Division of Neurosurgery, Department of Surgery, and.
Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.
J Neurosurg. 2017 Oct;127(4):892-898. doi: 10.3171/2016.9.JNS16908. Epub 2016 Dec 23.
OBJECTIVE The aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems. METHODS This study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging. RESULTS During phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed. CONCLUSIONS To the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.
目的 本研究旨在评估植入深部脑刺激（DBS）系统患者行 3-T MRI 的安全性。
方法 本研究分两阶段进行。在初始的体模研究中，组装了一个充满组织模拟凝胶的 Lucite 体模。该系统配备了一个与内部脉冲发生器相连的单 DBS 电极。电极尖端与光纤温度计相连，其温度分辨率为 0.1°C。测试了解剖学（T1 和 T2 加权）和功能 MRI 序列。将基线体温升高 2°C 以内视为安全。体模研究结果提示安全后，10 例植入 DBS 系统的患者（电极靶点位于不同脑区）自愿入组，并使用相同的成像序列行 3-T MRI。成像前后进行详细的神经学评估和内部脉冲发生器检测。
结果 在体模测试中，T2 加权序列下记录到最大的温度升高。在所有测试的序列中，DBS 电极尖端的最大温度变化均<1°C。在所有患者中，结构成像均获得了足够的图像，尽管导连线的显著伪影影响了功能成像的质量。未观察到加热、温热或不良的神经学效应。
结论 据作者所知，这是第一项评估完全植入 DBS 系统（电极、延长线和脉冲发生器）患者行 3-T MRI 临床安全性的研究。它提供了初步数据，将进一步检查和评估植入 DBS 系统患者行 3-T 成像研究的安全性。在获得更多安全性数据之前，作者不能提倡在植入 DBS 的患者中广泛使用这种类型的成像。
