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doi: 10.1227/NEU.0000000000000242

Magnetic Resonance Imaging Conditionally Safe Neurostimulation Leads: Investigation of the Maximum Safe Lead Tip Temperature

Coffey, Robert J. MD*; Kalin, Ron BS; Olsen, James M. BS, ME

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BACKGROUND: Magnetic resonance imaging (MRI) is preferred for imaging the central nervous system (CNS). An important hazard for neurostimulation patients is heating at the electrode interface induced, for example, by 64-MHz radiofrequency (RF) magnetic fields of a 1.5T scanner.

OBJECTIVE: We performed studies to define the thermal dose (time and temperature) that would not cause symptomatic neurological injury.

METHODS: Approaches included animal studies where leads with temperature probes were implanted in the brain or spine of sheep and exposed to RF-induced temperatures of 37°C to 49°C for 30 minutes. Histopathological examinations were performed 7 days after recovery. We also reviewed the threshold for RF lesions in the CNS, and for CNS injury from cancer hyperthermia. Cumulative equivalent minutes at 43°C was used to normalize the data to exposure times and temperatures expected during MRI.

RESULTS: Deep brain and spinal RF heating up to 43°C for 30 minutes produced indistinguishable effects compared with 37°C controls. Exposures greater than 43°C for 30 minutes produced temperature-dependent, localized thermal damage. These results are consistent with limits on hyperthermia exposure to 41.8°C for 60 minutes in patients who have cancer and with the reversibility of low-temperature and short-duration trial heating during RF lesion procedures.

CONCLUSION: A safe temperature for induced lead heating is 43°C for 30 minutes. MRI-related RF heating above 43°C or longer than 30 minutes may be associated with increased risk of clinically evident thermal damage to neural structures immediately surrounding implanted leads. The establishment of a thermal dose limit is a first step toward making specific neurostimulation systems conditionally safe during MRI procedures.

ABBREVIATIONS: ASTM, American Society for Testing and Materials

CEM, cumulative effect minutes

CNS, central nervous system

DBS, deep brain stimulation

RF, radiofrequency

SAR, specific absorption rate

SCS, spinal cord stimulation

WBHT, whole-body human hyperthermia

Copyright © by the Congress of Neurological Surgeons


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