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Published on: February 15, 2014
Safety assessment of spine MRI in deep brain stimulation patients
Alexandre Boutet1,2, Gavin J B Elias2, Robert Gramer2
11Joint Department of Medical Imaging, University of Toronto.
Objective:
Many centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors' goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort.
Methods:
A phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability.
Results:
The increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable.
Conclusions:
Patients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).
Insights
Spine MRI is safe for patients with deep brain stimulation (DBS) devices. Modified protocols with fewer slices allow safe imaging, avoiding adverse effects and ensuring device stability.
Area of Science:
- Neurology
- Radiology
- Biomedical Engineering
Background:
- Deep brain stimulation (DBS) devices present challenges for MRI due to safety concerns.
- Existing guidelines often restrict routine MRI scans in patients with DBS.
- Assessing MRI safety in DBS patients is crucial for comprehensive patient care.
Purpose of the Study:
- To evaluate the safety of spine MRI in patients with implanted DBS devices.
- To develop and validate a modified MRI protocol for DBS patients.
- To determine potential risks such as device heating and adverse effects.
Main Methods:
- Phantom model testing to assess DBS device heating during 1.5-T spine MRI.
- Modification of routine clinical MRI sequences to achieve a temperature rise < 2°C.
- Prospective validation in 9 DBS patients undergoing 67 spine MRI sequences.
Main Results:
- Modified spine MRI protocols (2D sequences, reduced slices) achieved a temperature rise < 2°C.
- No acute or long-term adverse effects were observed in DBS patients post-MRI.
- Device impedances remained stable, and no acute brain MRI findings were noted.
Conclusions:
- Clinically indicated spine MRI can be safely performed in patients with DBS devices.
- Modified protocols, with fewer slices than vendor guidelines, enable safe imaging.
- This approach may reduce the need for direct radiologist supervision during MRI acquisition.
