Safety assessment of spine MRI in deep brain stimulation patients

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  • 1 Joint Department of Medical Imaging, University of Toronto;
  • 2 University Health Network, Toronto;
  • 3 Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto;
  • 4 Krembil Brain Institute, Toronto;
  • 5 Department of Radiation Oncology, STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada; and
  • 6 National Institutes of Health, Center for Scientific Review, Bethesda, Maryland
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OBJECTIVE

Many centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors’ goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort.

METHODS

A phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability.

RESULTS

The increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable.

CONCLUSIONS

Patients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.

Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).

ABBREVIATIONS B1+rms = root-mean-square value of the MRI effective component of the radiofrequency magnetic (B1) field; C-spine = cervical spine; DBS = deep brain stimulation; IPG = implantable pulse generator; L-spine = lumbar spine; PD = Parkinson’s disease; RF = radiofrequency; SAR = specific absorption rate; T-spine = thoracic spine; T1W = T1-weighted; T2W = T2-weighted.

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Contributor Notes

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

INCLUDE WHEN CITING Published online February 14, 2020; DOI: 10.3171/2019.12.SPINE191241.

Disclosures This work was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG NE 2276/1-1) with funding to C.N., the RR Tasker Chair in Functional Neurosurgery at University Health Network, and a Tier 1 Canada Research Chair in Neuroscience. A.B. was responsible for the data analysis. The corresponding author confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.

I.H. is a National Institutes of Health (NIH) employee. The opinions expressed in this article are the authors’ own and do not reflect the views of the NIH, the Department of Health and Human Services, or the United States government. B.L. is now a Medtronic employee; he was not at the time of the completion of this work. Medtronic had no role in data acquisition, analysis, or interpretation. A.F. reports grants, personal fees, and nonfinancial support from Abbvie and Medtronic; grants and personal fees from Boston Scientific; personal fees from Sunovion, Chiesi farmaceutici, and UCB; and grants and personal fees from Ipsen, outside the submitted work. S.K.K. reports an honorarium and consulting fees from Medtronic. A.M.L. serves as a consultant for Medtronic, Abbott, Boston Scientific, St. Jude, and Functional Neuromodulation.

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