Reducing RF-induced Heating near Implanted Leads through High-Dielectric Capacitive Bleeding of Current (CBLOC)

RF-induced heating reduction by minimizing the external portion of the partially in and partially out medical devices under MRI at 1.5 T

PURPOSE

To address the issue of RF-induced heating for partially in and partially out (PIPO) medical devices during 1.5 T MRI scans by proposing a method of minimizing the external portion.

METHODS

A method of tightly winding the external segment of the PIPO device is proposed to minimize the overall device effective reception length during MRI scans to mitigate the RF-induced heating. Two commercially available PIPO medical devices and simplified solid wires were used to demonstrate the concept. RF heating results are compared between typical and minimized-length trajectories under the American Society for Testing and Materials (ASTM) testing procedure. In addition, 16 scaled and validated device models were used in conjuncture with human body numerical simulations within three virtual human models to estimate clinically relevant heating.

RESULTS

The wound segments in PIPO devices functioned as a lumped element rather than a receiving antenna, reducing induced energy/heating as compared to the original PIPO devices under typical straight or loop configurations. Minimizing the lead's external portion can reduce the RF-induced heating by significant factors for all studied cases during ASTM phantom measurements and in human body simulations.

CONCLUSION

Our findings show a significant reduction in RF heating by minimizing the external segment, thereby enhancing patient safety during 1.5 T MRI procedures. Although limited to four devices at 1.5 T across two applications, the extent of heating reduction may vary for others. Nonetheless, tightly winding the external segment of PIPO electrodes holds promise for improving device safety under MRI.

A deep brain stimulation-conditioned RF coil for 3T MRI

PURPOSE

To develop and test an MRI coil assembly for imaging deep brain stimulation (DBS) at 3 T with a reduced level of local specific absorption rate of RF fields near the implant.

METHODS

A mechanical rotatable linearly polarized birdcage transmitter outfitted with a 32-channel receive array was constructed. The coil performance and image quality were systematically evaluated using bench-level measurements and imaging performance tests, including SNR maps, array element noise correlation, and acceleration capabilities. Electromagnetic simulations and phantom experiments were performed with clinically relevant DBS device configurations to evaluate the reduction of specific absorption rate and temperature near the implant compared with a circular polarized body coil setup.

RESULTS

The linearly polarized birdcage coil features a block-shaped low electric field region to be co-aligned with the implanted DBS lead trajectory, while the close-fit receive array enables imaging with high SNR and enhanced encoding capabilities.

CONCLUSION

The 3T coil assembly, consisting of a rotating linear birdcage and a 32-channel close-fit receive array, showed DBS-conditioned imaging technology with substantially reduced heat generation at the DBS implants.

Improving Image Quality and Decreasing SAR With High Dielectric Constant Pads in 3 T Fetal MRI

BACKGROUND

At high magnetic fields, degraded image quality due to dielectric artifacts and elevated specific absorption rate (SAR) are two technical challenges in fetal MRI.

PURPOSE

To assess the potential of high dielectric constant (HDC) pad in increasing image quality and decreasing SAR for 3 T fetal MRI.

STUDY TYPE

Prospective.

FIELD STRENGTH/SEQUENCE

3 T. Balanced steady-state free precession (bSSFP) and single-shot fast spin-echo (SSFSE).

POPULATION

One hundred twenty-eight participants (maternal-age 29.0 ± 3.6, range 20-40; gestational-age 30.3 ± 3.5 weeks, range 22-37 weeks) undertook bSSFP and 40 participants (maternal-age 29.5 ± 3.8, range 19-40; gestational-age 30.4 ± 3.5 weeks, range 23-37 weeks) undertook SSFSE.

ASSESSMENT

Patient clinical characteristics were recorded, such as gestational-age, amniotic-fluid-index, abdominal-circumference, body-mass-index, and fetal-presentation. Quantitative Image-quality analysis included signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Qualitative analysis was performed by three radiologists with four-point scale to evaluate overall image quality, dielectric artifact, and diagnostic confidence. Whole-body total SAR was obtained from the vendor workstation.

STATISTICAL TESTING

Paired rank sum test was used to analyze the differences in SNR, CNR, overall image quality, dielectric artifact, diagnostic confidence, and SAR with and without HDC pad. Spearman correlation test was used to detect correlations between image quality variable changes and patient clinical characteristics. P values <0.05 were set as statistical significance.

RESULTS

With HDC pad, SNR and CNR was significantly higher (41.45% increase in SNR, 54.05% increase in CNR on bSSFP; 258.76% increase in SNR, 459.55% increase in CNR on SSFSE). Overall qualitative image quality, dielectric artifact and diagnostic confidence improved significantly. Adding HDC pad significantly reduced Whole-body total SAR (32.60% on bSSFP; 15.40% on SSFSE). There was no significant correlation between image quality variable changes and participant clinical characteristics (P-values ranging from 0.072 to 0.992).

DATA CONCLUSION

In the clinical setting, adding a HDC pad might increase image quality while reducing dielectric artifact and SAR.

PLAN LANGUAGE SUMMARY

Dielectric artifacts and elevated SAR are two technical problems in 3T fetal MRI. In a prospective analysis of 168 pregnant participants undertaking 3.0T fetal MRI scanning, high dielectric constant (HDC) pad increased SNR by 41.45%, CNR by 54.05% on bSSFP, and SNR by 258.76%, CNR by 459.55% on SSFSE. Overall image quality, dielectric artifact reduction, and diagnostic confidence assessed by three radiologists was improved. Whole-body total SAR decreased by 32.60% on bSSFP and by 15.40% on SSFSE. These findings suggested that the HDC pad can enhance fetal MRI safety and quality, making it a promising tool for clinical practice.

EVIDENCE LEVEL

2 TECHNICAL EFFICACY: Stage 5.

A Simulation Study of a Novel Patient-Adjustable MRI Coil for Safe Pediatric Imaging in Children with Cardiac Implantable Electronic Devices (CIEDs)

A substantial and growing population of individuals with conductive implants face persistent challenges in accessing magnetic resonance imaging (MRI) due to risks associated with radiofrequency (RF) heating of implants. Recently, a novel approach based on altering MRI electric fields at the location of individual's implants has shown promise in substantially reducing RF heating in adult patients with deep brain stimulation devices. In this study, we present the results of electromagnetic and thermal simulation studies demonstrating the applicability of this novel technique in pediatric patients with cardiac implantable electronic devices (CIEDs) at 1.5T MR. The outcomes contribute valuable insights into the development of new MRI transmit coils that can be mechanically adjusted on a patient-specific basis to accommodate patients with conductive implants, particularly in the pediatric population.

Comparative Analysis of RF Heating of Cardiac Implantable Electronic Devices (CIEDs) in Conventional Closed-bore vs. Vertical Open-bore MRI Systems

Radiofrequency (RF) induced tissue heating during magnetic resonance imaging (MRI) is the predominant safety risk for patients with active electronic implants such as cardiac implantable electronic devices (CIEDs) which typically have elongated conductive leads. Currently, abandoned CIED leads, as well as CIEDs with epicardial leads, are contraindicated for MRI exams. Recent studies have demonstrated the superior safety of vertical, open-bore MRI systems regarding RF heating compared to conventional closed-bore scanners. However, these studies only investigated deep brain stimulation (DBS) and passive devices. In this study, we compared the RF heating of three commercially available epicardial leads in clinically available closed-bore and open-bore MRI systems. Results from the phantom experiments revealed significantly lower RF heating with up to a nine-fold reduction in the mean temperature rise in the tissue-mimicking gel. Our results are in line with previous findings, suggesting that vertical MRI systems can offer a potentially safer platform for imaging this patient population.

A Resistive Tapered Cylindrical Conductor Can Substantially Reduce RF Heating of Implanted Leads During MRI: A Simulation Study of Helical Wire Structures

Active implanted electronic devices (AIMDs) are increasingly common and are often indicated to provide therapeutic stimulation to patients in cases such as pacemakers and deep brain stimulators. Such devices typically require leads of significant length to deliver stimulation. The use of long leads in combination with an implantable pulse generator often means that there is a significant risk of radiofrequency energy coupling with the leads when patients receive MRI scans. Previous studies have investigated the use of a multi-segment wires with sharp conductivity changes to mitigate this RF coupling. However, past work in this area has evaluated stripline and straight cylindrical geometries. Clinical lead designs often use helical wrapping for internal conductors for improved fatigue resistance. In this study we assessed the applicability of the multi-segment lead design with a helical structure at 1.5 T to better assess the potential heating reduction with a more clinically relevant geometry. A maximum SAR reduction of roughly 7-fold was achieved, and decreasing the helical pitch yielded shorter optimum lengths for the tissue-exposed wire segment.

Effect of surgical modification of deep brain stimulation lead trajectories on radiofrequency heating during MRI at 3T: from phantom experiments to clinical implementation

OBJECTIVE

Radiofrequency (RF) tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during MRI, resulting in strict imaging guidelines and limited allowable protocols. The implanted lead's trajectory and orientation with respect to the MRI electric fields contribute to variations in the magnitude of RF heating across patients. Currently, there are no surgical requirements for implanting the extracranial portion of the DBS lead, resulting in substantial variations in clinical lead trajectories and consequently RF heating. Recent studies have shown that incorporating concentric loops in the extracranial lead trajectory can reduce RF heating. However, optimal positioning of the loops and the quantitative benefit of trajectory modification in terms of added safety margins during MRI remain unknown. In this study, the authors systematically evaluated the characteristics of DBS lead trajectories that minimize RF heating during 3T MRI to develop the best surgical practices for safe access to postoperative MRI, and they present the first surgical implementation of these modified trajectories.

METHODS

The authors performed experiments to assess the maximum temperature increase of 244 distinct lead trajectories. They investigated the effect of the position, number, and size of the concentric loops on the skull. Experiments were performed in an anthropomorphic phantom implanted with a commercial DBS system, and RF exposure was generated by applying a high specific absorption rate sequence (B1+rms = 2.7 µT). The authors conducted test-retest experiments to assess the reliability of measurements. Additionally, they evaluated the effect of imaging landmarks and perturbations to the DBS device configuration on the efficacy of low-heating trajectories. Finally, two neurosurgeons implanted the recommended modified trajectories in patients, and the authors characterized their RF heating in comparison with unmodified trajectories.

RESULTS

The maximum temperature increase ranged from 0.09°C to 7.34°C. The authors found that increasing the number of loops and positioning them closer to the surgical burr hole, particularly for the contralateral lead, substantially reduced RF heating. These trajectory modifications were easily incorporated during the surgical procedure and resulted in a threefold reduction in RF heating.

CONCLUSIONS

Surgically modifying the extracranial portion of the DBS lead trajectory can substantially reduce RF heating during 3T MRI. The authors' results indicate that simple adjustments to the lead's configuration, such as small, concentric loops near the burr hole, can be readily adopted during DBS lead implantation to improve patient safety during MRI.

A new method to improve RF safety of implantable medical devices using inductive coupling at 3.0 T MRI

OBJECTIVE

To enhance RF safety when implantable medical devices are located within the body coil but outside the imaging region by using a secondary resonator (SR) to reduce electric fields, the corresponding specific absorption rate (SAR), and temperature change during MRI.

MATERIALS AND METHODS

This study was conducted using numerical simulations with an American Society for Testing and Materials (ASTM) phantom and adult human models of Ella and Duke from Virtual Family Models, along with corresponding experimental results of temperature change obtained using the ASTM phantom. The circular SR was designed with an inner diameter of 150 mm and a width of 6 mm. Experimental measurements were carried out using a 3 T Medical Implant Test System (MITS) body coil, electromagnetic (EM) field mapping probes, and an ASTM phantom.

RESULTS

The magnitudes of B1+ (|B1+|) and SAR1g were reduced by 15.2% and 5.85% within the volume of interest (VoI) of an ASTM phantom, when a SR that generates opposing electromagnetic fields was utilized. Likewise, the Δ|B1+| and ΔSAR1g were reduced by up to 56.7% and 57.5% within the VoI of an Ella model containing a copper rod when an opposing SR was used.

CONCLUSION

A novel method employing the designed SR, which generates opposing magnetic fields to partially shield a sample, has been proposed to mitigate the risk of induced-RF heating at the VoI through numerical simulations and corresponding experiments under various conditions at 3.0 T.

Modifying the trajectory of epicardial leads can substantially reduce MRI-induced RF heating in pediatric patients with a cardiac implantable electronic device at 1.5T

PURPOSE

After epicardial cardiac implantable electronic devices are implanted in pediatric patients, they become ineligible to receive MRI exams due to an elevated risk of RF heating. We investigated whether simple modifications in the trajectories of epicardial leads could substantially and reliably reduce RF heating during MRI at 1.5 T, with benefits extending to abandoned leads.

METHODS

Electromagnetic simulations were performed to assess RF heating of two common 35-cm epicardial lead trajectories exhibiting different degrees of coupling with MRI incident electric fields. Experiments in anthropomorphic phantoms implanted with commercial cardiac implantable electronic devices confirmed the findings. Both electromagnetic simulations and experimental measurements were performed using head-first and feet-first positioning and various landmarks. Transfer function approach was used to assess the performance of suggested modifications in realistic body models.

RESULTS

Simulations (head-first, chest landmark) of a 35-cm epicardial lead with a trajectory where the excess length of the lead was looped and placed on the inferior surface of the heart showed an 87-fold reduction in the 0.1 g-averaged specific absorption rate compared with the lead where the excess length was looped on the anterior surface. Repeated experiments with a commercial epicardial device confirmed this. For fully implanted systems following low-specific absorption rate trajectories, there was a 16-fold reduction in the average temperature rise and a 28-fold reduction for abandoned leads. The transfer function method predicted a 7-fold reduction in the RF heating in 336 realistic scenarios.

CONCLUSION

Surgical modification of epicardial lead trajectory can substantially reduce RF heating at 1.5 T, with benefits extending to abandoned leads.

A machine learning-based approach for RF transfer function modeling of active implantable medical electrodes at 3T MRI

Objective.The objective of this work is to propose a machine learning-based approach to rapidly and efficiently model the radiofrequency (RF) transfer function of active implantable medical (AIM) electrodes, and to overcome the limitations and drawbacks of traditional measurement methods when applied to heterogeneous tissue environments.Approach.AIM electrodes with different geometries and proximate tissue distributions were considered, and their RF transfer functions were modeled numerically. Machine learning algorithms were developed and trained with the simulated transfer function datasets for homogeneous and heterogeneous tissue distributions. The performance of the method was analyzed statistically and validated experimentally and numerically. A comprehensive uncertainty analysis was performed and uncertainty budgets were derived.Main results.The proposed method is able to predict the RF transfer function of AIM electrodes under different tissue distributions, with mean correlation coefficientsrof 0.99 and 0.98 for homogeneous and heterogeneous environments, respectively. The results were successfully validated by experimental measurements (e.g. the uncertainty of less than 0.9 dB) and numerical simulation (e.g. transfer function uncertainty <1.6 dB and power deposition uncertainty <1.9 dB). Up to 1.3 dBin vivopower deposition underestimation was observed near generic pacemakers when using a simplified homogeneous tissue model.Significance.Provide an efficient alternative of transfer function modeling, which allows a more realistic tissue distribution and the potential underestimation ofin vivoRF-induced power deposition near the AIM electrode can be reduced.

Implants talk to each-other: RF heating changes when two DBS leads are present simultaneously during MRI

Deep brain stimulation (DBS) has proven to be an effective treatment for Parkinson's disease and other brain disorders. The procedure often involves implanting two elongated leads aimed at specific brain nuclei in both the left and right hemispheres. However, evaluating the safety of MRI in patients with such implants has only been done on an individual lead basis, ignoring the possibility of crosstalk between the leads. This study evaluates the impact of crosstalk on power deposition at the lead tip through numerical simulation and phantom experiments. We used CT images to obtain patient-specific lead trajectories and compared the power deposition at the lead tip in cases with bilateral and unilateral DBS implants. Our results indicate that the RF power deposition at the lead tip can vary by up to 6-fold when two DBS leads are present together compared to when only one lead is present. Experimental measurements in a simplified case of two lead-only DBS systems confirmed the existence of crosstalk.Clinical Relevance-Our results indicate that RF heating of implanted leads during MRI can be affected by the presence of another lead in the body, which may increase or decrease the power deposition in the tissue depending on the position and configuration of the leads.

Low-field MRI's Spark on Implant Safety: A Closer Look at Radiofrequency Heating

Advances in low-field magnetic resonance imaging (MRI) are making imaging more accessible without significant losses in image quality. In addition to being more cost-effective and easier to place without as much needed infrastructure, it has been publicized that the lower field strengths make MRI safer for patients with implants. To test this claim, we conducted a total of 368 simulations with wires of various lengths and geometries in a gel phantom during radiofrequency (RF) exposure at 23 MHz and 63.6 MHz (corresponding to MRI at 0.55 T and 1.5 T). Our results showed that heating in the gel around wire tips could be higher in certain cases at 0.55 T. To examine the impact on real patients, we simulated two models of patients with deep brain stimulation (DBS) implants of different lengths. These simulations provide quantitative evidence that low-field MRI is not always safer, and this paper serves to illustrate some of the basic principles involved in RF heating of elongated implants in MRI environments.Clinical Relevance- This paper illustrates the physical concepts of resonance and inductive coupling in RF heating during MRI scanning with implants through systematic simulations and discusses the impact of these principles in practice.

Rapid prediction of MRI-induced RF heating of active implantable medical devices using machine learning

The interaction between an active implantable medical device and magnetic resonance imaging (MRI) radiofrequency (RF) fields can cause excessive tissue heating. Existing methods for predicting RF heating in the presence of an implant rely on either extensive phantom experiments or electromagnetic (EM) simulations with varying degrees of approximation of the MR environment, the patient, or the implant. On the contrary, fast MR thermometry techniques can provide a reliable real-time map of temperature rise in the tissue in the vicinity of conductive implants. In this proof-of-concept study, we examined whether a machine learning (ML) based model could predict the temperature increase in the tissue near the tip of an implanted lead after several minutes of RF exposure based on only a few seconds of experimentally measured temperature values. We performed phantom experiments with a commercial deep brain stimulation (DBS) system to train a fully connected feedforward neural network (NN) to predict temperature rise after ~3 minutes of scanning at a 3 T scanner using only data from the first 5 seconds. The NN effectively predicted ΔTmax-R2 = 0.99 for predictions in the test dataset. Our model also showed potential in predicting RF heating for other various scenarios, including a DBS system at a different field strength (1.5 T MRI, R2 = 0.87), different field polarization (1.2 T vertical MRI, R2 = 0.79), and an unseen implant (cardiac leads at 1.5 T MRI, R2 = 0.91). Our results indicate great potential for the application of ML in combination with fast MR thermometry techniques for rapid prediction of RF heating for implants in various MR environments.Clinical Relevance- Machine learning-based algorithms can potentially enable rapid prediction of MRI-induced RF heating in the presence of unknown AIMDs in various MR environments.

Optimizing the trajectory of deep brain stimulation leads reduces RF heating during MRI at 3 T: Characteristics and clinical translation

Radiofrequency (RF) induced tissue heating around deep brain stimulation (DBS) leads is a well-known safety risk during magnetic resonance imaging (MRI), hindering routine protocols for patients. Known factors that contribute to variations in the magnitude of RF heating across patients include the implanted lead's trajectory and its orientation with respect to the MRI electric fields. Currently, there are no consistent requirements for surgically implanting the extracranial portion of the DBS lead. Recent studies have shown that incorporating concentric loops in the extracranial trajectory of the lead can reduce RF heating, but the optimal positioning of the loop is unknown. In this study, we evaluated RF heating of 77 unique lead trajectories to determine how different characteristics of the trajectory affect RF heating during MRI at 3 T. We performed phantom experiments with commercial DBS systems from two manufacturers to determine how consistently modifying the lead trajectory mitigates RF heating. We also presented the first surgical implementation of these modified trajectories in patients. Low-heating trajectories included small concentric loops near the surgical burr hole which were readily implemented during the surgical procedure; these trajectories generated nearly a 2-fold reduction in RF heating compared to unmodified trajectories.Clinical Relevance- Surgically modifying the DBS lead trajectory can be a cost-effective strategy for reducing RF-induced heating during MRI at 3 T.

Application of Machine learning to predict RF heating of cardiac leads during magnetic resonance imaging at 1.5 T and 3 T: A simulation study

Predicting magnetic resonance imaging (MRI)-induced heating of elongated conductive implants, such as leads in cardiovascular implantable electronic devices, is essential to assessing patient safety. Phantom experiments have traditionally been used to estimate radio-frequency (RF) heating of implants, but they are time-consuming. Recently, machine learning has shown promise for fast prediction of RF heating of orthopaedic implants when the implant position within the MRI RF coil was predetermined. We explored whether deep learning could be applied to predict RF heating of conductive leads with variable positions and orientations during MRI at 1.5 T and 3 T. Models of 600 cardiac leads with clinically relevant trajectories were generated, and electromagnetic simulations were performed to calculate the maximum of the 1 g-averaged specific absorption rate (SAR) of RF energy at the tips of lead models during MRI at 1.5 T and 3 T. Neural networks were trained to predict the maximum SAR at the lead tip from the knowledge of the coordinates of points along the lead trajectory. Despite the large range of SAR values (∼230 W/kg to ∼ 3200 W/kg and ∼ 10 W/kg to ∼ 3300 W/kg), the root- mean-square error of the predicted vs ground truth SAR remained at 223 W/kg and 206 W/kg, with the R² scores of 0.89 and 0.85 on the testing set for 1.5 T and 3 T models, respectively. The results suggest that machine learning is a promising approach for fast assessment of RF heating of lead-like implants when only the knowledge of the lead geometry and MRI RF coil features are in hand.

Effect of field strength on RF power deposition near conductive leads: A simulation study of SAR in DBS lead models during MRI at 1.5 T-10.5 T

BACKGROUND

Since the advent of magnetic resonance imaging (MRI) nearly four decades ago, there has been a quest for ever-higher magnetic field strengths. Strong incentives exist to do so, as increasing the magnetic field strength increases the signal-to-noise ratio of images. However, ensuring patient safety becomes more challenging at high and ultrahigh field MRI (i.e., ≥3 T) compared to lower fields. The problem is exacerbated for patients with conductive implants, such as those with deep brain stimulation (DBS) devices, as excessive local heating can occur around implanted lead tips. Despite extensive effort to assess radio frequency (RF) heating of implants during MRI at 1.5 T, a comparative study that systematically examines the effects of field strength and various exposure limits on RF heating is missing.

PURPOSE

This study aims to perform numerical simulations that systematically compare RF power deposition near DBS lead models during MRI at common clinical and ultra-high field strengths, namely 1.5, 3, 7, and 10.5 T. Furthermore, we assess the effects of different exposure constraints on RF power deposition by imposing limits on either the B1+ or global head specific absorption rate (SAR) as these two exposure limits commonly appear in MRI guidelines.

METHODS

We created 33 unique DBS lead models based on postoperative computed tomography (CT) images of patients with implanted DBS devices and performed electromagnetic simulations to evaluate the SAR of RF energy in the tissue surrounding lead tips during RF exposure at frequencies ranging from 64 MHz (1.5 T) to 447 MHz (10.5 T). The RF exposure was implemented via realistic MRI RF coil models created based on physical prototypes built in our institutions. We systematically examined the distribution of local SAR at different frequencies with the input coil power adjusted to either limit the B1+ or the global head SAR.

RESULTS

The MRI RF coils at higher resonant frequencies generated lower SARs around the lead tips when the global head SAR was constrained. The trend was reversed when the constraint was imposed on B1+.

CONCLUSION

At higher static fields, MRI is not necessarily more dangerous than at lower fields for patients with conductive leads. Specifically, when a conservative safety criterion, such as constraints on the global SAR, is imposed, coils at a higher resonant frequency tend to generate a lower local SAR around implanted leads due to the decreased B1+ and, by proxy, E field levels.

Artifacts Can Be Deceiving: The Actual Location of Deep Brain Stimulation Electrodes Differs from the Artifact Seen on Magnetic Resonance Images

INTRODUCTION

Deep brain stimulation (DBS) is a common treatment for a variety of neurological and psychiatric disorders. Recent studies have highlighted the role of neuroimaging in localizing the position of electrode contacts relative to target brain areas in order to optimize DBS programming. Among different imaging methods, postoperative magnetic resonance imaging (MRI) has been widely used for DBS electrode localization; however, the geometrical distortion induced by the lead limits its accuracy. In this work, we investigated to what degree the difference between the actual location of the lead's tip and the location of the tip estimated from the MRI artifact varies depending on the MRI sequence parameters such as acquisition plane and phase encoding direction, as well as the lead's extracranial configuration. Accordingly, an imaging technique to increase the accuracy of lead localization was devised and discussed.

METHODS

We designed and constructed an anthropomorphic phantom with an implanted DBS system following 18 clinically relevant configurations. The phantom was scanned at a Siemens 1.5 Tesla Aera scanner using a T1MPRAGE sequence optimized for clinical use and a T1TSE sequence optimized for research purposes. We varied slice acquisition plane and phase encoding direction and calculated the distance between the caudal tip of the DBS lead MRI artifact and the actual tip of the lead, as estimated from MRI reference markers.

RESULTS

Imaging parameters and lead configuration substantially altered the difference in the depth of the lead within its MRI artifact on the scale of several millimeters - with a difference as large as 4.99 mm. The actual tip of the DBS lead was found to be consistently more rostral than the tip estimated from the MR image artifact. The smallest difference between the tip of the DBS lead and the tip of the MRI artifact using the clinically relevant sequence (i.e., T1MPRAGE) was found with the sagittal acquisition plane and anterior-posterior phase encoding direction.

DISCUSSION/CONCLUSION

The actual tip of an implanted DBS lead is located up to several millimeters rostral to the tip of the lead's artifact on postoperative MR images. This distance depends on the MRI sequence parameters and the DBS system's extracranial trajectory. MRI parameters may be altered to improve this localization.

A comparative study of RF heating of deep brain stimulation devices in vertical vs. horizontal MRI systems

The majority of studies that assess magnetic resonance imaging (MRI) induced radiofrequency (RF) heating of the tissue when active electronic implants are present have been performed in horizontal, closed-bore MRI systems. Vertical, open-bore MRI systems have a 90° rotated magnet and a fundamentally different RF coil geometry, thus generating a substantially different RF field distribution inside the body. Little is known about the RF heating of elongated implants such as deep brain stimulation (DBS) devices in this class of scanners. Here, we conducted the first large-scale experimental study investigating whether RF heating was significantly different in a 1.2 T vertical field MRI scanner (Oasis, Fujifilm Healthcare) compared to a 1.5 T horizontal field MRI scanner (Aera, Siemens Healthineers). A commercial DBS device mimicking 30 realistic patient-derived lead trajectories extracted from postoperative computed tomography images of patients who underwent DBS surgery at our institution was implanted in a multi-material, anthropomorphic phantom. RF heating around the DBS lead was measured during four minutes of high-SAR RF exposure. Additionally, we performed electromagnetic simulations with leads of various internal structures to examine this effect on RF heating. When controlling for RMS B1+, the temperature increase around the DBS lead-tip was significantly lower in the vertical scanner compared to the horizontal scanner (0.33 ± 0.24°C vs. 4.19 ± 2.29°C). Electromagnetic simulations demonstrated up to a 17-fold reduction in the maximum of 0.1g-averaged SAR in the tissue surrounding the lead-tip in the vertical scanner compared to the horizontal scanner. Results were consistent across leads with straight and helical internal wires. Radiofrequency heating and power deposition around the DBS lead-tip were substantially lower in the 1.2 T vertical scanner compared to the 1.5 T horizontal scanner. Simulations with different lead structures suggest that the results may extend to leads from other manufacturers.

On the accuracy of Tier 4 simulations to predict RF heating of wire implants during magnetic resonance imaging at 1.5 T

Magnetic Resonance Imaging (MRI) access remains conditional to patients with conductive medical implants, as RF heating generated around the implant during scanning may cause tissue burns. Experiments have been traditionally used to assess this heating, but they are time-consuming and expensive, and in many cases cannot faithfully replicate the in-vivo scenario. Alternatively, ISO TS 10974 outlines a four-tier RF heating assessment approach based on a combination of experiments and full-wave electromagnetic (EM) simulations with varying degrees of complexity. From these, Tier 4 approach relies entirely on EM simulations. There are, however, very few studies validating such numerical models against direct thermal measurements. In this work, we evaluated the agreement between simulated and measured RF heating around wire implants during RF exposure at 63.6 MHz (proton imaging at 1.5 T). Heating was assessed around wire implants with 25 unique trajectories within an ASTM phantom. The root mean square percentage error (RMSPE) of simulated vs. measured RF heating remained <1.6% despite the wide range of observed heating (0.2 °C-53 °C). Our results suggest that good agreement can be achieved between experiments and simulations as long as important experimental features such as characteristics of the MRI RF coil, implant's geometry, position, and trajectory, as well as electric and thermal properties of gel are closely mimicked in simulations.Clinical Relevance- This work validates the application of full-wave EM simulations for modeling and predicting RF heating of conductive wires in an MRI environment, providing researchers with a validated tool to assess MRI safety in patients with implants.

Predicting RF Heating of Conductive Leads During Magnetic Resonance Imaging at 1.5 T: A Machine Learning Approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:4204-4208. [PMID: 34892151 PMCID: PMC9940641 DOI: 10.1109/embc46164.2021.9630718]

The number of patients with active implantable medical devices continues to rise in the United States and around the world. It is estimated that 50-75% of patients with conductive implants will need magnetic resonance imaging (MRI) in their lifetime. A major risk of performing MRI in patients with elongated conductive implants is the radiofrequency (RF) heating of the tissue surrounding the implant's tip due to the antenna effect. Currently, applying full-wave electromagnetic simulation is the standard way to predict the interaction of MRI RF fields with the human body in the presence of conductive implants; however, these simulations are notoriously extensive in terms of memory requirement and computational time. Here we present a proof-of-concept simulation study to demonstrate the feasibility of applying machine learning to predict MRI-induced power deposition in the tissue surrounding conductive wires. We generated 600 clinically relevant trajectories of leads as observed in patients with cardiac conductive implants and trained a feedforward neural network to predict the 1g-averaged SAR at the lead tips knowing only the background field of MRI RF coil and coordinates of points along the lead trajectory. Training of the network was completed in 11.54 seconds and predictions were made within a second with R² = 0.87 and Root Mean Squared Error (RMSE) = 14.5 W/kg. Our results suggest that machine learning could provide a promising approach for safety assessment of MRI in patients with conductive leads.Clinical Relevance- Machine learning can potentially allow real-time assessment of MRI RF safety in patients with conductive leads when only the knowledge of lead's trajectory (image-based) and MRI RF coil features (vendor-specific) are in hand.

Modifying surgical implantation of deep brain stimulation leads significantly reduces RF-induced heating during 3 T MRI

Radiofrequency (RF) heating of tissue during magnetic resonance imaging (MRI) is a known safety risk in the presence of active implantable medical devices (AIMDs). As a result, access to MRI is limited for patients with these implants including those with deep brain stimulation (DBS) systems. Numerous factors contribute to excessive RF tissue heating at the DBS lead-tip, most notable being the trajectory of the lead. Phantom studies have demonstrated that looping the extracranial portion of the DBS lead at the surgical burr hole reduces the heating at the lead-tip; however, clinical implementation of this technique is challenging due to surgical constraints. As such, the intended looped trajectory is usually different from what is implanted in patients. To date, no data is available to quantify the extent by which surgical trajectory modification reduces RF heating of DBS leads compared to the typical surgical approach. In this work, we measured RF heating of a commercial DBS system during 3 T MRI, where the trajectory of the lead and extension cable mimicked lead trajectories constructed from postoperative CT images of 13 patients undergoing modified DBS surgery and 2 patients with unmodified trajectories. Two manually created trajectories mimicking typical heating cases seen in the literature were also evaluated. We found that modified lead trajectories reduced the average heating by 3-folds compared to unmodified lead trajectories.Clinical Relevance- This study evaluates the performance of a surgical modification in the routing of DBS leads in reducing RF-induced heating during MRI at 3 T.

Machine learning-based prediction of MRI-induced power absorption in the tissue in patients with simplified deep brain stimulation lead models

Interaction of an active electronic implant such as a deep brain stimulation (DBS) system and MRI RF fields can induce excessive tissue heating, limiting MRI accessibility. Efforts to quantify RF heating mostly rely on electromagnetic (EM) simulations to assess individualized specific absorption rate (SAR), but such simulations require extensive computational resources. Here, we investigate if a predictive model using machine learning (ML) can predict the local SAR in the tissue around tips of implanted leads from the distribution of the tangential component of the MRI incident electric field, E_tan. A dataset of 260 unique patient-derived and artificial DBS lead trajectories was constructed, and the 1 g-averaged SAR, 1gSAR_max, at the lead-tip during 1.5 T MRI was determined by EM simulations. E_tan values along each lead's trajectory and the simulated SAR values were used to train and test the ML algorithm. The resulting predictions of the ML algorithm indicated that the distribution of E_tan could effectively predict 1gSAR_max at the DBS lead-tip (R = 0.82). Our results indicate that ML has the potential to provide a fast method for predicting MR-induced power absorption in the tissue around tips of implanted leads such as those in active electronic medical devices.

Safety and image quality at 7T MRI for deep brain stimulation systems: Ex vivo study with lead-only and full-systems

Ultra-high field MRI at 7 T can produce much better visualization of sub-cortical structures compared to lower field, which can greatly help target verification as well as overall treatment monitoring for patients with deep brain stimulation (DBS) implants. However, use of 7 T MRI for such patients is currently contra-indicated by guidelines from the device manufacturers due to the safety issues. The aim of this study was to provide an assessment of safety and image quality of ultra-high field magnetic resonance imaging at 7 T in patients with deep brain stimulation implants. We performed experiments with both lead-only and complete DBS systems implanted in anthropomorphic phantoms. RF heating was measured for 43 unique patient-derived device configurations. Magnetic force measurements were performed according to ASTM F2052 test method, and device integrity was assessed before and after experiments. Finally, we assessed electrode artifact in a cadaveric brain implanted with an isolated DBS lead. RF heating remained below 2°C, similar to a fever, with the 95% confidence interval between 0.38°C-0.52°C. Magnetic forces were well below forces imposed by gravity, and thus not a source of concern. No device malfunctioning was observed due to interference from MRI fields. Electrode artifact was most noticeable on MPRAGE and T2*GRE sequences, while it was minimized on T2-TSE images. Our work provides the safety assessment of ultra-high field MRI at 7 T in patients with DBS implants. Our results suggest that 7 T MRI may be performed safely in patients with DBS implants for specific implant models and MRI hardware.

A technique for the reduction of RF-induced heating of active implantable medical devices during MRI

PURPOSE

The paper presents a novel method to reduce the RF-induced heating of active implantable medical devices during MRI.

METHODS

With the addition of an energy decoying and dissipating structure, RF energy can be redirected toward the dissipating rings through the decoying conductor. Three lead groups (45 cm-50 cm) and 4 (50 cm-100 cm) were studied in 1.5 Tesla MR systems by simulation and measurement, respectively. In vivo modeling was performed using human models to estimate the RF-induced heating of an active implantable medical device for spinal cord treatment.

RESULT

In the simulation study, it was shown that the peak 1g-averaged specific absorption rate near the lead-tips can be reduced by 70% to 80% compared to those from the control leads. In the experimental measurements during a 2-min exposure test in a 1.5 Telsa MR system, the temperature rises dropped from the original 18.3℃, 25.8℃, 8.1℃, and 16.1℃ (control leads 1-4) to 5.4℃, 6.9℃, 1.6℃, and 3.3℃ (leads 1-4 with the energy decoying and dissipation structure). The in vivo calculation results show that the maximum induced temperature rise among all cases can be substantially reduced (up to 80%) when the energy decoying and dissipating structures were used.

CONCLUSION

Our studies confirm the effectiveness of the novel technique for a variety of scanning scenarios. The results also indicate that the decoying conductor length, number of rings, and ring area must be carefully chosen and validated.

Vertical open-bore MRI scanners generate significantly less radiofrequency heating around implanted leads: A study of deep brain stimulation implants in 1.2T OASIS scanners versus 1.5T horizontal systems

PURPOSE

Patients with active implants such as deep brain stimulation (DBS) devices are often denied access to MRI due to safety concerns associated with the radiofrequency (RF) heating of their electrodes. The majority of studies on RF heating of conductive implants have been performed in horizontal close-bore MRI scanners. Vertical MRI scanners which have a 90° rotated transmit coil generate fundamentally different electric and magnetic field distributions, yet very little is known about RF heating of implants in this class of scanners. We performed numerical simulations as well as phantom experiments to compare RF heating of DBS implants in a 1.2T vertical scanner (OASIS, Hitachi) compared to a 1.5T horizontal scanner (Aera, Siemens).

METHODS

Simulations were performed on 90 lead models created from post-operative CT images of patients with DBS implants. Experiments were performed with wires and commercial DBS devices implanted in an anthropomorphic phantom.

RESULTS

We found significant reduction of 0.1 g-averaged specific absorption rate (30-fold, P < 1 × 10^-5 ) and RF heating (9-fold, P < .026) in the 1.2T vertical scanner compared to the 1.5T conventional scanner.

CONCLUSION

Vertical MRI scanners appear to generate lower RF heating around DBS leads, providing potentially heightened safety or the flexibility to use sequences with higher power levels than on conventional systems.

Safety of MRI in the localization of implanted intracranial electrodes for refractory epilepsy

BACKGROUND AND PURPOSE

This is an observational study to evaluate the safety of magnetic resonance imaging (MRI) to localize subdural grids and depth electrodes in patients with refractory epilepsy using a 1.5 Tesla MR scanner.

METHODS

We implemented an optimized MRI protocol providing adequate image quality for the assessment of subdural grids and depth electrodes, while minimizing the specific absorption rate (SAR). We reviewed all MRI studies performed in patients with subdural grids and depth electrodes between January 2010 and October 2018. Image quality was graded as acceptable or nonacceptable for the assessment of intracranial device positioning. We reviewed the medical record and any imaging obtained after intracranial implant removal for adverse event or complication occurring during and after the procedure.

RESULTS

Ninety-nine patients with refractory epilepsy underwent MRI scans using a magnetization-prepared rapid acquisition of gradient echo sequence and a transmit-receive head coil with depth electrodes and subdural grids in place. Two patients underwent two separate depth electrode implantations for a total of 101 procedures and MRI scans. No clinical adverse events were reported during or immediately after imaging. Image quality was graded as acceptable for 97 MRI scans. Review of follow-up CT and MRI studies after implant removal, available for 70 patients, did not demonstrate unexpected complications in 69 patients.

CONCLUSION

In our experience, a low SAR MRI protocol can be used to safely localize intracranial subdural grids and depth electrode in patients with refractory epilepsy.

Silicon Carbide and MRI: Towards Developing a MRI Safe Neural Interface

An essential method to investigate neuromodulation effects of an invasive neural interface (INI) is magnetic resonance imaging (MRI). Presently, MRI imaging of patients with neural implants is highly restricted in high field MRI (e.g., 3 T and higher) due to patient safety concerns. This results in lower resolution MRI images and, consequently, degrades the efficacy of MRI imaging for diagnostic purposes in these patients. Cubic silicon carbide (3C-SiC) is a biocompatible wide-band-gap semiconductor with a high thermal conductivity and magnetic susceptibility compatible with brain tissue. It also has modifiable electrical conductivity through doping level control. These properties can improve the MRI compliance of 3C-SiC INIs, specifically in high field MRI scanning. In this work, the MRI compliance of epitaxial SiC films grown on various Si wafers, used to implement a monolithic neural implant (all-SiC), was studied. Via finite element method (FEM) and Fourier-based simulations, the specific absorption rate (SAR), induced heating, and image artifacts caused by the portion of the implant within a brain tissue phantom located in a 7 T small animal MRI machine were estimated and measured. The specific goal was to compare implant materials; thus, the effect of leads outside the tissue was not considered. The results of the simulations were validated via phantom experiments in the same 7 T MRI system. The simulation and experimental results revealed that free-standing 3C-SiC films had little to no image artifacts compared to silicon and platinum reference materials inside the MRI at 7 T. In addition, FEM simulations predicted an ~30% SAR reduction for 3C-SiC compared to Pt. These initial simulations and experiments indicate an all-SiC INI may effectively reduce MRI induced heating and image artifacts in high field MRI. In order to evaluate the MRI safety of a closed-loop, fully functional all-SiC INI as per ISO/TS 10974:2018 standard, additional research and development is being conducted and will be reported at a later date.

Patient's body composition can significantly affect RF power deposition in the tissue around DBS implants: ramifications for lead management strategies and MRI field-shaping techniques

Patients with active implants such as deep brain stimulation (DBS) devices have limited access to magnetic resonance imaging (MRI) due to risks associated with RF heating of implants in MRI environment. With an aging population and increased prevalence of neurodegenerative disease, the indication for MRI exams in patients with such implants increases as well. In response to this growing need, many groups have investigated strategies to mitigate RF heating of DBS implants during MRI. These efforts fall into two main categories: MRI field-shaping methods, where the electric field of the MRI RF coil is modified to reduce the interaction with implanted leads, and lead management techniques where surgical modifications in the trajectory reduces the coupling with RF fields. Studies that characterize these techniques, however, have relied either on simulations with homogenous body models, or experiments with box-shaped single-material phantoms. It is well established, however, that the shape and heterogeneity of human body affects the distribution of RF electric fields, which by proxy, alters the heating of an implant inside the body. In this contribution, we applied numerical simulations and phantom experiments to examine the degree to which variations in patient's body composition affects RF power deposition. We then assessed effectiveness of RF-heating mitigation strategies under variant patient body compositions. Our results demonstrated that patient's body composition substantially alters RF power deposition in the tissue around implanted leads. However, both techniques based on MRI field-shaping and DBS lead management performed well under variant body types.

Reducing MRI RF-induced heating for the external fixation using capacitive structures

This paper presents a generic method to reduce the radiofrequency (RF) induced heating of external fixation devices during the magnetic resonance imaging (MRI) procedure. A simplified equivalent circuit model was developed to illustrate the interaction between the external fixation device and the MRI RF field. Carefully designed mechanical structures, which utilize capacitive reactance from the circuit model, were applied to the external fixation device to mitigate the coupling between the external fixation device and the MRI RF field for RF-induced heating reduction. Both numerical and experimental studies were performed to demonstrate the validity of the circuit model and the effectiveness of the proposed method. By adding capacitive structures in both the clamp-pin and rod-clamp joints, the peak specific absorption rate averaged in 1 gram (SAR_1g) near the pin tips were reduced from 760.4 W kg^-1 to 12.0 W kg^-1 at 1.5 T and 391.5 W kg^-1 to 25.2 W kg^-1 at 3 T from numerical simulations. Experimental results showed that RF-induced heating was reduced from 7.85 °C to 1.01 °C at 1.5 T and from 16.70 °C to 0.32 °C at 3 T for the external fixation device studied here. The carefully designed capacitive structures can be used to detune the coupling between the external fixation device and the MRI fields to reduce the RF-induced heating in the human body for both 1.5 T and 3 T MRI systems. However, as RF-induced heating is very device and design specific all devices must be thoroughly tested based on its final design.

RF heating of deep brain stimulation implants during MRI in 1.2 T vertical scanners versus 1.5 T horizontal systems: A simulation study with realistic lead configurations

Patients with deep brain stimulation (DBS) implants are often denied access to magnetic resonance imaging (MRI) due to safety concerns associated with RF heating of implants. Although MR-conditional DBS devices are available, complying with manufacturer guidelines has proved to be difficult as pulse sequences that optimally visualize DBS target structures tend to have much higher specific absorption rate (SAR) of radiofrequency energy than current guidelines allow. The MR-labeling of DBS devices, as well as the majority of studies on RF heating of conductive implants have been limited to horizontal close-bore MRI scanners. Vertical MRI scanners, originally introduced as open low-field MRI systems, are now available at 1.2 T field strength, capable of high-resolution structural and functional imaging. No literature exists on DBS SAR in this class of scanners which have a 90° rotated transmit coil and thus, generate a fundamentally different electric and magnetic field distributions. Here we present a simulation study of RF heating in a cohort of forty patient-derived DBS lead models during MRI in a commercially available vertical openbore MRI system (1.2 T OASIS, Hitachi) and a standard horizontal 1.5 T birdcage coil. Simulations were performed at two major imaging landmarks representing head and chest imaging. We calculated the maximum of 0.1g-averaged SAR (0.1g-SARMax) around DBS lead tips when a B1+ = 4 µT was generated on an axial plane passing through patients body. For head landmark, 0.1g-SARMax reached 220±188 W/kg in the 1.5 T birdcage coil, but only 14±11 W/kg in the OASIS coil. For chest landmark, 0.1g-SARMax was 24±17 W/kg in the 1.5 T birdcage coil and 3±2 W/kg in the OASIS coil. A paired two-tail t-test revealed a significant reduction in SAR with a large effect-size during head MRI (p < 1.5×10-8, Cohen's d = 1.5) as well as chest MRI (p < 6.5×10-10, Cohen's d = 1.7) in 1.2 T Hitachi OASIS coil compared to a standard 1.5 T birdcage transmitter. Our findings suggest that open-bore vertical scanners may offer an untapped opportunity for MRI of patients with DBS implants.

A counterpoise design for RF-induced heating reduction

This paper presents a novel lead body design for active implantable medical devices (AIMD) to reduce Radio-frequency (RF) induced heating during magnetic resonance imaging (MRI) scanning. By introducing a counterpoise electrode to the original lead construct, part of the RF-induced energy can be decoyed into the surrounding tissues while the therapy signal is intact. The numerical simulation studies of three leads with different configurations are presented to demonstrate the effectiveness of this technique. From simulation results at 1.5 T, the peak 1g average SAR value can be reduced by a factor of 3 when the length of the counterpoise electrode is properly designed.

Evaluating Accuracy of Numerical Simulations in Predicting Heating of Wire Implants During MRI at 1.5 T

Patients with long conductive implants such as deep brain stimulation (DBS) leads are often denied access to magnetic resonance imaging (MRI) exams due to safety concerns associated with radiofrequency (RF) heating of implants. Experimental temperature measurements in tissue-mimicking gel phantoms under MRI RF exposure conditions are common practices to predict in-vivo heating in the tissue surrounding wire implants. Such experiments are both expensive-as they require access to MRI units-and time-consuming due to complex implant setups. Recently, full-wave numerical simulations, which include realistic MRI RF coil models and human phantoms, are suggested as an alternative to experiments. There is however, little literature available on the accuracy of such numerical models against direct thermal measurements. This study aimed to evaluate the agreement between simulations and measurements of temperature rise at the tips of wire implants exposed to RF exposure at 64 MHz (1.5 T) for different implant trajectories typically encountered in patients with DBS leads. Heating was assessed in seven patient-derived lead configurations using both simulations and RF heating measurements during imaging of an anthropomorphic head phantom with implanted wires. We found substantial variation in RF heating as a function of lead trajectory; there was a 9.5-fold and 9-fold increase in temperature rise from ID1 to ID7 during simulations and experimental measurements, respectively. There was a strong correlation (r2 = 0.74) between simulated and measured temperatures for different lead trajectories. The maximum difference between simulated and measured temperature was 0.26 °C with simulations overestimating the temperature rise.

Improving Safety of MRI in Patients with Deep Brain Stimulation Devices

MRI is a valuable clinical and research tool for patients undergoing deep brain stimulation (DBS). However, risks associated with imaging DBS devices have led to stringent regulations, limiting the clinical and research utility of MRI in these patients. The main risks in patients with DBS devices undergoing MRI are heating at the electrode tips, induced currents, implantable pulse generator dysfunction, and mechanical forces. Phantom model studies indicate that electrode tip heating remains the most serious risk for modern DBS devices. The absence of adverse events in patients imaged under DBS vendor guidelines for MRI demonstrates the general safety of MRI for patients with DBS devices. Moreover, recent work indicates that-given adequate safety data-patients may be imaged outside these guidelines. At present, investigators are primarily focused on improving DBS device and MRI safety through the development of tools, including safety simulation models. Existing guidelines provide a standardized framework for performing safe MRI in patients with DBS devices. It also highlights the possibility of expanding MRI as a tool for research and clinical care in these patients going forward.

RF heating of deep brain stimulation implants in open-bore vertical MRI systems: A simulation study with realistic device configurations

PURPOSE

Patients with deep brain stimulation (DBS) implants benefit highly from MRI, however, access to MRI is restricted for these patients because of safety hazards associated with RF heating of the implant. To date, all MRI studies on RF heating of medical implants have been performed in horizontal closed-bore systems. Vertical MRI scanners have a fundamentally different distribution of electric and magnetic fields and are now available at 1.2T, capable of high-resolution structural and functional MRI. This work presents the first simulation study of RF heating of DBS implants in high-field vertical scanners.

METHODS

We performed finite element electromagnetic simulations to calculate specific absorption rate (SAR) at tips of DBS leads during MRI in a commercially available 1.2T vertical coil compared to a 1.5T horizontal scanner. Both isolated leads and fully implanted systems were included.

RESULTS

We found 10- to 30-fold reduction in SAR implication at tips of isolated DBS leads, and up to 19-fold SAR reduction at tips of leads in fully implanted systems in vertical coils compared to horizontal birdcage coils.

CONCLUSIONS

If confirmed in larger patient cohorts and verified experimentally, this result can open the door to plethora of structural and functional MRI applications to guide, interpret, and advance DBS therapy.

Reconfigurable MRI coil technology can substantially reduce RF heating of deep brain stimulation implants: First in-vitro study of RF heating reduction in bilateral DBS leads at 1.5 T

Patients with deep brain stimulation (DBS) implants can significantly benefit from magnetic resonance imaging (MRI), however access to MRI is restricted in these patients because of safety concerns due to RF heating of the leads. Recently we introduced a patient-adjustable reconfigurable transmit coil for low-SAR imaging of DBS at 1.5T. A previous simulation study demonstrated a substantial reduction in the local SAR around single DBS leads in 9 unilateral lead models. This work reports the first experimental results of temperature measurement at the tips of bilateral DBS leads with realistic trajectories extracted from postoperative CT images of 10 patients (20 leads in total). A total of 200 measurements were performed to record temperature rise at the tips of the leads during 2 minutes of scanning with the coil rotated to cover all accessible rotation angles. In all patients, we were able to find an optimum coil rotation angle and reduced the heating of both left and right leads to a level below the heating produced by the body coil. An average heat reduction of 65% was achieved for bilateral leads. When considering each lead alone, an average heat reduction of 80% was achieved. Our results suggest that reconfigurable coil technology introduces a promising approach for imaging of patients with DBS implants.

Reconfigurable MRI technology for low-SAR imaging of deep brain stimulation at 3T: Application in bilateral leads, fully-implanted systems, and surgically modified lead trajectories

Patients with deep brain stimulation devices highly benefit from postoperative MRI exams, however MRI is not readily accessible to these patients due to safety risks associated with RF heating of the implants. Recently we introduced a patient-adjustable reconfigurable coil technology that substantially reduced local SAR at tips of single isolated DBS leads during MRI at 1.5 T in 9 realistic patient models. This contribution extends our work to higher fields by demonstrating the feasibility of scaling the technology to 3T and assessing its performance in patients with bilateral leads as well as fully implanted systems. We developed patient-derived models of bilateral DBS leads and fully implanted DBS systems from postoperative CT images of 13 patients and performed finite element simulations to calculate SAR amplification at electrode contacts during MRI with a reconfigurable rotating coil at 3T. Compared to a conventional quadrature body coil, the reconfigurable coil system reduced the SAR on average by 83% for unilateral leads and by 59% for bilateral leads. A simple surgical modification in trajectory of implanted leads was demonstrated to increase the SAR reduction efficiency of the rotating coil to >90% in a patient with a fully implanted bilateral DBS system. Thermal analysis of temperature-rise around electrode contacts during typical brain exams showed a 15-fold heating reduction using the rotating coil, generating <1°C temperature rise during ∼4-min imaging with high-SAR sequences where a conventional CP coil generated >10°C temperature rise in the tissue for the same flip angle.