Magnetic Resonance Imaging of Implanted Deep Brain Stimulators: Experience in a Large Series

Abstract

Magnetic resonance imaging (MRI) is a commonly used and important imaging modality to evaluate lead location and rule out complications after deep brain stimulation (DBS) surgery. Recent safety concerns have prompted new safety recommendations for the use of MRI in these patients, including a new recommendation to limit the specific absorption rate (SAR) of the MRI sequences used to less than 0.1 W/kg. Following SAR recommendations in real-world situations is problematic for a variety of reasons. We review our experience scanning patients with implanted DBS systems over a 7-year period using a variety of scanning techniques and four scanning platforms. 405 patients with 746 implanted DBS systems were imaged using 1.5-tesla MRI with an SAR of up to 3 W/kg. Many of the DBS systems were imaged multiple times, for a total of 1,071 MRI events in this group of patients with no adverse events. This series strongly suggests that the 0.1 W/kg recommendation for SAR may be unnecessarily low for the prevention of MRI-related adverse events.

Role of radiology in central nervous system stimulation

“…Inversion recovery and T 2 weighted sequences demonstrate the STN, substantia nigra and the red nucleus adequately. [29][30][31][32][33][34] In our centre, we obtain T 1 weighted, T 2 weighted, fluid-attenuated inversion recovery and inversion recovery whole-brain volume acquisitions parallel to the anterior commissure-posterior commissure plane (AC-PC) ( Table 2). Diffusion tensor imaging is also acquired.…”

Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators

“…[5][6][7] The deposited RF power (specific absorption rate [SAR]) increases with field strength; and the effective sequences, including FSTIR or T2, pose significant RF heating risk, 8 which has been a potential deterrent for MR imaging of DBS recipients. 9 Although experiences of incident-free routine high-SAR brain MR imaging in large groups of DBS patients have been reported 2,10 and sentinel events, including serious brain injury or death, are very few, 11 some researchers observed 12 a greater incidence of neurologic deficits and tissue edema surrounding electrodes in DBS recipients after routine MR imaging that perhaps were not caused by the surgical procedure itself. Note that local SAR near the contact points at the DBS electrode base is unknown, and because DBS belongs to a class of critical-length implants, the SAR can be an order of magnitude higher.…”

“…T he diagnostic quality and radiofrequency (RF) safety of MR imaging for visualizing the subthalamic nucleus (STN) and globus pallidus are not simultaneously achievable, though both are crucial for surgical accuracy and treatment efficacy of deep brain stimulation (DBS) procedures [1][2][3] in patients with drug-refractory Parkinson disease (PD). Kitajima et al 3 observed significantly better, though not perfect, mapping of the STN by using inversion recovery (fast spin-echo short inversion recovery [FSTIR]) sequences.…”

Neuroradiology, Anesthesia, Bioengineering, and Hardware Programming in the Clinical Applications of Deep Brain Stimulation

“…Serious injury and even death may result from heating, movement, and electrical current in the implanted cables and electrodes. Nevertheless, after careful consideration of safety issues, postoperative MRI after DBS placement has been safely used by many centers to determine accurate lead placement and complications, such as intracranial hemorrhage [92].…”