3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients

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OBJECTIVE

The aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems.

METHODS

This study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging.

RESULTS

During phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed.

CONCLUSIONS

To the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.

ABBREVIATIONS DBS = deep brain stimulation; fMRI = functional MRI; FRFSE = fast recovery fast spin echo; FSPGR = fast spoiled gradient–recalled; GRE-EPI = gradient-echo echo-planar imaging; IPG = internal pulse generator; PROBE-SV = point-resolved single-voxel spectroscopy; PVG = periventricular gray; RF = radiofrequency; SAR = specific absorption rate; STN = subthalamic nucleus; VIM = ventral intermediate.

Article Information

Correspondence Francesco Sammartino, Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON M5T 2S8, Canada. email: docpatient@gmail.com.

INCLUDE WHEN CITING Published online December 23, 2016; DOI: 10.3171/2016.9.JNS16908.

Disclosures Dr. Hodaie has received grant support from Medtronic for efforts not related to this study. Dr. Lozano is the owner of Functional Neuromodulation and has served as a consultant for St. Jude, Boston Scientific, and Medtronic.

© AANS, except where prohibited by US copyright law.

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Figures

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    Schematic diagram of phantom, experimental DBS configuration, and position of measurement tools. Drawing is not to scale. R = right; RHS = right hemisphere electrode; t/r = transmit-receive coil; 8ch = 8 channel. Figure is available in color online only.

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    Sample 3D T1-weighted, T2-weighted, and EPI sequences are shown for each patient. Patient 1 had 1 DBS electrode in the left VIM thalamus for tremor; Patient 3 had 2 DBS electrodes in the right hemisphere (1 electrode in the ventrocaudal thalamus and 1 in the PVG area); and Patients 2, 4, 5, 6, 7, 8, 9, and 10 had 2 DBS electrodes (1 electrode on each side) in the STN for Parkinson's disease.

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