the strengths of MRI in examining soft tissue, “the availability of being able to perform these exams in this patient population is extremely important,” Doud said in an interview.

I’m interested for this study to complete. The idea that implantable devices should limit access to such a now important medical technology, especially in this day and age.

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