Magnetic Resonance Imaging in Deep Brain Stimulation Alexandre Boutet Andres M. Lozano Editors 123 Magnetic Resonance Imaging in Deep Brain Stimulation Alexandre Boutet • Andres M. Lozano Editors Magnetic Resonance Imaging in Deep Brain Stimulation Editors Alexandre Boutet Andres M. Lozano Joint Department of Medical Imaging Division of Neurosurgery University of Toronto University Health Network and University Toronto, ON, Canada of Toronto Toronto, ON, Canada ISBN 978-3-031-16347-0 ISBN 978-3-031-16348-7 (eBook) https://doi.org/10.1007/978-3-031-16348-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Several books have been written on DBS-related topics, primarily focusing on clini- cal and technical aspects of the treatment from neurological and neurosurgical per- spectives. However, few of those books have focused on the role of neuroimaging, specifically MRI, in DBS surgery. With recent advances in neuroimaging technol- ogy and its increasingly prominent role, we felt that it would be timely for the DBS community to have an all-in-one resource summarizing the roles of MRI in DBS. We wanted to discuss the established as well as the innovative roles of MRI spanning the preoperative and postoperative care of these patients. Over the past 25 years, the Toronto group has accumulated a large experience with DBS and has advanced several aspects of this field. Each chapter is written by local authors informed by our longstanding experience with DBS in Toronto. These were written in collaboration with international expert co-authors, who have ensured a thorough and global perspective on the topics covered. We hope this book provides a succinct and clear summary of the various roles of MRI in DBS. It is our wish that the work herein sparks your interest so that you may further your knowledge of the topics using the references provided in each chapter. We believe that the roles of MRI in DBS will only grow over the next few years and will become increasingly central to most future clinical and research endeavours. Toronto, ON, Canada Alexandre Boutet Toronto, ON, Canada Andres M. Lozano v Contents 1 Deep Brain Stimulation and Magnetic Resonance Imaging: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Alexandre Boutet and Andres M. Lozano 2 A Historical Perspective on the Role of Imaging in Deep Brain Stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Gavin J. B. Elias, Aazad Abbas, Aaron Loh, Jürgen Germann, and Michael L. Schwartz 3 Overview of the Clinical Aspects of DBS . . . . . . . . . . . . . . . . . . . . . . . . 17 Oliver Flouty, Brian Dalm, and Andres M. Lozano 4 Preoperative Planning of DBS Surgery with MRI . . . . . . . . . . . . . . . . . 35 Aaron Loh, Clement T. Chow, Aida Ahrari, Kâmil Uludağ, Sriranga Kashyap, Harith Akram, and Ludvic Zrinzo 5 Safety of Magnetic Resonance Imaging in Patients with Deep Brain Stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Clement T. Chow, Sriranga Kashyap, Aaron Loh, Asma Naheed, Nicole Bennett, Laleh Golestanirad, and Alexandre Boutet 6 Postoperative MRI Applications in Patients with DBS . . . . . . . . . . . . . 73 Jürgen Germann, Flavia V. Gouveia, Emily H. Y. Wong, and Andreas Horn 7 Acquiring Functional Magnetic Resonance Imaging in Patients Treated with Deep Brain Stimulation . . . . . . . . . . . . . . . . . 85 Dave Gwun, Aaron Loh, Artur Vetkas, Alexandre Boutet, Mojgan Hodaie, Suneil K. Kalia, Alfonso Fasano, and Andres M. Lozano vii viii Contents 8 MRI in Pediatric Patients Undergoing DBS . . . . . . . . . . . . . . . . . . . . . . 107 Han Yan, Elysa Widjaja, Carolina Gorodetsky, and George M. Ibrahim 9 Deep Brain Stimulation and Magnetic Resonance Imaging: Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Alexandre Boutet and Andres M. Lozano Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Deep Brain Stimulation and Magnetic 1 Resonance Imaging: Introduction Alexandre Boutet and Andres M. Lozano In its broadest sense, functional neurosurgery includes the surgical treatment of pain, movement disorders, epilepsy, and psychiatric conditions. Fundamentally, the field is dedicated to treat pathological activity in circuits associated with a wide range of neurological conditions. Generally speaking, this can be achieved through stereotactic methods using lesioning or electrical stimulation of key brain struc- tures. As a basic principle, the targeted structure represents a crucial hub within the circuit of interest: the motor circuit is targeted in Parkinson’s disease, whereas structures implicated in mood regulation are targeted in psychiatric disorders and cognitive circuits in dementias and memory disorders [1]. Deep brain stimulation (DBS) has emerged as the dominant stereotactic func- tional neurosurgical procedure, in part due to its reversibility and also because it allows for the postoperative titration of electrical stimulation according to a patient’s specific needs [2]. Following surgical insertion, an electrode placed into the desired brain target delivers controlled electrical stimulation, analogous in some ways to a cardiac pacemaker [3]. Most commonly employed in movement disorders such as Parkinson’s disease, dystonia, and tremor, DBS is also being investigated for use in psychiatric and cognitive disorders, including depression and Alzheimer’s disease [1, 2, 4]. It is estimated that more than 200,000 patients have undergone DBS sur- gery worldwide [4]. Imaging techniques, specifically magnetic resonance imaging (MRI), play central roles in the preoperative and postoperative aspects of DBS surgery. A. Boutet (*) Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada e-mail: [email protected] A. M. Lozano Division of Neurosurgery, University Health Network and University of Toronto, Toronto, ON, Canada e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature 1 Switzerland AG 2022 A. Boutet, A. M. Lozano (eds.), Magnetic Resonance Imaging in Deep Brain Stimulation, https://doi.org/10.1007/978-3-031-16348-7_1 2 A. Boutet and A. M. Lozano During the preoperative period, MRI is critical for surgical planning, and the advent of novel MRI sequences now offer unparalleled visualization of DBS targets [3, 5]. Postoperatively, MRI can be used to assess electrode location and to model the local field of stimulation, while also permitting the investigation of clinical ben- efits and adverse events in terms of structural and functional anatomy. This can be done at the individual level, and more recently—thanks to advances in neuroimag- ing techniques—at the group level. Towards refining DBS therapy, group-level MRI-based probabilistic stimulation mapping is a powerful tool that leverages large amounts of historical data on targeting, programming, and clinical outcomes from past DBS interventions to be pooled and scrutinized [6, 7]. Furthermore, sequences such as functional MRI can now be acquired in DBS patients to investigate network engagement during active stimulation [8, 9]. This opens the door to a new field in neuromodulation research in which we can non-invasively probe the effects of brain stimulation in vivo. However, concerns over safety means that MRI in patients with DBS can only be performed under strict guidelines [10, 11]. Recent improvements in MRI and DBS safety knowledge have demonstrated that it is possible to acquire high resolution MRI in patients with DBS, thereby offering the potential to expand the possibilities of MRI and neuroimaging research in this population. This book focuses on the established as well as the innovative roles of MRI in DBS. MRI and DBS are first introduced from an historical perspective and a review of the clinical aspects of DBS is performed. Then, the preoperative and postopera- tive applications of MRI in DBS are covered. The crucial aspect of MRI safety in these patients is also discussed. Finally, possible upcoming MRI applications for patients with DBS are discussed in a future directions chapter. References 1. Lozano AM, Lipsman N. Probing and regulating dysfunctional circuits using deep brain stimu- lation. Neuron. 2013;77(3):406–24. 2. Lozano AM, Lipsman N, Bergman H, Brown P, Chabardes S, Chang JW, et al. Deep brain stimulation: current challenges and future directions. Nat Rev Neurol. 2019;15(3):148–60. 3. Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, et al. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol. 2021;17(2):75–87. 4. Vedam-Mai V, Deisseroth K, Giordano J, Lazaro-Munoz G, Chiong W, Suthana N, et al. Proceedings of the eighth annual deep brain stimulation think tank: advances in Optogenetics, ethical issues affecting DBS research, Neuromodulatory approaches for depression, adaptive Neurostimulation, and emerging DBS technologies. Front Hum Neurosci. 2021;15:644593. 5. Boutet A, Loh A, Chow CT, Taha A, Elias GJB, Neudorfer C, et al. A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets. J Neurosurg. 2021:1–14. https://doi.org/10.3171/2020.8.JNS201125. 6. Elias GJB, Boutet A, Joel SE, Germann J, Gwun D, Neudorfer C, et al. Probabilistic mapping of deep brain stimulation: insights from 15 years of therapy. Ann Neurol. 2021;89(3):426–43. 7. Horn A, Reich M, Vorwerk J, Li N, Wenzel G, Fang Q, et al. Connectivity predicts deep brain stimulation outcome in Parkinson disease. Ann Neurol. 2017;82(1):67–78. 8. Boutet A, Madhavan R, Elias GJB, Joel SE, Gramer R, Ranjan M, et al. Predicting optimal deep brain stimulation parameters for Parkinson's disease using functional MRI and machine learning. Nat Commun. 2021;12(1):3043. 1 Deep Brain Stimulation and Magnetic Resonance Imaging: Introduction 3 9. Elias GJB, Germann J, Boutet A, Loh A, Li B, Pancholi A, et al. 3 T MRI of rapid brain activity changes driven by subcallosal cingulate deep brain stimulation. Brain. 2021;145(6):2214–26. 10. Boutet A, Chow CT, Narang K, Elias GJB, Neudorfer C, Germann J, et al. Improving safety of MRI in patients with deep brain stimulation devices. Radiology. 2020;296(2):250–62. 11. Boutet A, Rashid T, Hancu I, Elias GJB, Gramer RM, Germann J, et al. Functional MRI safety and artifacts during deep brain stimulation: experience in 102 patients. Radiology. 2019;293(1):174–83.