Optimized Brain Functional MRI for Patients With Deep Brain Stimulation Systems

BACKGROUND AND OBJECTIVES: Deep brain stimulation (DBS) is an established neuromodulation therapy for Parkinson disease and other neurological disorders. Active DBS–functional MRI (fMRI) enables visualization of circuit engagement and may provide objective biomarkers of therapeutic efficacy, yet susceptibility artifacts compromise data quality. The aim of this study was to develop optimized blood oxygenation-level–dependent (BOLD) fMRI protocols for DBS patients by adjusting operator-accessible parameters to mitigate susceptibility artifacts while preserving image quality. METHODS: In vitro testing was performed on a 3-dimensional–printed anthropomorphic phantom simulating a patient with a 3T-conditional directional DBS system. We evaluated operator-adjustable parameters—spatial resolution, GeneRalized Autocalibrating Partially Parallel Acquisitions (GRAPPA) acceleration, echo time, and simultaneous multislice acceleration—for their effects on artifact volume and temporal signal-to-noise ratio (tSNR). As exploratory analysis, optimized protocols were demonstrated in subthalamic nucleus-DBS patients (n = 3). RESULTS: Higher spatial resolution and GRAPPA acceleration significantly reduced artifact volume (isotropic voxel size: 95% CI [1620.2, 2605.6], P P P P P P CONCLUSION: Optimized BOLD fMRI protocols effectively minimized susceptibility artifacts while preserving image quality, enabling reliable functional imaging in DBS patients—a timely advancement given the rise in DBS implants and introduction of directional stimulation systems.