Deep brain stimulation (DBS) systems are approved for the treatment of Parkinson's disease, essential tremor, dystonias, depression, and obsessive-compulsive disorder. An implanted pulse generator (IPG) is typically placed subcutaneously in the infraclavicular fossa, connected by wires that travel up the neck and enter the skull through small burr holes. Electrodes at the distal end of each wire terminate in the thalamus, internal globus pallidus, or subthalamic nucleus.
- Use of 1.5T horizontal closed bore system only
- Prone or supine position only
- Maximum RF-power deposition ≤ 0.1W/kg or RF-field of ≤ 2 μT (rms)
- Maximum slew rate ≤ 200 T/m/s
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A common situation that arises concerns patients with partially implanted leads (i.e., those without an IPG attached). These patients should be considered eligible for a head only study using a transmit-receive head coil. The percutaneous leads should be wrapped with thermally and electrically insulating material and kept out of contact with the patient. The leads should also be kept straight (no loops) and running down center of head coil. Even still, one patient has been injured using this method (see article by Spiegel et al in references below.)
Henderson JM, Tkach J, Phillips M, et al. Permanent neurological deficit related to magnetic resonance imaging in a patient with implanted deep brain stimulation electrodes for Parkinson's disease: case report. Neurosurgery 2005; 57:E1063 (Report of hemorrhage and edema with permanent injury surrounding DBS electrodes following MRI of the lumbar spine. This case was unusual in that the DBS wires and pulse generator were placed in the abdomen and whole-body RF-excitation was used). Medtronic. MRI guidelines for Medtronic deep brain stimulation systems. (Product info updated 1 Dec 2015, please check manufacturer's site for most up-to-date version.)
Spiegel J, Fuss G, Backens M, et al. Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson disease. J Neurosurg 2003; 99:772-774. (First reported case of an adverse effect in a DBS patient undergoing MRI. Patient had bilateral electrodes placed externally but no implanted neurostimulator. The field strength was 1.0T but other imaging parameters seemed reasonable — transmit-receive head coil, SAR and slew rate within recommended limits, proper handling of external wires. Nevertheless the patient developed dystonic/ballistic leg movements immediately after MRI requiring several months to resolve. This may have resulted from a so-called "antenna effect" due to currents induced in the long leads.)
Zrinzo L, Yoshida F, Hariz MI, et al. Clinical safety of brain magnetic resonance imaging with implanted deep brain stimulation hardware: large case series and review of the literature. World Neurosurg 2011; 76:164-172. (review of complications up to 2011 including a new case of peri-electrode edema and transient neurological symptoms after MRI using recommended parameters).
Can patients with spinal cord stimulators undergo MRI?