Tagliati Michele, Jankovic Joseph, Pagan Fernando, Susatia Frandy, Isaias Ioannis U, Okun Michael S
Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Neuroimage. 2009 Aug;47 Suppl 2:T53-7. doi: 10.1016/j.neuroimage.2009.04.044. Epub 2009 Apr 17.
To survey the safety of MRI in PD patients implanted with DBS devices.
MRI in patients with DBS implants is useful to confirm electrode placement, optimize programming and investigating complications. However, several medical centers do not perform MRI studies in DBS patients because of safety concerns. The safety profile of MRI in DBS patients has not been documented in large clinical series.
42 NPF Centers of Excellence (COEs) were asked to complete a questionnaire on MRI use and DBS.
Investigators from 40 of 42 (95%) NPF COEs completed the survey and 23 (58%) reported that they were currently performing brain MRI in DBS patients, while 3 (7.5%) had done it in the past. The 17 COEs currently not performing post-operative MRI for DBS listed the following reasons: 1) industry guidelines and/or warnings (53%); 2) decision deferred to outside department (29%); 3) liability/risk/safety (18%); 4) no active DBS program (18%); 5) no available MRI (12%); and 6) insurance and reimbursement concerns (6%). A total of 3304 PD patients with one or more DBS leads had a brain MRI scan, and 177 DBS patients had MRI of other body regions. In one case MRI was associated with an IPG failure without neurological sequelae after IPG replacement. No other complications were reported.
these data provide evidence for a favorable risk/benefit ratio for brain MRI in patients with DBS implants. Further studies will need to address whether a re-assessment of more restrictive recommendations (i.e. very low SAR values) may be warranted.
调查植入脑深部电刺激（DBS）装置的帕金森病（PD）患者进行磁共振成像（MRI）检查的安全性。
植入DBS的患者进行MRI检查有助于确认电极位置、优化程控以及调查并发症。然而，由于安全担忧，一些医疗中心不对植入DBS的患者进行MRI检查。DBS患者MRI检查的安全性在大型临床系列研究中尚无记录。
邀请42个国家帕金森病基金会卓越中心（COE）填写一份关于MRI使用和DBS的调查问卷。
42个NPF COE中的40个（95%）的研究者完成了调查，其中23个（58%）报告他们目前正在对植入DBS的患者进行脑部MRI检查，3个（7.5%）过去曾进行过此项检查。目前未对植入DBS患者进行术后MRI检查的17个COE列出了以下原因：1）行业指南和/或警告（53%）；2）决定交由外部科室（29%）；3）责任/风险/安全（18%）；4）无活跃的DBS项目（18%）；5）无可用的MRI设备（12%）；6）保险和报销问题（6%）。共有3304例植入一个或多个DBS电极的PD患者进行了脑部MRI扫描，177例植入DBS的患者进行了身体其他部位的MRI检查。1例患者MRI检查后出现植入式脉冲发生器（IPG）故障，更换IPG后无神经后遗症。未报告其他并发症。
这些数据为植入DBS的患者进行脑部MRI检查具有良好的风险/效益比提供了证据。进一步的研究需要探讨是否有必要重新评估更严格的建议（即非常低的比吸收率值）。
