title: Optimized, Minimal Specific Absorption Rate MRI for High-Resolution Imaging in Patients with Implanted Deep Brain Stimulation Electrodes.
abstract: OBJECTIVE
  Obtaining high-resolution brain MR imaging in patients with a previously implanted deep brain stimulator has been challenging and avoided by many centers due to safety concerns relating to implantable devices. We present our experience with a practical clinical protocol at 1.5T by using 2 magnet systems capable of achieving presurgical quality imaging in patients undergoing bilateral, staged deep brain stimulator insertion.
  
  
  METHODS
  Protocol optimization was performed to minimize the specific absorption rate while providing image quality necessary for adequate surgical planning of the second electrode placement. We reviewed MR imaging studies performed with a minimal specific absorption rate protocol in patients with a deep brain stimulator in place at our institution between February 1, 2012, and August 1, 2015. Images were reviewed by a neuroradiologist and a functional neurosurgeon. Image quality was qualitatively graded, and the presence of artifacts was noted.
  
  
  RESULTS
  Twenty-nine patients (22 with Parkinson disease, 6 with dystonia, 1 with essential tremor) were imaged with at least 1 neuromodulation implant in situ. All patients were imaged under general anesthesia. There were 25 subthalamic and 4 globus pallidus implants. Nineteen patients were preoperative for the second stage of bilateral deep brain stimulator placement; 10 patients had bilateral electrodes in situ and were being imaged for other neurologic indications, including lead positioning. No adverse events occurred during or after imaging. Mild device-related local susceptibility artifacts were present in all studies, but they were not judged to affect overall image quality. Minimal aliasing artifacts were seen in 7, and moderate motion, in 4 cases on T1WI only. All preoperative studies were adequate for guidance of a second deep brain stimulator placement.
  
  
  CONCLUSIONS
  An optimized MR imaging protocol that minimizes the specific absorption rate can be used to safely obtain high-quality images in patients with previously implanted deep brain stimulators, and these images are adequate for surgical guidance.
authors.affiliation: From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.).
authors.forename: A M
authors.identifier: http://orcid.org/0000-0003-2577-9738
authors.initials: AM
authors.lastname: Franceschi
authors.affiliation: From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.).
authors.forename: G C
authors.identifier: http://orcid.org/0000-0002-5899-6993
authors.initials: GC
authors.lastname: Wiggins
authors.affiliation: Neurosurgery (A.Y.M.), New York University School of Medicine, New York, New York.
authors.forename: A Y
authors.identifier: http://orcid.org/0000-0003-1493-0463
authors.initials: AY
authors.lastname: Mogilner
authors.affiliation: From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.).
authors.forename: T
authors.identifier: http://orcid.org/0000-0003-0232-1636
authors.initials: T
authors.lastname: Shepherd
authors.affiliation: From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.).
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-1132-900X
authors.initials: S
authors.lastname: Chung
authors.affiliation: From the Departments of Radiology (A.M.F., G.C.W., T.S., S.C., Y.W.L.) Yvonne.lui@nyumc.org.
authors.forename: Y W
authors.identifier: http://orcid.org/0000-0002-9984-9164
authors.initials: YW
authors.lastname: Lui