脑深部电刺激术后磁共振成像:现状与进展

doi:10.19854/j.cnki.1008-2425.2023.05.0010

摘要/Abstract

摘要： 患有运动障碍和精神疾病的患者,越来越多地通过植入脑深部电刺激(Deep brain stimulation,DBS)系统来得到治疗。该类患者的围术期与远期术后检查,都需要影像学支持。磁共振成像(Magnetic Resonance Imaging,MRI)是对这些患者进行监测和诊断的首选方式。然而,MRI的磁场环境和植入物之间的相互作用给患者带来了潜在的健康隐患,如局部异常发热和设备故障。这种矛盾使得研发兼容MRI的DBS系统变得迫切。近年来,兼容MRI的DBS系统得到初步发展,能够兼容较低磁场强度(如1.5T)的DBS系统已经进入临床,而提高兼容的MRI磁场强度的同时抑制伪影、更加精确地成像和防范MRI相关不良反应,是当下临床对DBS系统提出的更高要求。本文综合以往相关文献,对DBS术后MRI扫描的现状,不良反应及其原因和MRI兼容DBS系统的近年的发展趋势做一综述,以期对临床工作提供一定指导。

中图分类号:

R741

刘杰, 马硕, 王宇涵, 潘宜新, 孙伯民. 脑深部电刺激术后磁共振成像:现状与进展[J]. 立体定向和功能性神经外科杂志, 2023, 36(5): 309-315.

参考文献

[1] Lozano AM,Lipsman N.Probing and regulating dysfunctional circuits using deep brain stimulation[J].Neuron,2013,77(3):406~424.
[2] Lozano AM,Lipsman N,Bergman H,et al.Deep brain stimulation:current challenges and future directions[J].Nat Rev Neurol,2019,15(3):148~160.
[3] Sheth SA,Bijanki KR,Metzger B,et al.Deep brain stimulation for depression informed by intracranial recordings[J].Biological Psychiatry,2022,92(3):246~251.
[4] Hariz M.My 25 stimulating years with DBS in parkinson's Disease[J].J Parkinsons Dis,2017,7(s1):S33~S41.
[5] Lauterbur PC.Image formation by induced local interactions.Examples employing nuclear magnetic resonance.1973[J].Clin Orthop Relat Res,1989,(244):3~6.
[6] Watson RE.Lessons Learned from MRI Safety Events[J].Current Radiology Reports,2015,3(10):37.
[7] O'gorman RL,Jarosz JM,Samuel M,et al.CT/MR image fusion in the postoperative assessment of electrodes implanted for deep brain stimulation[J].Stereotactic and functional neurosurgery,2009,87(4):205~210.
[8] Bot M,Van Den Munckhof P,Bakay R,et al.Accuracy of intraoperative computed tomography during deep brain stimulation procedures:comparison with postoperative magnetic resonance imaging[J].Stereotactic and Functional Neurosurgery,2017,95(3):183~188.
[9] Merola A,Singh J,Reeves K,et al.New frontiers for deep brain stimulation:directionality,sensing technologies,remote programming,robotic stereotactic assistance,asleep procedures,and connectomics[J].Front Neurol,2021,12:694747.
[10] Dormont D,Seidenwurm D,Galanaud D,et al.Neuroimaging and deep brain stimulation[J].AJNR Am J Neuroradiol,2010,31(1):15~23.
[11] Falowski S,Safriel Y,Ryan MP,et al.The rate of magnetic resonance imaging in patients with deep brain stimulation[J].Stereotact Funct Neurosurg,2016,94(3):147~153.
[12] Bove F,Mulas D,Cavallieri F,et al.Long-term outcomes (15 Years) after subthalamic nucleus deep brain stimulation in patients with Parkinson disease[J].Neurology,2021,97(3):e254.
[13] Hancu I,Boutet A,Fiveland E,et al.On the (Non-)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients[J].J Magn Reson Imaging,2019,49(6):1736~1749.
[14] Horn A,Wenzel G,Irmen F,et al.Deep brain stimulation induced normalization of the human functional connectome in Parkinson's disease[J].Brain,2019,142(10):3129~3143.
[15] Hiss S,Hesselmann V,Hunsche S,et al.Intraoperative functional magnetic resonance imaging for monitoring the effect of deep brain stimulation in patients with obsessive-compulsive disorder[J].Stereotactic and functional neurosurgery,2015,93(1):30~37.
[16] Miao J,Tantawi M,Koa V,et al.Use of Functional MRI in deep brain stimulation in parkinson's diseases:A systematic review[J].Front Neurol,2022,13:849918.
[17] Loh A,Gwun D,Chow CT,et al.Probing responses to deep brain stimulation with functional magnetic resonance imaging[J].Brain Stimul,2022,15(3):683~694.
[18] Vasques X,Tancu C,Cif L,et al.Cerebral magnetic resonance imaging feasibility in patients with implanted neurostimulation system for deep brain stimulation[J].The open magnetic resonance journal,2008,1(1).
[19] Tagliai M,Jankovic J,Pagan F,et al.Safety of MRI in patients with implanted deep brain stimulation devices[J].Neuroimage,2009,47:T53~T57.
[20] Siiegel 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.Case report[J].J Neurosurg,2003,99(4):772~774.
[21] 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[J].World Neurosurg,2011,76(1-2).
[22] 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[J].Neurosurgery,2005,57(5):E1063;discussion E.
[23] Weise LM,Schneider GH,Kupsch A,et al.Postoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol[J].Acta Neurochir (Wien),2010,152(12):2021~2027.
[24] Larson PS,Richardson RM,Starr PA,et al.Magnetic resonance imaging of implanted deep brain stimulators:experience in a large series[J].Stereotactic and Functional Neurosurgery,2008,86(2).
[25] Martin AJ.MRI in patients with deep brain stimulation electrodes:balancing risks and benefits[J].Radiology,2019,293(1):184~185.
[26] Rezai AR,Phillips M,Baker KB,et al.Neurostimulation system used for deep brain stimulation (DBS):MR safety issues and implications of failing to follow safety recommendations[J].Invest Radiol,2004,39(5):300~303.
[27] Boutet A,Chow CT,Narang K,et al.Improving safety of MRI in patients with deep brain stimulation devices[J].Radiology,2020,296(2):250~262.
[28] Kalin R,Stanton MS.Current clinical issues for MRI scanning of pacemaker and defibrillator patients[J].Pace-Pacing And Clinical Electrophysiology,2005,28(4):326~328.
[29] Oluigbo CO,Rezal AR.Magnetic resonance imaging safety of deep brain stimulator devices[J].Handb Clin Neurol,2013,116:73~76.
[30] 张宇晶.脑深部电刺激装置的MRI相容性[J].中国医疗器械杂志,2013,37(4):244~247.
[31] Winter L,Seifert F,Zilberti L,et al.MRI-related heating of implants and devices:A review[J].J Magn Reson Imaging,2021,53(6):1646~665.
[32] Ruggera PS,Witters DM,Von Maltzahn G,et al.In vitro assessment of tissue heating near metallic medical implants by exposure to pulsed radio frequency diathermy[J].Phys Med Biol,2003,48(17):2919~2928.
[33] Kazemivalipour E,Keil B,Vali A,et al.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[J].NeuroImage,2019,199:18~29.
[34] Medtronic.MRI guidelines for Medtronic deep brain stimulation systems[EB/OL].(2015-12-01)[2023-03-15].https://mriquestions.com/uploads/3/4/5/7/34572113/dbs_medtronics_contrib_228155.pdf
[35] Scientific B.ImageReady MRI Guidelines for Boston Scientific Deep Brain Stimulation Systems[EB/OL].(2020-04-01)[2023-03-15].https://www.bostonscientific.com/content/dam/elabeling/nm/92328636-10B_MRI%20Guide_for_DB_StimSystem_IFU_MRI_OUS_ML_s.pdf
[36] Medical SJ.MRI procedure information for St.Jude Medical MR conditional deep brain stimulation systems.[EB/OL].(2019-07-01)[2023-03-15].https://www.neuromodulation.abbott/us/en/healthcare-professionals/mri-support/mri-dbs-full-systems.html
[37] Boutet A,Hancu I,Saha U,et al.3-tesla MRI of deep brain stimulation patients: Safety assessment of coils and pulse sequences[J].Journal of Neurosurgery,2020,132(2): 586-594.
[38] Boston Scientific Receives FDA Approval For The Vercise Genus? Deep Brain Stimulation System[EB/OL] (2021-01-22)[2023-03-15]. https://news.bostonscientific.com/2021-01-22-Boston-Scientific-Receives-FDA-Approval-For-The-Vercise-Genus-TM-Deep-Brain-Stimulation-System.
[39] G106R,安全3T 随心全身 3.0TMRI 全身核磁兼容[EB/OL] (2022-02-23)[2023-03-15].http://www.pinsmedical.com/nd.jsp?id=104.
[40] Erhardt JB,Fuhrer E,Gruschke OG,et al.Should patients with brain implants undergo MRI?[J].J Neural Eng,2018,15(4):041002.
[41] Bhusal B,Nguyen BT,Sanpitak PP,et al.Effect of device configuration and patient's body composition on the RF heating and nonsusceptibility artifact of deep brain stimulation implants during MRI at 1.5T and 3T[J].J Magn Reson Imaging,2021,53(2):599~610.
[42] Bhusal B,Stockmann J,Guerin B,et al.Safety and image quality at 7T MRI for deep brain stimulation systems:Ex vivo study with lead-only and full-systems[J].PLoS One,2021,16(9):e0257077.
[43] Vu J,Bhusal B,Nguyen BT,et al.A comparative study of RF heating of deep brain stimulation devices in vertical vs.horizontal MRI systems[J].PLoS One,2022,17(12):e0278187.
[44] Elwassif MM,Kong Q,Vazquez M,et al.Bio-heat transfer model of deep brain stimulation-induced temperature changes[J].J Neural Eng,2006,3(4):306~315.
[45] Elwassif MM,Datta A,Rahman A,et al.Temperature control at DBS electrodes using a heat sink:experimentally validated FEM model of DBS lead architecture[J].J Neural Eng,2012,9(4):046009.
[46] Khadka N,HarmsenARMSEN i E,Lozano AM,et al.Bio-heat model of kilohertz-frequency deep brain stimulation increases brain tissue temperature[J].Neuromodulation,2020,23(4):489~495.
[47] Fujimoto K,Angelone LM,Lucano E,et al.Radio-frequency safety assessment of stents in blood vessels during magnetic resonance imaging[J].Front Physiol,2018,9:1439.
[48] Csrluccio G,Akgun C,Vaughan J T,et al.Temperature-based MRI safety simulations with a limited number of tissues[J].Magnetic Resonance In Medicine,2021,86(1):543~550.
[49] Golestanirad L,Angelone LM,Kirsch J,et al.Reducing RF-induced heating near implanted leads through high-dielectric capacitive bleeding of current (CBLOC)[J].IEEE Trans Microw Theory Tech,2019,67(3):1265~1273.
[50] Bonmassar G,Serano P.MRI-Induced heating of coils for microscopic magnetic stimulation at 1.5 Tesla:An Initial Study[J].Front Hum Neurosci,2020,14:53.
[51] Jimenez-Shahed J.Device profile of the percept PC deep brain stimulation system for the treatment of Parkinson's disease and related disorders[J].Expert Rev Med Devices,2021,18(4):319~332.
[52] Yang R.Effective methods to reduce the Rf-Induced heating for medical implants in mri[D].University of Houston,2020.
[53] Zheng J,Yang R,Wang Q,et al.Reducing MRI RF-induced heating for the external fixation using capacitive structures[J].Phys Med Biol,2020,65(15):155017.
[54] Sfondrini MF,Gallo S,Pascadopoli M,et al.Effect of magnetic resonance imaging at 1.5 T and 3 T on temperature and bond strength of orthodontic bands with welded tubes:An in vitro study[J].Materials (Basel),2023,16(2).
[55] Boutet A,Rashid T,Hancu I,et al.Functional MRI safety and artifacts during deep brain stimulation:experience in 102 patients[J].Radiology,2019,293(1):174~183.
[56] Li Y,Buch S,He N,et al.Imaging patients pre and post deep brain stimulation:Localization of the electrodes and their targets[J].Magn Reson Imaging,2021,75:34~44.
[57] 李波姜,张锋,李路明.基于伪影模板的术后电极定位方法[J].清华大学学报(自然科学版),2017,57(9):952~957.
[58] Nimbalkar S,Fuhrer E,Silva P,et al.Glassy carbon microelectrodes minimize induced voltages,mechanical vibrations,and artifacts in magnetic resonance imaging[J].Microsyst Nanoeng,2019,5:61.
[59] Ashok Kumar N,Chauhan M,Kkndala SK,et al.Development and testing of implanted carbon electrodes for electromagnetic field mapping during neuromodulation[J].Magn Reson Med,2020,84(4):2103~2116.
[60] Zhao S,Li G,Tong C,et al.Full activation pattern mapping by simultaneous deep brain stimulation and fMRI with graphene fiber electrodes[J].Nat Commun,2020,11(1):1788.
[61] Kolaya E,Firstein BL.Deep brain stimulation:Challenges at the tissue-electrode interface and current solutions[J].Biotechnol Prog,2021,37(5):e3179.