Phillips Micheal D, Baker Kenneth B, Lowe Mark J, Tkach Jean A, Cooper Scott E, Kopell Brian H, Rezai Ali R
Departments of Radiology, Neurology, and Neurosurgery, Cleveland Clinic Foundation, Mellen Center/U-15, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Radiology. 2006 Apr;239(1):209-16. doi: 10.1148/radiol.2391041990.
To prospectively determine the pattern of functional magnetic resonance (MR) imaging activation at 3 T produced by deep brain stimulation (DBS) of subthalamic nucleus (STN) for treatment of Parkinson disease and to determine the safety of DBS electrode stimulation during functional MR imaging at 3 T.
Informed consent was obtained from all subjects participating in the study, and the study protocol was approved by the institutional review board at the Cleveland Clinic Foundation and was HIPAA compliant. After extensive phantom safety testing of DBS lead systems, five patients (three men, two women; mean age, 49.4 years +/- 14.5 [standard deviation]; range, 31-74 years) with percutaneously extended bilateral DBS electrodes placed in the STN for treatment of Parkinson disease were examined at 3 T on the 1st or 2nd postoperative day. Imaging consisted of a three-dimensional anatomic data set with leads disconnected and a blood oxygen level-dependent functional MR image with a single lead connected to the external pulse generator in the MR imaging control room by using stimulation parameters previously determined to produce optimal stimulation for alleviation of symptoms. A total of nine leads were tested with the functional MR imaging protocol. Subjects underwent neurologic examination immediately before and after MR imaging.
All five patients completed the study without change in their neurologic examination and with activation seen in eight of nine electrodes stimulated. Activation was seen in the ipsilateral basal ganglia in all subjects and ipsilateral thalamus in six of the electrodes tested. Two of the electrode stimulations demonstrated additional activation in the STN and/or substantia nigra region adjacent to the electrode tip. For three electrode stimulations, activation was seen in the contralateral superior cerebellum.
Therapeutically effective DBS of STN can be performed safely during functional MR imaging at 3 T and produces a consistent pattern of ipsilateral activation of deep brain motor structures.
前瞻性地确定丘脑底核（STN）深部脑刺激（DBS）治疗帕金森病时在3T磁场下功能磁共振（MR）成像激活模式，并确定3T功能MR成像期间DBS电极刺激的安全性。
所有参与研究的受试者均签署知情同意书，研究方案经克利夫兰诊所基金会机构审查委员会批准，并符合健康保险流通与责任法案（HIPAA）规定。在对DBS导联系统进行广泛的体模安全性测试后，对5例（3例男性，2例女性；平均年龄49.4岁±14.5[标准差]；范围31 - 74岁）经皮双侧扩展DBS电极植入STN治疗帕金森病的患者在术后第1天或第2天进行3T检查。成像包括导联断开时的三维解剖数据集，以及通过使用先前确定的可产生最佳刺激以缓解症状的刺激参数，将单个导联连接至MR成像控制室中的外部脉冲发生器时的血氧水平依赖性功能MR图像。总共对9个导联进行了功能MR成像方案测试。受试者在MR成像前后立即接受神经学检查。
所有5例患者均完成研究，神经学检查无变化，9个受刺激电极中有8个可见激活。所有受试者同侧基底节均可见激活，6个测试电极的同侧丘脑也可见激活。2次电极刺激在电极尖端相邻的STN和/或黑质区域显示额外激活。3次电极刺激在对侧上小脑可见激活。
在3T功能MR成像期间可安全地进行治疗有效的STN-DBS，并产生一致的同侧深部脑运动结构激活模式。
