1
|
Zulkarnain NIH, Sadeghi-Tarakameh A, Thotland J, Harel N, Eryaman Y. A workflow for predicting radiofrequency-induced heating around bilateral deep brain stimulation electrodes in MRI. Med Phys 2024; 51:1007-1018. [PMID: 38153187 PMCID: PMC10922480 DOI: 10.1002/mp.16913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/04/2023] [Accepted: 12/10/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Heating around deep brain stimulation (DBS) in magnetic resonance imaging (MRI) occurs when the time-varying electromagnetic (EM) fields induce currents in the electrodes which can generate heat and potentially cause tissue damage. Predicting the heating around the electrode contacts is important to ensure the safety of patients with DBS implants undergoing an MRI scan. We previously proposed a workflow to predict heating around DBS contacts and introduced a parameter, equivalent transimpedance, that is independent of electrode trajectories, termination, and radiofrequency (RF) excitations. The workflow performance was validated in a unilateral DBS system. PURPOSE To predict RF heating around the contacts of bilateral (DBS) electrodes during an MRI scan in an anthropomorphic head phantom. METHODS Bilateral electrodes were fixed in a skull phantom filled with hydroxyethyl cellulose (HEC) gel. The electrode shafts were suspended extracranially, in a head and torso phantom filled with the same gel material. The current induced on the electrode shaft was experimentally measured using an MR-based technique 3 cm above the tip. A transimpedance value determined in a previous offline calibration was used to scale the shaft current and calculate the contact voltage. The voltage was assigned as a boundary condition on the electrical contacts of the electrode in a quasi-static (EM) simulation. The resulting specific absorption rate (SAR) distribution became the input for a transient thermal simulation and was used to predict the heating around the contacts. RF heating experiments were performed for eight different lead trajectories using circularly polarized (CP) excitation and two linear excitations for one trajectory. The measured temperatures for all experiments were compared with the simulated temperatures and the root-mean-squared errors (RMSE) were calculated. RESULTS The RF heating around the contacts of both bilateral electrodes was predicted with ≤ 0.29°C of RMSE for 20 heating scenarios. CONCLUSION The workflow successfully predicted the heating for different bilateral DBS trajectories and excitation patterns in an anthropomorphic head phantom.
Collapse
Affiliation(s)
- Nur Izzati Huda Zulkarnain
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Alireza Sadeghi-Tarakameh
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Jeromy Thotland
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Noam Harel
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| | - Yigitcan Eryaman
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota, 55455, USA
| |
Collapse
|
2
|
Esplin N, Kusyk D, Jeong SW, Elhamdani S, Abdel Aziz K, Webb A, Angle C, Whiting D, Tomycz ND. Movement disorder Deep brain stimulation Hybridization: Patient and caregiver outcomes. Clin Park Relat Disord 2024; 10:100234. [PMID: 38292816 PMCID: PMC10827541 DOI: 10.1016/j.prdoa.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Deep brain stimulation (DBS) is a well-established surgical treatment for certain movement disorders and involves the implantation of brain electrodes connected to implantable pulse generators (IPGs). As more device manufacturers have entered the market, some IPG technology has been designed to be compatible with brain electrodes from other manufacturers, which has facilitated the hybridization of implant technology. The aim of this study was to assess the benefits of hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs. Methods A list of DBS movement disorder patients who had their non-rechargeable, constant voltage IPGs replaced with rechargeable, constant current IPGs from a different manufacturer was compiled. Structured surveys of these patients, and their caregivers when applicable, were undertaken to determine both patient and caregiver satisfaction in this DBS hybridization strategy. Results Eighteen patients met inclusion criteria and twelve patients or their caregivers completed the structured survey (67% response rate). Nine patients had Parkinson's disease (75%), three had essential tremor (25%). Nine (75%) were converted from bilateral single-channel IPGs, and three (25%) were converted from a unilateral dual-channel IPGs. Overall, 92% of patients and caregivers surveyed reported improvement or no change in their symptoms, 92% reported a decrease or no change in their medication requirements, and 92% report they are satisfied or very satisfied with their IPG hybridization and would recommend the surgery to similar patients. There were no immediate surgical complications. Conclusion In this series of movement disorder DBS patients, surgery was safe and patient and caregiver satisfaction were high with a hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs.
Collapse
Affiliation(s)
- Nathan Esplin
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Dorian Kusyk
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Seung W Jeong
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Shahed Elhamdani
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Khaled Abdel Aziz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Amanda Webb
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Cindy Angle
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Donald Whiting
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Nestor D. Tomycz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| |
Collapse
|
3
|
Hayley J, Hart MG, Mostofi A, Morgante F, Pereira EA. No Adverse Effects following Off-Label Magnetic Resonance Imaging in a Patient with Two Deep Brain Stimulation Systems: A Case Report. Stereotact Funct Neurosurg 2022; 100:253-258. [PMID: 35820403 DOI: 10.1159/000525538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
Magnetic resonance imaging (MRI) in patients with implanted deep brain stimulation (DBS) systems is subject to strict guidelines in order to ensure patient safety. Criteria include limits on the number of implanted leads. Here, we describe the case of a 29-year-old patient with generalized dystonia implanted with 4 DBS electrodes and 2 implantable pulse generators, who had an off-label spinal MRI without regard for manufacturer guidance yet suffered no adverse effects. This suggests that manufacturer guidelines might be overly restrictive with regards to limits on implanted DBS hardware. Further research in this area is needed to widen access to this fundamental imaging modality for patients with DBS.
Collapse
Affiliation(s)
- James Hayley
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom
| | - Michael G Hart
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom.,St. George's University Hospital, London, United Kingdom
| | - Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom.,St. George's University Hospital, London, United Kingdom
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom.,St. George's University Hospital, London, United Kingdom.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, United Kingdom.,St. George's University Hospital, London, United Kingdom
| |
Collapse
|
4
|
Tsutsui S, Matsuda T, Takeda K, Sasaki M, Kubo Y, Setta K, Fujiwara S, Chida K, Ogasawara K. Assessment of Heating on Titanium Alloy Cerebral Aneurysm Clips during 7T MRI. AJNR Am J Neuroradiol 2022; 43:972-977. [PMID: 35738672 DOI: 10.3174/ajnr.a7561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Patients with cerebral aneurysms often undergo MR imaging after microsurgical clipping. Ultra-high-field MR imaging at 7T may provide high diagnostic capability in such clinical situations. However, titanium alloy clips have safety issues such as adverse interactions with static magnetic fields and radiofrequency-induced heating during 7T MR imaging. The purpose of this study was to quantitatively assess temperature increases on various types of titanium alloy aneurysm clips during 7T MR imaging. MATERIALS AND METHODS Five types of titanium alloy aneurysm clips were tested, including combinations of short, long, straight, angled, and fenestrated types. Each clip was set in a phantom filled with gelled saline mixed with polyacrylic acid and underwent 7T MR imaging with 3D T1WI with a spoiled gradient recalled acquisition in the steady-state technique. Temperature was chronologically measured at the tips of the clip blade and head, angled part of the clip, and 5 mm from the tip of the clip head using MR imaging-compatible fiber-optic thermometers. RESULTS Temperature increases at all locations for right-angled and short straight clips were <1°C. Temperature increases at the angled part for the 45° angled clip and the tip of the clip head for the straight fenestrated clip were >1°C. Temperature increases at all locations for the long straight clip were >2°C. CONCLUSIONS Temperature increases on the right-angled and short straight clips remained below the regulatory limit during 7T MR imaging, but temperature increases on the 45° angled, straight fenestrated, and long straight clips exceeded this limit.
Collapse
Affiliation(s)
- S Tsutsui
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| | - T Matsuda
- Division of Ultrahigh Field MRI (T.M., K.T., M.S.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - K Takeda
- Division of Ultrahigh Field MRI (T.M., K.T., M.S.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - M Sasaki
- Division of Ultrahigh Field MRI (T.M., K.T., M.S.), Institute for Biomedical Sciences, Iwate Medical University School of Medicine, Morioka, Japan
| | - Y Kubo
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| | - K Setta
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| | - S Fujiwara
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| | - K Chida
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| | - K Ogasawara
- From the Department of Neurosurgery (S.T., Y.K., K.S., S.F., K.C., K.O.)
| |
Collapse
|
5
|
Loh A, Boutet A, Chow CT, Elias GJB, Germann J, Kucharczyk W, Lozano AM. Letter: Unforeseen Hurdles Associated With Magnetic Resonance Imaging in Patients With Deep Brain Stimulation Devices. Neurosurgery 2022; 90:e129. [PMID: 35199650 DOI: 10.1227/neu.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
- Krembil Research Institute, Toronto, Canada
| |
Collapse
|
6
|
Davidson B, Tam F, Yang B, Meng Y, Hamani C, Graham SJ, Lipsman N. Three-Tesla Magnetic Resonance Imaging of Patients With Deep Brain Stimulators: Results From a Phantom Study and a Pilot Study in Patients. Neurosurgery 2021; 88:349-355. [PMID: 33045736 DOI: 10.1093/neuros/nyaa439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is a standard of care treatment for multiple neurologic disorders. Although 3-tesla (3T) magnetic resonance imaging (MRI) has become the gold-standard modality for structural and functional imaging, most centers refrain from 3T imaging in patients with DBS devices in place because of safety concerns. 3T MRI could be used not only for structural imaging, but also for functional MRI to study the effects of DBS on neurocircuitry and optimize programming. OBJECTIVE To use an anthropomorphic phantom design to perform temperature and voltage safety testing on an activated DBS device during 3T imaging. METHODS An anthropomorphic 3D-printed human phantom was constructed and used to perform temperature and voltage testing on a DBS device during 3T MRI. Based on the phantom assessment, a cohort study was conducted in which 6 human patients underwent MRI with their DBS device in an activated (ON) state. RESULTS During the phantom study, temperature rises were under 2°C during all sequences, with the DBS in both the deactivated and activated states. Radiofrequency pulses from the MRI appeared to modulate the electrical discharge from the DBS, resulting in slight fluctuations of voltage amplitude. Six human subjects underwent MRI with their DBS in an activated state without any serious adverse events. One patient experienced stimulation-related side effects during T1-MPRAGE scanning with the DBS in an ON state because of radiofrequency-induced modulation of voltage amplitude. CONCLUSION Following careful phantom-based safety testing, 3T structural and functional MRI can be safely performed in subjects with activated deep brain stimulators.
Collapse
Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Benson Yang
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Ying Meng
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| | - Simon J Graham
- Sunnybrook Research Institute, Toronto, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| |
Collapse
|