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

Restricted access


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


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.


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.


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.



  • View in gallery

    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.

  • View in gallery

    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.


  • 1

    Alhourani AMcDowell MMRandazzo MJWozny TAKondylis EDLipski WJ: Network effects of deep brain stimulation. J Neurophysiol 114:210521172015

  • 2

    Back CAlesch FLanmüller H: Postoperative monitoring of the electrical properties of tissue and electrodes in deep brain stimulation. Neuromodulation 6:2482532003

  • 3

    Bhidayasiri RBronstein JMSinha SKrahl SEAhn SBehnke EJ: Bilateral neurostimulation systems used for deep brain stimulation: in vitro study of MRI-related heating at 1.5 T and implications for clinical imaging of the brain. Magn Reson Imaging 23:5495552005

  • 4

    Bottomley PA: Turning up the heat on MRI. J Am Coll Radiol 5:8538552008

  • 5

    Butson CRMaks CBMcIntyre CC: Sources and effects of electrode impedance during deep brain stimulation. Clin Neurophysiol 117:4474542006

  • 6

    Carmichael DWPinto SLimousin-Dowsey PThobois SAllen PJLemieux L: Functional MRI with active, fully implanted, deep brain stimulation systems: safety and experimental confounds. Neuroimage 37:5085172007

  • 7

    Chow NHwang KSHurtz SGreen AESomme JHThompson PM: Comparing 3T and 1.5T MRI for mapping hippocampal atrophy in the Alzheimer's Disease Neuroimaging Initiative. AJNR Am J Neuroradiol 36:6536602015

  • 8

    Elias WJLozano AM: Deep brain stimulation: the spectrum of application. Neurosurg Focus 29:2Introduction2010

  • 9

    Gleason CAKaula NFHricak HSchmidt RATanagho EA: The effect of magnetic resonance imagers on implanted neurostimulators. Pacing Clin Electrophysiol 15:81941992

  • 10

    Gondard EChau HNMann ATierney TSHamani CKalia SK: Rapid modulation of protein expression in the rat hippocampus following deep brain stimulation of the fornix. Brain Stimulat 8:105810642015

  • 11

    Henderson JMTkach JPhillips MBaker KShellock FGRezai AR: Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson's disease: case report. Neurosurgery 57:E10632005

  • 12

    Johnson MDOtto KJKipke DR: Repeated voltage biasing improves unit recordings by reducing resistive tissue impedances. IEEE Trans Neural Syst Rehabil Eng 13:1601652005

  • 13

    Kahan JPapadaki AWhite MMancini LYousry TZrinzo L: The safety of using body-transmit MRI in patients with implanted deep brain stimulation devices. PLoS One 10:e01290772015

  • 14

    Kainz WNeubauer GUberbacher RAlesch FChan DD: Temperature measurement on neurological pulse generators during MR scans. Biomed Eng Online 1:22002

  • 15

    Kronenbuerger MNolte KWCoenen VABurgunder JMKrauss JKWeis J: Brain alterations with deep brain stimulation: New insight from a neuropathological case series. Mov Disord 30:112511302015

  • 16

    Lee KHChang SYJang DPKim IGoerss SVan Gompel J: Emerging techniques for elucidating mechanism of action of deep brain stimulation. Conf Proc IEEE Eng Med Biol Soc 2011:6776802011

  • 17

    Lozano AMLipsman N: Probing and regulating dysfunctional circuits using deep brain stimulation. Neuron 77:4064242013

  • 18

    McIntyre CCSavasta MKerkerian-Le Goff LVitek JL: Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both. Clin Neurophysiol 115:123912482004

  • 19

    Medtronic: Medtronic announces FDA approval for the only full-body MR conditional deep brain stimulation systems. Medtronic Newsroom December92015. (http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2121236) [Accessed October 12 2016]

  • 20

    Min HKHwang SCMarsh MPKim IKnight EStriemer B: Deep brain stimulation induces BOLD activation in motor and non-motor networks: an fMRI comparison study of STN and EN/GPi DBS in large animals. Neuroimage 63:140814202012

  • 21

    Min HKRoss EKLee KHDennis KHan SRJeong JH: Subthalamic nucleus deep brain stimulation induces motor network BOLD activation: use of a high precision MRI guided stereotactic system for nonhuman primates. Brain Stimulat 7:6036072014

  • 22

    Miocinovic SSomayajula SChitnis SVitek JL: History, applications, and mechanisms of deep brain stimulation. JAMA Neurol 70:1631712013

  • 23

    Phillips MDBaker KBLowe MJTkach JACooper SEKopell HB: Pattern of functional MR imaging activation during deep brain stimulation of subthalamic nucleus—initial experience. Radiology 239:2092162006

  • 24

    Rezai ARBaker KBTkach JAPhillips MHrdlicka GSharan AD: Is magnetic resonance imaging safe for patients with neurostimulation systems used for deep brain stimulation?. Neurosurgery 57:105610622005

  • 25

    Rezai ARLozano AMCrawley APJoy MLDavis KDKwan CL: Thalamic stimulation and functional magnetic resonance imaging: localization of cortical and subcortical activation with implanted electrodes. Technical note. J Neurosurg 90:5835901999

  • 26

    Saint-Cyr JAHoque TPereira LCDostrovsky JOHutchison WDMikulis DJ: Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 97:115211662002

  • 27

    Sankar TChakravarty MMBescos ALara MObuchi TLaxton AW: Deep brain stimulation influences brain structure in Alzheimer's disease. Brain Stimulat 8:6456542015

  • 28

    Sarkar SNSarkar PRPapavassiliou ERojas RR: Utilizing fast spin echo MRI to reduce image artifacts and improve implant/tissue interface detection in refractory Parkinson's patients with deep brain stimulators. Parkinsons Dis 2014:5085762014

  • 29

    Spiegel JFuss GBackens MReith WMagnus TBecker G: Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson disease. Case report. J Neurosurg 99:7727742003

  • 30

    Stone SSDTeixeira CMDevito LMZaslavsky KJosselyn SALozano AM: Stimulation of entorhinal cortex promotes adult neurogenesis and facilitates spatial memory. J Neurosci 31:13469134842011

  • 31

    Taylor JRWilliams NCusack RAuer TShafto MADixon M: The Cambridge Centre for Ageing and Neuroscience (Cam-CAN) data repository: structural and functional MRI, MEG, and cognitive data from a cross-sectional adult lifespan sample. Neuroimage [epub ahead of print]2015

  • 32

    Tronnier VMStaubert AHähnel SSarem-Aslani A: Magnetic resonance imaging with implanted neurostimulators: an in vitro and in vivo study. Neurosurgery 44:1181261999

  • 33

    Zaremba LAFDA guidance for magnetic resonance system safety and patient exposures: current status and future considerations. Shellock FG: Magnetic Resonance Procedures: Health Effects and Safety Boca Raton, FLCRC Press2001


Cited By



All Time Past Year Past 30 Days
Abstract Views 84 84 44
Full Text Views 547 547 4
PDF Downloads 245 245 1
EPUB Downloads 0 0 0


Google Scholar