Background: Interventional magnetic resonance imaging (iMRI) allows deep brain stimulator lead placement under general anesthesia. While the accuracy of lead targeting has been described for iMRI systems utilizing 1.5-tesla magnets, a similar assessment of 3-tesla iMRI procedures has not been performed. Objective: To compare targeting accuracy, the number of lead targeting attempts, and surgical duration between procedures performed on 1.5- and 3-tesla iMRI systems. Methods: Radial targeting error, the number of targeting attempts, and procedure duration were compared between surgeries performed on 1.5- and 3-tesla iMRI systems (SmartFrame and ClearPoint systems). Results: During the first year of operation of each system, 26 consecutive leads were implanted using the 1.5-tesla system, and 23 consecutive leads were implanted using the 3-tesla system. There was no significant difference in radial error (Mann-Whitney test, p = 0.26), number of lead placements that required multiple targeting attempts (Fisher's exact test, p = 0.59), or bilateral procedure durations between surgeries performed with the two systems (p = 0.15). Conclusions: Accurate DBS lead targeting can be achieved with iMRI systems utilizing either 1.5- or 3-tesla magnets. The use of a 3-tesla magnet, however, offers improved visualization of the target structures and allows comparable accuracy and efficiency of placement at the selected targets.

Keywords:
Deep brain stimulation, Interventional magnetic resonance imaging, Functional neurosurgery
1.
Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ, et al: Bilateral deep brain stimulation vs. best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 2009;301:63-73.
2.
Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, et al: Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 2010;362:2077-2091.
3.
Anheim M, Batir A, Fraix V, Silem M, Chabardès S, Seigneuret E, et al: Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol 2008;65:612-616.
4.
Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS: Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg 2010;112:479-490.
5.
Larson PS, Starr PA, Bates G, Tansey L, Richardson RM, Martin AJ: An optimized system for interventional magnetic resonance imaging-guided stereotactic surgery: preliminary evaluation of targeting accuracy. Neurosurgery 2012;70:95-103.
6.
Starr PA, Markun LC, Larson PS, Volz MM, Martin AJ, Ostrem JL: Interventional MRI-guided deep brain stimulation in pediatric dystonia: first experience with the ClearPoint system. J Neurosurg Pediatr 2014;14:400-408.
7.
Ostrem JL, Galifianakis NB, Markun LC, Grace JK, Martin AJ, Starr PA, et al: Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement. Clin Neurol Neurosurg 2013;115:708-712.
8.
Slavin K V, Thulborn KR, Wess C, Nersesyan H: Direct visualization of the human subthalamic nucleus with 3T MR imaging. Am J Neuroradiol 2006;27:80-84.
9.
Abosch A, Yacoub E, Ugurbil K, Harel N: An assessment of current brain targets for deep brain stimulation surgery with susceptibility-weighted imaging at 7 Tesla. Neurosurgery 2010;67:1745-1756.
10.
Thani NB, Bala A, Lind CRP: Accuracy of magnetic resonance imaging-directed frame-based stereotaxis. Neurosurgery 2012;70:114.
11.
Dietrich O, Reiser MF, Schoenberg SO: Artifacts in 3-T MRI: physical background and reduction strategies. Eur J Radiol 2008;65:29-35.
12.
Vega RA, Holloway KL, Larson PS: Image-guided deep brain stimulation. Neurosurg Clin N Am 2014;25:159-172.
13.
Pohmann R, Speck O, Scheffler K: Signal-to-noise ratio and MR tissue parameters in human brain imaging at 3, 7, and 9.4 tesla using current receive coil arrays. Magn Reson Med 2016:75:801-809.
14.
Burchiel KJ, McCartney S, Lee A, Raslan AM: Accuracy of deep brain stimulation electrode placement using intraoperative computed tomography without microelectrode recording. J Neurosurg 2013;119:301-306.
15.
Starr PA, Christine CW, Theodosopoulos P V, Lindsey N, Byrd D, Mosley A, et al: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97:370-387.
16.
Holloway K, Gaede S, Starr P: Frameless stereotaxy using bone fiducial markers for deep brain stimulation. J Neurosurg 2005;103:404-413.
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2016
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