Safety of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation

Chow, Chung‐Wai; Kashyap, Sriranga; Loh, Aaron; Naheed, Asma; Bennett, Nicole; Golestanirad, Laleh; Boutet, Alexandre

doi:10.1007/978-3-031-16348-7_5

Cited by 6 publications

(5 citation statements)

References 77 publications

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“…Deep brain stimulation (DBS) as a therapeutic approach to a variety of neurological and psychiatric disorders has heavily relied on neuroimaging for precise electrode placement [1,2]. Recently, the application of neuroimaging for patient-specific DBS programming has also gained traction, both due to concerted efforts to make safe postoperative magnetic resonance imaging (MRI) accessible to DBS patients [1][2][3][4][5][6] and thanks to studies that demonstrated added benefits of MRI-based DBS management [7][8][9]. This trend is likely to continue as the feasibility and benefits of high and ultra-high field MRI for DBS are explored [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions

Henry,

Miulli,

Nuzov

et al. 2023

Stereotact Funct Neurosurg

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Introduction: Directional deep brain stimulation (DBS) leads have become widely used in the past decade. Understanding the asymmetric stimulation provided by directional leads requires precise knowledge of the exact orientation of the lead in respect to its anatomical target. Recently, the DiODe algorithm was developed to automatically determine the orientation angle of leads from the artifact on postoperative computed tomography (CT) images. However, manual DiODe results are user-dependent. This study analyzed the extent of lead rotation as well as the user agreement of DiODe calculations across the two most common DBS systems, namely, Boston Scientific’s Vercise and Abbott’s Infinity, and two independent medical institutions. Methods: Data from 104 patients who underwent an anterior-facing unilateral/bilateral directional DBS implantation at either Northwestern Memorial Hospital (NMH) or Albany Medical Center (AMC) were retrospectively analyzed. Actual orientations of the implanted leads were independently calculated by three individual users using the DiODe algorithm in Lead-DBS and patients’ postoperative CT images. The deviation from the intended orientation and user agreement were assessed. Results: All leads significantly deviated from the intended 0° orientation (p < 0.001), regardless of DBS lead design (p < 0.05) or institution (p < 0.05). However, the Boston Scientific leads showed an implantation bias toward the left at both institutions (p = 0.014 at NMH, p = 0.029 at AMC). A difference of 10° between at least two users occurred in 28% (NMH) and 39% (AMC) of all Boston Scientific and 76% (NMH) and 53% (AMC) of all Abbott leads. Conclusion: Our results show that there is a significant lead rotation from the intended surgical orientation across both DBS systems and both medical institutions; however, a bias toward a single direction was only seen in the Boston Scientific leads. Additionally, these results raise questions into the user error that occurs when manually refining the orientation angles calculated with DiODe.

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Section: Introductionmentioning

confidence: 99%

Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions

Henry,

Miulli,

Nuzov

et al. 2023

Stereotact Funct Neurosurg

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“…Radiofrequency (RF) induced heating is a well-established safety concern, limiting the types of MRI exams patients with DBS devices can receive. The implanted DBS lead behaves like an antenna when coupled with the electric field of the MRI transmit coil, which increases the specific absorption rate (SAR) of RF energy deposited in the tissue surrounding the lead’s tip [ 10 ]–[ 12 ]. To mitigate the safety concerns associated with RF heating, DBS manufacturers have established stringent device-specific guidelines for MRI protocols.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the trajectory of deep brain stimulation leads reduces RF heating during MRI at 3 T: Characteristics and clinical translation

Vu,

Bhusal,

Rosenow

et al. 2023

2023 45th Annual International Conference of the IEEE Engineering in Medicine &Amp; Biology Society (EMBC)

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Radiofrequency (RF) induced tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during magnetic resonance imaging (MRI), hindering routine protocols for patients. Known factors that contribute to variations in the magnitude of RF heating across patients include the implanted lead’s trajectory and its orientation with respect to the MRI electric fields. Currently, there are no consistent requirements for surgically implanting the extracranial portion of the DBS lead. Recent studies have shown that incorporating concentric loops in the extracranial trajectory of the lead can reduce RF heating, but the optimal positioning of the loop is unknown. In this study, we evaluated RF heating of 77 unique lead trajectories to determine how different characteristics of the trajectory affect RF heating during MRI at 3 T. We performed phantom experiments with commercial DBS systems from two manufacturers to determine how consistently modifying the lead trajectory mitigates RF heating. We also presented the first surgical implementation of these modified trajectories in patients. Low-heating trajectories included small concentric loops near the surgical burr hole which were readily implemented during the surgical procedure; these trajectories generated nearly a 2-fold reduction in RF heating compared to unmodified trajectories.

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“…Deep brain stimulation (DBS) as a therapeutic approach to a variety of neurological and psychiatric disorders has heavily relied on neuroimaging for precise electrode placement [1,2]. Recently, the application of neuroimaging for patient-specific DBS programming has also gained traction, both due to concerted efforts to make safe post-operative magnetic resonance imaging (MRI) accessible to DBS patients (1)(2)(3)(4)(5)(6), and thanks to studies that demonstrate added benefits of MRI-based DBS management (7)(8)(9). This trend is likely to continue as the feasibility and benefits of high and ultrahigh field MRI for DBS is explored (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Variations in determining actual orientations of segmented deep brain stimulation leads using the manually refined DiODe algorithm: a retrospective study across different lead designs and medical institutions

Henry

Miulli

Nuzov

et al. 2022

Preprint

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Purpose: Directional deep brain stimulation (DBS) leads have become widely used in the past decade. Understanding the asymmetric stimulation provided by directional leads requires precise knowledge of the exact orientation of the lead in respect to its anatomical target. Recently, the DiODe algorithm was developed to automatically determine the orientation angle of leads from the artifact on postoperative computed tomography (CT) images. However, DiODe results are user-dependent. This study analyzed the significance of lead rotation as well as the user agreement of DiODe calculations across the two most common DBS systems and two independent medical institutions. Methods: Data from 104 patients who underwent an anterior-facing unilateral/bilateral directional DBS implantation at either Northwestern Memorial Hospital (NMH) or Albany Medical Center (AMC) were retrospectively analyzed. Actual orientations of the implanted leads were independently calculated by three individual users using the DiODe algorithm in Lead-DBS and patients' postoperative CT images. Deviation from the intended orientation and user agreement were assessed. Results: All leads significantly deviated from the intended 0° orientation (p<0.001), regardless of DBS lead design (p<0.05) or institution (p<0.05). However, a bias of the implantation towards a single direction was seen for the Boston Scientific leads (p=0.014 at NMH, p=0.029 at AMC). A difference of 10° between at least two users occurred in 28% (NMH) and 39% (AMC) of all Boston Scientific and 53% (AMC) and 76% (NMH) of all St. Jude leads. Conclusion: Our results show that there is a significant lead rotation from the intended surgical orientation across both DBS systems and both medical institutions, however, a bias towards a single direction was only seen in Boston Scientific leads. Additionally, these results raise questions into the user error that occurs when manually refining the orientation angles calculated with DiODe.

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Safety of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation

Cited by 6 publications

References 77 publications

Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions

Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions

Optimizing the trajectory of deep brain stimulation leads reduces RF heating during MRI at 3 T: Characteristics and clinical translation

Variations in determining actual orientations of segmented deep brain stimulation leads using the manually refined DiODe algorithm: a retrospective study across different lead designs and medical institutions

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