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

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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.


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.


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.


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.



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

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    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.

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    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.



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