Reconfigurable MRI technology for safe and high-resolution imaging of deep brain stimulation at 3T

Deep brain stimulation (DBS) is a neurosurgical procedure that involves implanting electrodes into specific areas within the brain and delivering constant or intermittent electric pulses from an implanted pulse generator (IPG) to modulate neural function. DBS is the gold standard treatment for Parkinson’s disease, and has shown promise in treating other disorders, most notably chronic pain, epilepsy, major depression, and Alzheimer’s disease. Magnetic resonance imaging (MRI) is extremely useful in patients with DBS implants, as it can provide information on precise location of implanted electrodes and functional response to stimulation. Unfortunately, the interaction of radiofrequency (RF) fields generated by MRI scanners with the leads of DBS devices can trigger potentially fatal RF heating within the tissue. This means that current MRI technology is inaccessible to most patients with DBS implants, presenting a significant barrier to progress in the field of DBS therapeutics. This project seeks to develop novel MRI methodologies alongside DBS implantation techniques that together will make cutting-edge MRI technology fully compatible with implanted DBS devices. Here, this two-pronged approach takes the form of (1) building on our recently introduced concept of reconfigurable MRI technology; and (2) establishing surgical guidelines specific to DBS device implantation. Reconfigurable MRI technology is based on the idea that through innovative engineering we can control local electric fields generated by MR on a patient-by-patient basis, thus avoiding interactions with an implanted device, wherever it happens to be. Part and parcel with engineering-based solutions, we recognize the importance of DBS device lead placement in optimizing the success of the reconfigurable MRI approach. Although RF heating depends exquisitely on lead-trajectory, surgical guidelines are completely silent as to how to best place the extracranial portion of the leads. This in turn leads to arbitrary (and highly variable) lead positioning, which can make RF heating unpredictable even when using reconfigurable technology. Thus, we propose work to develop and validate novel MR technology (Aim 1), intra-surgical implantation strategies (Aim 2), and simulation-based, patient-specific approaches to defining safe imaging parameters (Aim 3). Together, these efforts will eliminate RF heating, reduce image artifact, and support the use of next generation MRI in patients with DBS implants. Our team includes experts in MRI hardware development and instrumentation, MRI computational modeling and safety assessment, FDA regulatory scientists, DBS clinical management and neurosurgery, as well as collaborators from DBS device industry. If successful, we will bring state-of-the-art 3T MRI to DBS patients in its full capacity. This will allow for methodical analysis of DBS parameters/targets in emerging applications, improve our understanding of DBS in existing indications, and bring standard-of-care imaging to patients with existing DBS implants.