Breast MRI in Patients With Active Implanted Metallic Devices: How We Do It

Given increases in both breast MRI utilization and the prevalence of active implanted metallic devices (AIMDs), radiology practices are expected to encounter growing number of referrals for breast MRI in patients with AIMDs. Under MRI, AIMDs can experience forces and torques, vibrations, heating, and electrical interference or malfunction. AIMDs also distort the magnetic field, causing signal voids, signal pile-up, geometric distortion, and fat suppression failure. Yet limited guidance exists on safely performing breast MRI in this patient population. This Perspective presents approaches for safely performing breast MRI in patients with AIMDs while maintaining diagnostic integrity. Key components include multistep screening for early identification of AIMDs, adherence to vendor MRI-conditional guidelines, and protocol modification techniques to meet these guidelines while balancing image quality, scan time, and artifact mitigation. Illustrative clinical cases demonstrate breast MRI examinations performed safely in patients with various AIMDs including a cardiac pacemaker, cardiac loop recorder, sacral nerve stimulator, responsive neurostimulator, hypoglossal nerve stimulator, spinal cord stimulator, and deep brain stimulator. Situations where MRI is inadvisable and alternative modalities may be preferred are also considered. New MRI safety CPT codes are also highlighted. Implementing the described workflows can expand safe access to breast MRI for patients with AIMDs.