Successful cervical MR scan in a patient several hours after pacemaker implantation

Recent data showed that patients with electrical implanted devices may under certain conditions be scanned safely by magnetic resonance imaging (MRI). The device must have been in place preferably for at least 4-8 weeks [Correction added after online publication 31-Aug-2009: number of weeks has been updated.] prior to MR imaging to allow healing and pacemaker pocket formation. We report on a patient with quadriplegia and suspected epidural hematoma referred for MR scan a day after he had a pacemaker implantation. The patient was also pacemaker-dependent. After considering the risk/benefit ratio in this patient, it was decided to perform the scan. The pacemaker was reprogrammed. MRI was performed under strict monitoring. A spinal cord contusion at the level of C1-3 was diagnosed. Based on the imaging findings no invasive procedure was done. Device interrogation found no change in sensing or pacing parameters or in the pacemaker's battery. At the end of the scan, the device was reprogrammed back to the initial settings. In this population, each scan should be discussed thoroughly and the risks to benefit ratio should be considered. Given appropriate precautions, in well-experienced imaging centers, MRI may be safely performed in patients with permanent cardiac electronic implantable devices.