Safety of magnetic resonance imaging of deep brain stimulator systems: a serial imaging and clinical retrospective study

Clinical article

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Object

With the expanding indications and increasing number of patients undergoing deep brain stimulation (DBS), postoperative MR imaging is becoming even more important in guiding clinical care and practice-based learning; important safety concerns have recently emerged, however. Although phantom model studies have driven conservative recommendations regarding imaging parameters, highlighted by 2 recent reports describing adverse neurological events associated with MR imaging in patients with implanted DBS systems, the risks of MR imaging in such patients in clinical practice has not been well addressed. In this study, the authors capitalized on their large experience with serial MR imaging (3 times per patient) to use MR imaging itself and clinical outcomes to examine the safety of MR imaging in patients who underwent staged implantation of DBS electrodes for Parkinson disease, tremor, and dystonia.

Methods

Sixty-four patients underwent staged bilateral lead implantations between 1997 and 2006, and each patient underwent 3 separate MR imaging sessions subsequent to DBS placement. The first of these was performed after the first DBS placement, the second occurred prior to the second DBS placement, and third was after the second DBS placement. Follow-up was conducted to examine adverse events related either to MR imaging or to DBS-induced injury.

Results

One hundred and ninety-two MR images were obtained, and the mean follow-up time was 3.67 years. The average time between the first and second, and second and third MR imaging sessions was 19.4 months and 14.7 hours, respectively. Twenty-two MR imaging–detected new findings of hemorrhage were documented. However, all new findings were related to acute DBS insertion, whereas there were no new findings after imaging of the chronically implanted electrode.

Conclusions

Although potential risks of MR imaging in patients undergoing DBS may be linked to excessive heating, induced electrical currents, disruption of the normal operation of the device, and/or magnetic field interactions, MR imaging can be performed safely in these patients and provides useful information on DBS lead location to inform patient-specific programming and practice-based learning.

Abbreviations used in this paper: DBS = deep brain stimulation; FSE = fast spin echo; IPG = internal pulse generator; SAR = specific absorption rate.

Article Information

Address correspondence to: Robert E. Gross, M.D., Ph.D., The Emory Clinic, 1365 Clifton Road Northeast, Suite 6200, Atlanta, Georgia 30322. email: rgross@emory.edu.

Please include this information when citing this paper: published online August 14, 2009; DOI: 10.3171/2009.7.JNS09572.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Diagram depicting the timeline of DBS lead implantation and MR imaging studies. The first MR imaging session (MRI1) was performed within 24 hours of the first DBS lead implantation. Patients returned at a mean of 19.4 months for the contralateral lead (2nd DBS), for which preoperative MR imaging (MRI2) was performed and, usually within 24 hours (mean 14.7 hours), a postoperative study (MRI3).

  • View in gallery

    Representative T2-weighted (A–D, G, and H) and FLAIR (E) and hemosiderin (F) imaging sequences demonstrating insertional adverse effects. A and B: Examples of edema (arrow) surrounding the first DBS lead in the subcortical region on the postoperative MR images. That this was not the result of MR imaging itself is supported by the observation of edema only immediately after electrode implantation, either on the first set of MR images or the images obtained immediately after the second DBS insertion, but never on the second set, performed months after the first insertion. The edema shown in panel B (arrow) surrounds the acutely implanted DBS, and was never seen surrounding the chronically implanted lead. C: Example of subcortical hemorrhage (arrow) associated with acute lead implantation as seen during the first MR imaging session. Again, this was not the result of MR imaging because it was only seen on the first or third imaging sessions, and never in the second set. D: Image obtained immediately after placement of the second lead in the same patient as in panel C. Again, there is hemorrhage associated with the acutely implanted second lead on the patient's right side, whereas the site of the chronically implanted first lead (left side) now manifests encephalomalacic changes (arrow). Note also in panels A–D that the MR imaging–apparent changes surround the insulated part of the electrode rather than the exposed lead array where possible MR imaging–induced currents would flow. E and F: The small hemorrhage seen in panels E (FLAIR sequence) and F (hemosiderin sequence) is around the acutely implanted second DBS electrode array (arrows), but was never seen surrounding the chronically implanted array. G and H: Positive control images depicting what MR imaging–induced changes might look like. This patient underwent radiofrequency ablation delivered through the left DBS electrode, which induced a large region of perielectrode edema (arrows) and ultimately necrosis.

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