Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.
J Neurosurg. 2010 Mar;112(3):497-502. doi: 10.3171/2009.7.JNS09572.
With the expanding indications and increasing number of patients undergoing deep brain stimulation (DBS), postoperative MR imaging is becoming even more important in guiding clinical care and practice-based learning; important safety concerns have recently emerged, however. Although phantom model studies have driven conservative recommendations regarding imaging parameters, highlighted by 2 recent reports describing adverse neurological events associated with MR imaging in patients with implanted DBS systems, the risks of MR imaging in such patients in clinical practice has not been well addressed. In this study, the authors capitalized on their large experience with serial MR imaging (3 times per patient) to use MR imaging itself and clinical outcomes to examine the safety of MR imaging in patients who underwent staged implantation of DBS electrodes for Parkinson disease, tremor, and dystonia.
Sixty-four patients underwent staged bilateral lead implantations between 1997 and 2006, and each patient underwent 3 separate MR imaging sessions subsequent to DBS placement. The first of these was performed after the first DBS placement, the second occurred prior to the second DBS placement, and third was after the second DBS placement. Follow-up was conducted to examine adverse events related either to MR imaging or to DBS-induced injury.
One hundred and ninety-two MR images were obtained, and the mean follow-up time was 3.67 years. The average time between the first and second, and second and third MR imaging sessions was 19.4 months and 14.7 hours, respectively. Twenty-two MR imaging-detected new findings of hemorrhage were documented. However, all new findings were related to acute DBS insertion, whereas there were no new findings after imaging of the chronically implanted electrode.
Although potential risks of MR imaging in patients undergoing DBS may be linked to excessive heating, induced electrical currents, disruption of the normal operation of the device, and/or magnetic field interactions, MR imaging can be performed safely in these patients and provides useful information on DBS lead location to inform patient-specific programming and practice-based learning.
随着接受深部脑刺激 (DBS) 的适应证不断扩大和患者数量不断增加，术后磁共振成像在指导临床护理和基于实践的学习方面变得更加重要；然而，最近出现了一些重要的安全问题。尽管幻影模型研究推动了对成像参数的保守建议，最近有 2 份报告描述了与植入 DBS 系统的患者的磁共振成像相关的不良神经事件，但这种患者的磁共振成像风险在临床实践中尚未得到很好的解决。在这项研究中，作者利用他们在多次磁共振成像 (每位患者 3 次) 方面的丰富经验，利用磁共振成像本身和临床结果来检查分期植入 DBS 电极治疗帕金森病、震颤和肌张力障碍患者的磁共振成像安全性。
1997 年至 2006 年间，64 例患者接受了分期双侧导联植入，每位患者在 DBS 放置后进行了 3 次单独的磁共振成像检查。第一次是在第一次 DBS 放置后进行的，第二次是在第二次 DBS 放置前进行的，第三次是在第二次 DBS 放置后进行的。通过随访检查与磁共振成像或 DBS 诱导损伤相关的不良事件。
共获得 192 次磁共振图像，平均随访时间为 3.67 年。第一次和第二次、第二次和第三次磁共振成像检查之间的平均时间分别为 19.4 个月和 14.7 小时。记录到 22 次磁共振成像检测到的新出血发现。然而，所有新发现都与急性 DBS 插入有关，而在对慢性植入电极进行成像后没有新发现。
尽管接受 DBS 的患者进行磁共振成像可能存在与过度加热、感应电流、设备正常运行中断和/或磁场相互作用相关的潜在风险，但可以在这些患者中安全地进行磁共振成像，并提供有关 DBS 导联位置的有用信息，以告知患者特异性编程和基于实践的学习。
