脑深部电刺激植入物患者行脑磁共振成像的临床安全性：大型病例系列及文献复习。

Clinical safety of brain magnetic resonance imaging with implanted deep brain stimulation hardware: large case series and review of the literature.

机构信息

Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

出版信息

World Neurosurg. 2011 Jul-Aug;76(1-2):164-72; discussion 69-73. doi: 10.1016/j.wneu.2011.02.029.

DOI:10.1016/j.wneu.2011.02.029

PMID:21839969

Abstract

BACKGROUND

Over 75,000 patients have undergone deep brain stimulation (DBS) procedures worldwide. Magnetic resonance imaging (MRI) is an important clinical and research tool in analyzing electrode location, documenting postoperative complications, and investigating novel symptoms in DBS patients. Functional MRI may shed light on the mechanism of action of DBS. MRI safety in DBS patients is therefore an important consideration.

METHODS

We report our experience with MRI in patients with implanted DBS hardware and examine the literature for clinical reports on MRI safety with implanted DBS hardware.

RESULTS

A total of 262 MRI examinations were performed in 223 patients with intracranial DBS hardware, including 45 in patients with an implanted pulse generator. Only 1 temporary adverse event occurred related to patient agitation and movement during immediate postoperative MR imaging. Agitation resolved after a few hours, and an MRI obtained before implanted pulse generator implantation revealed edema around both electrodes. Over 4000 MRI examinations in patients with implanted DBS hardware have been reported in the literature. Only 4 led to adverse events, including 2 hardware failures, 1 temporary and 1 permanent neurological deficit. Adverse neurological events occurred in a unique set of circumstances where appropriate safety protocols were not followed. MRI guidelines provided by DBS hardware manufacturers are inconsistent and vary among devices.

CONCLUSIONS

The importance of MRI in modern medicine places pressure on industry to develop fully MRI-compatible DBS devices. Until then, the literature suggests that, when observing certain precautions, cranial MR images can be obtained with an extremely low risk in patients with implanted DBS hardware.

摘要

背景

全球已有超过 75000 名患者接受了深部脑刺激（DBS）手术。磁共振成像（MRI）是分析电极位置、记录术后并发症以及研究 DBS 患者新症状的重要临床和研究工具。功能磁共振成像可能有助于揭示 DBS 的作用机制。因此，DBS 患者的 MRI 安全性是一个重要的考虑因素。

方法

我们报告了我们在植入 DBS 硬件的患者中进行 MRI 的经验，并为植入 DBS 硬件的 MRI 安全性的临床报告检查了文献。

结果

共对 223 名颅内 DBS 硬件植入患者进行了 262 次 MRI 检查，其中 45 次在植入脉冲发生器的患者中进行。仅在术后即刻 MRI 成像期间因患者激动和运动导致 1 例短暂不良事件。几小时后激动缓解，在植入脉冲发生器植入前获得的 MRI 显示两个电极周围有水肿。文献中报告了超过 4000 例植入 DBS 硬件的患者进行 MRI 检查。仅导致 4 例不良事件，包括 2 例硬件故障、1 例暂时和 1 例永久性神经功能缺损。不良神经事件发生在未遵循适当安全协议的独特情况下。DBS 硬件制造商提供的 MRI 指南不一致，并且在设备之间有所不同。