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<meta name="DC.Title" content="Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3896" />
<meta name="DC.Date" content="2014-03-27" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging–guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.

MATERIALS AND METHODS: Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.

RESULTS: The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.

CONCLUSIONS: Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.

### Abbreviations

CNR
:   contrast-to-noise ratio
DBS
:   deep brain stimulator or stimulation
FSTIR
:   fast spin-echo short τ inversion recovery
SAR
:   specific absorption rate
PD
:   Parkinson disease
RF
:   radiofrequency
STN
:   subthalamic nucleus" />
<meta name="DC.Contributor" content="S.N. Sarkar" />
<meta name="DC.Contributor" content="E. Papavassiliou" />
<meta name="DC.Contributor" content="R. Rojas" />
<meta name="DC.Contributor" content="D.L. Teich" />
<meta name="DC.Contributor" content="D.B. Hackney" />
<meta name="DC.Contributor" content="R.A. Bhadelia" />
<meta name="DC.Contributor" content="J. Stormann" />
<meta name="DC.Contributor" content="R.L. Alterman" />
<meta name="article:published_time" content="2014-03-27" />
<meta name="article:section" content="BRAIN" />
<meta name="citation_title" content="Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging–guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.&lt;/p&gt;" />
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<meta name="citation_author" content="S.N. Sarkar" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="E. Papavassiliou" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="R. Rojas" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
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<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="D.B. Hackney" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="R.A. Bhadelia" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="citation_author" content="J. Stormann" />
<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
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<meta name="citation_author_institution" content="From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts." />
<meta name="twitter:title" content="Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging–guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.

MATERIALS AND METHODS: Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.

RESULTS: The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.

CONCLUSIONS: Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.

### Abbreviations

CNR
:   contrast-to-noise ratio
DBS
:   deep brain stimulator or stimulation
FSTIR
:   fast spin-echo short τ inversion recovery
SAR
:   specific absorption rate
PD
:   Parkinson disease
RF
:   radiofrequency
STN
:   subthalamic nucleus" />
<meta name="og-title" property="og:title" content="Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2014/03/27/ajnr.A3896" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging–guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.

MATERIALS AND METHODS: Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.

RESULTS: The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.

CONCLUSIONS: Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.

### Abbreviations

CNR
:   contrast-to-noise ratio
DBS
:   deep brain stimulator or stimulation
FSTIR
:   fast spin-echo short τ inversion recovery
SAR
:   specific absorption rate
PD
:   Parkinson disease
RF
:   radiofrequency
STN
:   subthalamic nucleus" />
<meta name="og-type" property="og:type" content="article" />
<meta name="og-image" property="og:image" content="" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node50581--5" data-node-nid="50581" id="top-node-50581--6892752000" data-pisa="ajnr;ajnr.A3896v1" data-pisa-master="ajnr;ajnr.A3896" data-apath="/ajnr/early/2014/03/27/ajnr.A3896.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">BRAIN</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.N. Sarkar</span>, <span class="highwire-citation-author" data-delta="1">E. Papavassiliou</span>, <span class="highwire-citation-author" data-delta="2">R. Rojas</span>, <span class="highwire-citation-author" data-delta="3">D.L. Teich</span>, <span class="highwire-citation-author" data-delta="4">D.B. Hackney</span>, <span class="highwire-citation-author" data-delta="5">R.A. Bhadelia</span>, <span class="highwire-citation-author" data-delta="6">J. Stormann</span> and <span class="highwire-citation-author" data-delta="7">R.L. Alterman</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2014,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3896 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-50581--6892752000" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.N. Sarkar </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.N.%2BSarkar%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sarkar%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.N.%2BSarkar%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E. Papavassiliou </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BPapavassiliou%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Papavassiliou%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.%2BPapavassiliou%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">R. Rojas </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BRojas%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rojas%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.%2BRojas%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.L. Teich </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.L.%2BTeich%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Teich%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.L.%2BTeich%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D.B. Hackney </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.B.%2BHackney%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hackney%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.B.%2BHackney%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">R.A. Bhadelia </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.A.%2BBhadelia%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Bhadelia%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.A.%2BBhadelia%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">J. Stormann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BStormann%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Stormann%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJ.%2BStormann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">R.L. Alterman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Radiology (S.N.S., R.R., D.L.T., D.B.H., R.A.B., J.S.) and Division of Neurosurgery (E.P., R.L.A.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.L.%2BAlterman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Alterman%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.L.%2BAlterman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Fast spin-echo short τ inversion recovery sequences have been very useful for MR imaging–guided deep brain stimulation procedures in Parkinson disease. However, high-quality fast spin-echo imaging deposits significant heat, exceeding FDA-approved limits when patients already have undergone deep brain stimulation and need a second one or a routine brain MR imaging for neurologic indications. We have developed a STIR sequence with an ultra-low specific absorption rate that meets hardware limitations and produces adequate tissue contrast in cortical and subcortical brain tissues for deep brain stimulation recipients.</p></div>
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<p id="p-2"><strong>MATERIALS AND METHODS:</strong> Thirteen patients with medically refractory Parkinson disease who qualified for deep brain stimulation were imaged at 1.5T with a fast spin-echo short τ inversion recovery sequence modified to meet conditional MR imaging hardware and specific absorption rate restrictions. Tissue contrast-to-noise ratios and implant localization were objectively and subjectively compared by 2 neuroradiologists, and image quality for surgical planning was assessed by a neurosurgeon for high and low specific absorption rate images.</p></div>
<div id="sec-3" class="subsection">
<p id="p-3"><strong>RESULTS:</strong> The mean contrast-to-noise ratio for cerebral tissues without including the contrast-to-noise ratio for ventricular fluid was 35 and 31 for high and low specific absorption rate images. Subjective ratings for low specific absorption rate tissue contrast in 77% of patients were identical to (and in a few cases higher than) those of high specific absorption rate contrast, while the neurosurgical coordinates for fusing the stereotactic atlas with low specific absorption rate MR imaging were equivalent to those of the high specific absorption rate for 69% of patients.</p></div>
<div id="sec-4" class="subsection">
<p id="p-4"><strong>CONCLUSIONS:</strong> Patients with Parkinson disease who have already had a deep brain stimulation face a risk of neural injury if routine, high specific absorption rate MR imaging is performed. Our modified fast spin-echo short τ inversion recovery sequence conforms to very conservative radiofrequency safety limits, while it maintains high tissue contrast for presurgical planning, postsurgical assessment, and radiologic evaluations with greater confidence for radiofrequency safety.</p>
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</div><div class="section glossary" id="glossary-1">
<h3>Abbreviations</h3>
<dl id="def-list-1"><dt id="def-item-1">CNR<span class="def-item-dt-sep"></span></dt><dd>contrast-to-noise ratio<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DBS<span class="def-item-dt-sep"></span></dt><dd>deep brain stimulator or stimulation<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">FSTIR<span class="def-item-dt-sep"></span></dt><dd>fast spin-echo short τ inversion recovery<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">SAR<span class="def-item-dt-sep"></span></dt><dd>specific absorption rate<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">PD<span class="def-item-dt-sep"></span></dt><dd>Parkinson disease<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">RF<span class="def-item-dt-sep"></span></dt><dd>radiofrequency<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">STN<span class="def-item-dt-sep"></span></dt><dd>subthalamic nucleus</dd></dl>
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      <div class="highwire-cite-title">Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2014, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3896 </span></div>
  
  
  
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      <div class="highwire-cite-title">Low-Power Inversion Recovery MRI Preserves Brain Tissue Contrast for Patients with Parkinson Disease with Deep Brain Stimulators</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.N.</span> <span class="nlm-surname">Sarkar</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Papavassiliou</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Rojas</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.L.</span> <span class="nlm-surname">Teich</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.B.</span> <span class="nlm-surname">Hackney</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Bhadelia</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Stormann</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">R.L.</span> <span class="nlm-surname">Alterman</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2014, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3896 </span></div>
  
  
  
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