Thermoregulatory consequences of cardiovascular impairment during NMR imaging in warm/humid environments.

A simple model of physiological thermoregulation, previously adapted to predict the thermoregulatory consequences of exposure to the nuclear magnetic resonance (NMR) imaging environment, has been further adapted to simulate impaired cardiovascular function. Restrictions on the rate of skin blood flow (SkBF), ranging from 0 to 89% of normal, were studied. Predictions of physiological heat loss responses in real time were generated as a function of ambient temperature (Ta), relative humidity (RH) and rate of whole-body radiofrequency (RF) energy deposition (SAR). Under conditions that are desirable in the clinic (Ta = 20 degrees C, 50% RH, still air), moderate restrictions (up to 67%) of SkBF yield tolerable increases in core temperature (delta Tco less than or equal to 1 degree C) during NMR exposures (SAR less than or equal to 4 W/kg) of 40 min or less. Increased Ta and RH exacerbate the thermal stress imposed by absorbed RF energy; severely impaired SkBF encourages short NMR exposures (e.g., 20 min or less) at SARs less than or equal to 3 W/kg. In warm/humid environments, sweating is predicted to be profuse and evaporative cooling curtailed, yielding a state of extreme thermal discomfort. Added insulation (e.g., a blanket) is discouraged. Some guidelines, incorporating SkBF restrictions, Ta, RH, and insulation, are offered for the prediction of tolerable NMR exposure conditions.