3-Tesla MRI of deep brain stimulation patients: safety assessment of coils and pulse sequences

Restricted access

OBJECTIVE

Physicians are more frequently encountering patients who are treated with deep brain stimulation (DBS), yet many MRI centers do not routinely perform MRI in this population. This warrants a safety assessment to improve DBS patients’ accessibility to MRI, thereby improving their care while simultaneously providing a new tool for neuromodulation research.

METHODS

A phantom simulating a patient with a DBS neuromodulation device (DBS lead model 3387 and IPG Activa PC model 37601) was constructed and used. Temperature changes at the most ventral DBS electrode contacts, implantable pulse generator (IPG) voltages, specific absorption rate (SAR), and B1+rms were recorded during 3-T MRI scanning. Safety data were acquired with a transmit body multi-array receive and quadrature transmit-receive head coil during various pulse sequences, using numerous DBS configurations from “the worst” to “the most common.”

In addition, 3-T MRI scanning (T1 and fMRI) was performed on 41 patients with fully internalized and active DBS using a quadrature transmit-receive head coil. MR images, neurological examination findings, and stability of the IPG impedances were assessed.

RESULTS

In the phantom study, temperature rises at the DBS electrodes were less than 2°C for both coils during 3D SPGR, EPI, DTI, and SWI. Sequences with intense radiofrequency pulses such as T2-weighted sequences may cause higher heating (due to their higher SAR). The IPG did not power off and kept a constant firing rate, and its average voltage output was unchanged. The 41 DBS patients underwent 3-T MRI with no adverse event.

CONCLUSIONS

Under the experimental conditions used in this study, 3-T MRI scanning of DBS patients with selected pulse sequences appears to be safe. Generally, T2-weighted sequences (using routine protocols) should be avoided in DBS patients. Complementary 3-T MRI phantom safety data suggest that imaging conditions that are less restrictive than those used in the patients in this study, such as using transmit body multi-array receive coils, may also be safe. Given the interplay between the implanted DBS neuromodulation device and the MRI system, these findings are specific to the experimental conditions in this study.

ABBREVIATIONS ASL = arterial spin labeling; B1+rms = root-mean-square value of the MRI effective component of the RF magnetic [B1] field; DBS = deep brain stimulation; DTI = diffusion tensor imaging; fMRI = functional magnetic resonance imaging; FSE = fast spin echo; GRE-EPI = gradient recalled echo–echo-planar imaging; IPG = implantable pulse generator; PD = Parkinson’s disease; RF = radiofrequency; SAR = specific absorption rate; SPGR = spoiled gradient recalled; SWI = susceptibility-weighted imaging.

Article Information

Correspondence Andres M. Lozano: Toronto Western Hospital, Toronto, ON, Canada. lozano@uhnresearch.ca.

INCLUDE WHEN CITING Published online February 22, 2019; DOI: 10.3171/2018.11.JNS181338.

Disclosures Dr. Hancu reports being a GE Global Research employee. Dr. Lozano reports being the owner of Functional Neuromodulation and a consultant for Boston Scientific, Medtronic, Abbott, and St. Jude Medical.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Schematic representations of the Lucite phantom model used during the experiments. Experiment 1 configuration is represented. Figure is available in color online only.

  • View in gallery

    Schematic representation of the Lucite phantom model used during the various experiments. Experiment 1: unilateral DBS with extension wire hanging loose at the side of the phantom. Experiment 2: bilateral DBS with the excess extension wire coiled partly at the head portion of the phantom (2 loops) and partly behind the IPG (2 loops) (most common at our institution). Experiment 3: bilateral DBS with the excess extension wire coiled behind the IPG (4 loops) (“worst-case scenario”12). Experiment 4: unilateral DBS with a Kinetra adaptor and with the excess extension wire coiled partly at the head (2 loops) portion of the phantom and partly behind the IPG (2 loops). Loops of extension wire had a diameter of approximately 2 cm. Figure is available in color online only.

  • View in gallery

    Digitizing data recorder tracings obtained with DBS ON; voltage recordings over time of the DBS pulses when the MRI is (A) OFF and (B) ON. The DBS parameters were set at common PD IPG settings (monopolar stimulation, frequency 130 Hz, pulse width 90 μsec, voltage 3 V). A: Regular DBS pulses firing at average voltage of 2.8 V when the MRI is OFF. B: Example of the voltage recordings during GRE-EPI acquisition with the multi-array receive coil. The DBS pulse frequency and average voltages are stable compared to A. Gradient = gradient switchings; RF = radiofrequency pulses; s = seconds; V = voltage. Figure is available in color online only.

  • View in gallery

    Example of 3D SPGR and GRE-EPI in a DBS patient. Select axial 3D SPGR (A and B) and GRE-EPI (C and D) images acquired with a 3-T MRI in a PD patient with the DBS electrode located in the subthalamic nucleus. Artifact along the distal DBS lead measures 6 mm and 12 mm for the 3D SPGR (A) and GRE-EPI (C), respectively. Images with a red frame are zoomed-in views of A and C. The subgaleal coiled DBS extension wire creates a left parietofrontal artifact (B and D). Figure is available in color online only.

References

1

Baker KBTkach JANyenhuis JAPhillips MShellock FGGonzalez-Martinez J: Evaluation of specific absorption rate as a dosimeter of MRI-related implant heating. J Magn Reson Imaging 20:3153202004

2

Baker KBTkach JAPhillips MDRezai AR: Variability in RF-induced heating of a deep brain stimulation implant across MR systems. J Magn Reson Imaging 24:123612422006

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

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

5

de Zwart JAvan Gelderen PDuyn JH: Receive coil arrays and parallel imaging for functional magnetic resonance imaging of the human brain. Conf Proc IEEE Eng Med Biol Soc 1:17202006

6

Finelli DARezai ARRuggieri PMTkach JANyenhuis JAHrdlicka G: MR imaging-related heating of deep brain stimulation electrodes: in vitro study. AJNR Am J Neuroradiol 23:179518022002

7

Georgi JCStippich CTronnier VMHeiland S: Active deep brain stimulation during MRI: a feasibility study. Magn Reson Med 51:3803882004

8

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

9

Golestanirad LPilitsis JMartin ALarson PKeil BBonmassar G: Variation of RF heating around deep brain stimulation leads during 3.0 T MRI in fourteen patient-derived realistic lead models: the role of extracranial lead management in ISMRM 25th Annual Meeting and ExhibitionApril 22–27 2017 (https://www.ismrm.org/17/program_files/O87.htm) [Accessed December 16 2018]

10

Guerin PSerano PIacono MHerrington TWidge ADougherty D: Patient specific modeling of deep brain stimulation patients for MRI safety studies in ISMRM 25th Annual Meeting and ExhibitionApril 22–27 2017 (https://www.ismrm.org/17/program_files/PP21.htm) [Accessed December 16 2018]

11

Gupte AAShrivastava DSpaniol MAAbosch A: MRI-related heating near deep brain stimulation electrodes: more data are needed. Stereotact Funct Neurosurg 89:1311402011

12

Hancu IFiveland ERanjan MPrusik JDimarzio MRashia T: On the (non-)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson’s disease patients. J Magn Reson Imaging [epub ahead of print] 2018

13

Hariz M: My 25 stimulating years with DBS in Parkinson’s disease. J Parkinsons Dis 7 (Suppl 1):S33S412017

14

Health Canada (CA): Guidelines on Exposure to Electromagnetic Fields From Magnetic Resonance Clinical Systems—Safety Code 26. Ottawa, ON: Health Canada2008 (http://www.hc-sc.gc.ca/ewh-semt/pubs/radiation/87ehd-dhm127/index-eng.php) [Accessed December 16 2018]

15

Health Protection Agency (UK): Protection of Patients and Volunteers Undergoing MRI Procedures. London: Health Protection Agency2014 p 89

16

Helpern JA: The promise of high-field-strength MR imaging. AJNR Am J Neuroradiol 24:173817392003

17

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

18

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

19

Medtronic. MRI Guidelines for Medtronic Deep Brain Stimulation Systems. Minneapolis: Medtronic2015 pp 3338

20

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

21

Rezai ARFinelli DNyenhuis JAHrdlicka GTkach JSharan A: Neurostimulation systems for deep brain stimulation: in vitro evaluation of magnetic resonance imaging-related heating at 1.5 tesla. J Magn Reson Imaging 15:2412502002

22

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

23

Rezai ARPhillips MBaker KBSharan ADNyenhuis JTkach J: Neurostimulation system used for deep brain stimulation (DBS): MR safety issues and implications of failing to follow safety recommendations. Invest Radiol 39:3003032004

24

Sammartino FKrishna VSankar TFisico JKalia SKHodaie M: 3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients. J Neurosurg 127:8928982017

25

Tagliati MJankovic JPagan FSusatia FIsaias IUOkun MS: Safety of MRI in patients with implanted deep brain stimulation devices. Neuroimage 47 (Suppl 2):T53T572009

26

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

27

US Food & Drug Administration: Criteria for Significant Risk Investigations of Magnetic Resonance Diagnostic Devices—Guidance for Industry and Food and Drug Administration Staff. Silver Spring, MD: US Food & Drug Administration2015 (https://www.fda.gov/RegulatoryInformation/Guidances/ucm072686.htm) [Accessed December 16 2017]

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 637 637 637
Full Text Views 107 107 107
PDF Downloads 68 68 68
EPUB Downloads 0 0 0

PubMed

Google Scholar