title: Safety of externally stimulated intracranial electrodes during functional MRI at 1.5T.
abstract: Surgical resection of the epileptogenic zone (EZ) is a potential cure for medically refractory focal epilepsy. Proper identification of the EZ is essential for such resection. Synergistic application of functional magnetic resonance imaging (fMRI) simultaneously with stimulation of a single externalized intracranial stereotactic EEG (SEEG) electrode has the potential to improve identification of the EZ. While most EEG-fMRI studies use the electrodes passively to record electrical activity, it is possible to stimulate the brain using the electrodes by connecting them with conducting cables to the stimulation hardware. In this study, we investigated the effect of MRI-induced heating on a single SEEG electrode and its sensitivity to geometry, configuration, and associated connections required for the stimulation. The temperature increase of a single electrode embedded within a gel phantom and connected to an external stimulation system was measured during 1.5T MRI scans using adjacent fluoroptic temperature sensors. A receive-only split-array head coil and a transmit-receive head coil were used for testing. Sequences included a standard localizer, T1-weighted axial fast low-angle shot (FLASH), gradient echo-planar imaging (GE-EPI) axial fMRI, and a high specific absorption rate T2-weighted turbo spin-echo (TSE) axial scan. Variations of the electrode location and connecting cable configuration were tested. No unacceptable heating was observed with the standard sequences used for evaluation of the EZ. Considerable heating (up to 14°C) was observed with the TSE sequence, which is not used clinically. The temperature increase was insignificant (<0.05°C) for electrode contacts closest to the isocenter and connecting cables lying along the isocenter, and varied with configurations of the connecting cable assembly. Simultaneous intracranial electrode stimulation during fMRI using an externalized stimulation system may be safe with strict adherence to settings tested prior to the fMRI. Localizer, FLASH, and GE-EPI fMRI may be safely performed in patients with a single SEEG electrode following the configurations tested in this study, but high SAR TSE scans should not be performed in these patients.
authors.affiliation: Cleveland Clinic Foundation, Imaging Institute, USA; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Radiology, Cleveland, OH, USA.
authors.forename: Pallab K
authors.initials: PK
authors.lastname: Bhattacharyya
authors.affiliation: Cleveland Clinic Foundation, Department of Neurological Surgery, USA.
authors.forename: Jeffery
authors.initials: J
authors.lastname: Mullin
authors.affiliation: Cleveland Clinic Foundation, Department of Neurological Surgery, USA.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Cleveland Clinic Foundation, Department of Neurological Surgery, USA; Cleveland Clinic Foundation, Epilepsy Center, USA.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Gonzalez-Martinez
authors.affiliation: Cleveland Clinic Foundation, Imaging Institute, USA; Cleveland Clinic Foundation, Epilepsy Center, USA. Electronic address: Joness19@ccf.org.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Jones
mesh_terms: D000886:Anthropometry; D001921:Brain / Q000000981:diagnostic imaging; D017352:Echo-Planar Imaging / Q000295:instrumentation; D004566:Electrodes; D004569:Electroencephalography / Q000295:instrumentation*; D006358:Hot Temperature; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D061214:Patient Safety; D019047:Phantoms, Imaging
keywords: Electrodes; Epilepsy; Functional MRI; Heating; Safety; Stereoelectroencephalography