BackgroundPatients with deep brain stimulation (DBS) implants have limited access to MRI due to safety concerns associated with RF‐induced heating. Currently, MRI in these patients is allowed in 1.5T horizontal bore scanners utilizing pulse sequences with reduced power. However, the use of 3T MRI in such patients is increasingly reported based on limited safety assessments. Here we present the results of comprehensive RF heating measurements for two commercially available DBS systems during MRI at 1.5T and 3T.PurposeTo assess the effect of imaging landmark, DBS lead configuration, and patient's body composition on RF heating of DBS leads during MRI at 1.5T and 3T.Study TypePhantom and ex vivo study.Population/Subjects/Phantom/Specimen/Animal ModelGel phantoms and cadaver brain.Field Strength/Sequence1.5T and 3T, T1‐weighted turbo spin echo.AssessmentRF heating was measured at the tips of DBS leads implanted in brain‐mimicking gel. Image artifact was assessed in a cadaver brain implanted with an isolated DBS lead.Statistical TestsDescriptive.ResultsWe observed substantial fluctuation in RF heating, mainly affected by phantom composition and DBS lead configuration, ranging from 0.14°C to 23.73°C at 1.5T, and from 0.10°C to 7.39°C at 3T. The presence of subcutaneous fat substantially altered RF heating at the electrode tips (3.06°C < ∆T < 19.05° C). Introducing concentric loops in the extracranial portion of the lead at the surgical burr hole reduced RF heating by up to 89% at 1.5T and up to 98% at 3T compared to worst‐case heating scenarios.Data ConclusionDevice configuration and patient's body composition substantially altered the RF heating of DBS leads during MRI. Interestingly, certain lead trajectories consistently reduced RF heating and image artifact.Level of Evidence 1Technical Efficacy Stage 1J. MAGN. RESON. IMAGING 2021;53:599–610.

For the partially immersed implants like stereo-electroencephalography electrode, the resonant lengths were found to be independent of the penetration depths and entry modes, although the temperature increases may vary. Avoiding such lengths of cables can reduce the risk of tissue heating during in vivo MRI.

Purpose Patients with active implants such as deep brain stimulation (DBS) devices are often denied access to MRI due to safety concerns associated with the radiofrequency (RF) heating of their electrodes. The majority of studies on RF heating of conductive implants have been performed in horizontal close‐bore MRI scanners. Vertical MRI scanners which have a 90° rotated transmit coil generate fundamentally different electric and magnetic field distributions, yet very little is known about RF heating of implants in this class of scanners. We performed numerical simulations as well as phantom experiments to compare RF heating of DBS implants in a 1.2T vertical scanner (OASIS, Hitachi) compared to a 1.5T horizontal scanner (Aera, Siemens). Methods Simulations were performed on 90 lead models created from post‐operative CT images of patients with DBS implants. Experiments were performed with wires and commercial DBS devices implanted in an anthropomorphic phantom. Results We found significant reduction of 0.1 g‐averaged specific absorption rate (30‐fold, P < 1 × 10−5) and RF heating (9‐fold, P < .026) in the 1.2T vertical scanner compared to the 1.5T conventional scanner. Conclusion Vertical MRI scanners appear to generate lower RF heating around DBS leads, providing potentially heightened safety or the flexibility to use sequences with higher power levels than on conventional systems.

Ultra-high field MRI at 7 T can produce much better visualization of sub-cortical structures compared to lower field, which can greatly help target verification as well as overall treatment monitoring for patients with deep brain stimulation (DBS) implants. However, use of 7 T MRI for such patients is currently contra-indicated by guidelines from the device manufacturers due to the safety issues. The aim of this study was to provide an assessment of safety and image quality of ultra-high field magnetic resonance imaging at 7 T in patients with deep brain stimulation implants. We performed experiments with both lead-only and complete DBS systems implanted in anthropomorphic phantoms. RF heating was measured for 43 unique patient-derived device configurations. Magnetic force measurements were performed according to ASTM F2052 test method, and device integrity was assessed before and after experiments. Finally, we assessed electrode artifact in a cadaveric brain implanted with an isolated DBS lead. RF heating remained below 2°C, similar to a fever, with the 95% confidence interval between 0.38°C-0.52°C. Magnetic forces were well below forces imposed by gravity, and thus not a source of concern. No device malfunctioning was observed due to interference from MRI fields. Electrode artifact was most noticeable on MPRAGE and T2*GRE sequences, while it was minimized on T2-TSE images. Our work provides the safety assessment of ultra-high field MRI at 7 T in patients with DBS implants. Our results suggest that 7 T MRI may be performed safely in patients with DBS implants for specific implant models and MRI hardware.

Patients with active implants such as deep brain stimulation (DBS) devices have limited access to magnetic resonance imaging (MRI) due to risks associated with RF heating of implants in MRI environment. With an aging population and increased prevalence of neurodegenerative disease, the indication for MRI exams in patients with such implants increases as well. In response to this growing need, many groups have investigated strategies to mitigate RF heating of DBS implants during MRI. These efforts fall into two main categories: MRI field-shaping methods, where the electric field of the MRI RF coil is modified to reduce the interaction with implanted leads, and lead management techniques where surgical modifications in the trajectory reduces the coupling with RF fields. Studies that characterize these techniques, however, have relied either on simulations with homogenous body models, or experiments with box-shaped single-material phantoms. It is well established, however, that the shape and heterogeneity of human body affects the distribution of RF electric fields, which by proxy, alters the heating of an implant inside the body. In this contribution, we applied numerical simulations and phantom experiments to examine the degree to which variations in patient’s body composition affects RF power deposition. We then assessed effectiveness of RF-heating mitigation strategies under variant patient body compositions. Our results demonstrated that patient’s body composition substantially alters RF power deposition in the tissue around implanted leads. However, both techniques based on MRI field-shaping and DBS lead management performed well under variant body types.

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The majority of studies that assess magnetic resonance imaging (MRI) induced radiofrequency (RF) heating of the tissue when active electronic implants are present have been performed in horizontal, closed-bore MRI systems. Vertical, open-bore MRI systems have a 90° rotated magnet and a fundamentally different RF coil geometry, thus generating a substantially different RF field distribution inside the body. Little is known about the RF heating of elongated implants such as deep brain stimulation (DBS) devices in this class of scanners. Here, we conducted the first large-scale experimental study investigating whether RF heating was significantly different in a 1.2 T vertical field MRI scanner (Oasis, Fujifilm Healthcare) compared to a 1.5 T horizontal field MRI scanner (Aera, Siemens Healthineers). A commercial DBS device mimicking 30 realistic patient-derived lead trajectories extracted from postoperative computed tomography images of patients who underwent DBS surgery at our institution was implanted in a multi-material, anthropomorphic phantom. RF heating around the DBS lead was measured during four minutes of high-SAR RF exposure. Additionally, we performed electromagnetic simulations with leads of various internal structures to examine this effect on RF heating. When controlling for RMS B1+, the temperature increase around the DBS lead-tip was significantly lower in the vertical scanner compared to the horizontal scanner (0.33 ± 0.24°C vs. 4.19 ± 2.29°C). Electromagnetic simulations demonstrated up to a 17-fold reduction in the maximum of 0.1g-averaged SAR in the tissue surrounding the lead-tip in the vertical scanner compared to the horizontal scanner. Results were consistent across leads with straight and helical internal wires. Radiofrequency heating and power deposition around the DBS lead-tip were substantially lower in the 1.2 T vertical scanner compared to the 1.5 T horizontal scanner. Simulations with different lead structures suggest that the results may extend to leads from other manufacturers.

BACKGROUNDPatients with deep brain stimulation (DBS) implants have limited access to MRI due to safety concerns associated with RF-induced heating. Currently, MRI in these patients is allowed only in 1.5T horizontal scanners and with pulse sequences with reduced power.Nevertheless, off-label use of MRI at 3T is increasingly reported based on limited safety assessments. Here we present results of systematic RF heating measurements for two commercially available DBS systems during MRI at 1.5T and 3T. from 0.10℃ to 7.39℃ at 3T. The presence of subcutaneous fat substantially altered RF heating at electrode tips (-3.06℃ < ∆ < 19.05℃). Introducing concentric loops in the extracranial portion of the lead at the surgical burr hole reduced RF heating by up to 89% at 1.5T and up to 98% at 3T compared to worst case heating scenarios. DATA CONCLUSIONDevice configuration and patient body composition significantly altered the RF heating of DBS leads during MRI at 1.5T and 3T. Interestingly, certain lead trajectories consistently reduced RF heating and image artifact over different imaging landmarks, RF frequencies, and phantom compositions. Such trajectories could be implemented in patients with minimal disruption to the surgical workflow.