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

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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

Contributor Notes

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.
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