Clinical Safety of Brain Magnetic Resonance Imaging with Implanted Deep Brain Stimulation Hardware: Large Case Series and Review of the Literature

Zrinzo, Ludvic; Yoshida, Fumiaki; Hariz, Marwan; Thornton, John S.; Foltynie, Thomas; Yousry, Tarek; Limousin, Patricia

doi:10.1016/j.wneu.2011.02.029

Cited by 105 publications

(75 citation statements)

References 43 publications

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“…There was a small amount of signal loss at the DBS leads in low SAR images, similar to that at high-SAR imaging reported in the literature, 2,10 and far less compared with gradient-echo sequences. Gradient echo-based susceptibilityweighted imaging with phase-correction software is a low-SAR sequence and offers high conspicuity for nuclei 22 and works well for preoperative MR imaging for the first DBS.…”

Section: Table 2: Subjective Assessment Of High-and Low-sar Fstir Imasupporting

confidence: 84%

“…[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.…”

Section: Reported Improved Stnmentioning

confidence: 99%

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

Sarkar¹,

Papavassiliou

Rojas

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Fast spin-echo short inversion recovery sequences have been very useful for MR imaging-guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.

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Section: Table 2: Subjective Assessment Of High-and Low-sar Fstir Imasupporting

confidence: 84%

Section: Reported Improved Stnmentioning

confidence: 99%

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

Sarkar¹,

Papavassiliou

Rojas

et al. 2014

AJNR Am J Neuroradiol

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“…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.…”

Section: Patient Selectionmentioning

confidence: 99%

“…Very few adverse events such as hardware failure, unintended stimulation or heating causing ablation at the electrode tip have been reported. 32,33,[39][40][41][42] By following these guidelines, imaging of the brain in these patients is deemed to be very low risk. The use of any other coil or imaging another part of the body will produce larger induced voltages and may potentially increase the risk of heating.…”

Section: Mr Safety Issuesmentioning

confidence: 99%

Role of radiology in central nervous system stimulation

Minks

Pereira²,

Young³

et al. 2015

BJR

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Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. The use of imaging in determining the underlying mechanisms of DBS is increasing, and the dependence on imaging is likely to expand as deep brain targeting becomes more refined. This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ.Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. ANATOMY OF THE DEEP BRAIN NUCLEIThe basal ganglia are a complex group of anatomically and neurochemically interconnected structures whose role is the control of complex and intentional movements and to inhibit unwanted movements.1 They comprise the corpus striatum (caudate nucleus, nucleus accumbens and putamen), globus pallidus [external segment (GPe) and internal segment (GPi)], substantia nigra [compact part and reticular part (SNr)] and the subthalamic nucleus (STN) (Figure 1). The pedunculopontine nucleus is highly interconnected with the basal ganglia and is now considered by many to be part of this group. Disorders of the basal ganglia therefore manifest by movement, posture and muscle tone abnormalities.There are wider connections to other parts of the brain such as the thalamus, limbic cortex and prefrontal cortex. These highlight their role in cognition and emotion and explain their implication in some psychiatric disorders and the cognitive symptoms associated with movement disorders.It is these structures and their interconnected neighbours that are the targets for treatment by DBS. The STN is the most common target for DBS treatment because it is capable of treating the entire gamut of advanced Parkinson's disease symptoms, including tremor, rigidity, bradykinesia and drug-induced dyskinesia.2 DBS reduces the need for dopaminergic medication. The benefits are a reduction of motor signs and improvement of functionality in the off-medication phase, a reduction of the required medication dose and its associated complications, and an increased quality of life.3 The benefits usually persist for at least 2 years and can last for many more.The STN plays a key role in the basal ganglia-thalamocortical motor circuit (Figure 2). The striatum receives input from the cerebral cortex and direct pathway information pa...

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“…Safety consideration of MRI after DBS placement is important, given the complex interaction between implanted DBS hardware and MRI scanner electromagnetic fields [91]. Serious injury and even death may result from heating, movement, and electrical current in the implanted cables and electrodes.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

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

Jacob

Chakravarthy²

2014

Cureus

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Clinical Safety of Brain Magnetic Resonance Imaging with Implanted Deep Brain Stimulation Hardware: Large Case Series and Review of the Literature

Cited by 105 publications

References 43 publications

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

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

Role of radiology in central nervous system stimulation

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

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