Use of Neurophysiological Monitoring during MR Imaging-Guided Ablation Procedures at 1.5 T: Workflow and Safety...

To evaluate the feasibility of intraoperative neurophysiological monitoring (IONM) during magnetic resonance (MR) imaging-guided ablations and identify strategies to reduce IONM electrode radiofrequency (RF) heating during MR imaging.

Ex vivo experiments with a porcine tissue phantom simulating a typical high RF heating risk IONM setup during an MR imaging-guided ablation procedure on the shoulder were performed using a 1.5-T scanner. Mutual interference between MR imaging and IONM was evaluated. To assess RF heating risks, 4 pairs of IONM electrodes were inserted into the phantom at regions corresponding to the shoulders, midarm, and wrist. MR imaging of the "shoulder" was performed at 3 different specific absorption rates (SARs) with electrode wires positioned in various geometric configurations. Different combinations of electrode connections to the IONM system were investigated. Temperatures of each electrode were recorded using fiber-optic sensors.

Simultaneous IONM readout and MR imaging resulted in distortion of the IONM signal, but interleaving MR imaging and IONM without moving electrodes was feasible. During MR imaging, temperature elevations greater than 60°C at the electrode insertion sites were observed. Temperature reductions were achieved by routing electrode wires along the scanner central axis, reducing the wire length within the scanner bore, or lowering the SAR of the imaging sequence. Altering the electrode connection with the IONM system did not result in consistent changes in RF heating.

With electrodes in the scanner bore, interleaving IONM and MR imaging is desired to avoid signal interference, and several strategies identified herein can reduce risk of electrode RF heating during MR imaging-guided ablation.