Patient-adjustable MRI technology for high-resolution imaging of deep brain stimulation

项目摘要/摘要 脑深部刺激(DBS)是美国食品和药物管理局(FDA)批准的神经外科手术 已经成为抗药性帕金森氏病(PD)的黄金标准疗法，仅次于 常见的神经退行性疾病，影响的患者比总人口还多 被诊断为多发性硬化症、肌营养不良症和卢·格里克病。DBS也被用来治疗 顽固性慢性疼痛，这是一种影响超过1亿美国人的虚弱疾病。尽管 尽管星展银行的总体效果尚不明朗，但其潜在的作用机制仍不清楚。不确定的因素仍然存在 哪些电路受到影响，需要针对哪些确切的纤维束，以及最有效的刺激 协议。精心使用神经成像，既用于靶点验证，也用于监测治疗引起的 受影响的大脑网络功能连接性的变化是解释临床的重要步骤 结果，测试新的假说，因此，设计改进的治疗方案。在这 在这一点上，磁共振成像(Mri)作为一种高分辨率、非侵入性的成像技术显得非常有优势。 成像工具，可以帮助解决这些悬而未决的问题。然而，射频的相互作用 核磁共振扫描仪和植入电极的(RF)场存在严重的安全隐患，限制了 磁共振成像在星状细胞瘤患者中的适用性。因此，可用于DBS患者的MRI方法仅限于 分辨率和严重的图像伪影，扰乱了对受影响的功能连接性的研究 大脑网络。 该计划开发和验证针对特定患者量身定做和验证的新MRI方法 几何结构，这将使MRI与临床问题有关的机制和靶点 DBS治疗。因此，这个项目的具体目标是：(1)开发和验证患者可调的， 可重新配置的MRI传输线圈，与32通道紧密配合的脑阵列集成，从而实现了 产生的射频场和植入电极之间的有害相互作用 目前可用的系统，同时将信噪比(SNR)提高到四倍 皮质结构；(2)用综合电磁方法验证开发的方法 用于确定成像参数安全范围和优化临床的模拟和体模实验 成像协议；以及(3)设计使用开发的技术来增强预测的方法 晚期帕金森氏症患者皮质-纹状体环功能连接模式的改变。 该项目的直接目标是开发和优化磁共振成像方法，以增强结构和 在FDA批准用于DBS成像的场强下对受PD影响的脑网络进行功能成像 并将这些方法应用于晚期帕金森病患者皮质-纹状体环的增强功能标测 病人。这一成果是实现研究动态的长期目标的起点 DBS引起的大脑功能结构的变化。

Project Summary/Abstract Deep brain stimulation (DBS) is a Food and Drug Administration (FDA) approved neurosurgical procedure that has emerged as the gold-standard treatment for drug-resistant Parkinson's disease (PD), the second most common neurodegenerative disorder, which affects more patients than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy, and Lou Gehrig's disease. DBS is also used to treat refractory chronic pain, a debilitating condition that affects more than 100 million Americans. Despite the general effectiveness of DBS, its underlying mechanisms of action are still unclear. Uncertainties remain about which circuits are affected, which exact fiber bundles need to be targeted, and the most efficacious stimulation protocol. The meticulous use of neuroimaging, both for target verification and for monitoring treatment-induced changes in the functional connectivity of affected brain networks is an essential step in interpreting clinical outcomes, testing new hypotheses and, consequently, designing enhanced therapeutic protocols. In this regard, magnetic resonance imaging (MRI) appears excellently poised as a high-resolution, non-invasive imaging tool, which could help address these open questions. However, the interaction of the radiofrequency (RF) fields of MRI scanners and the implanted electrodes imposes serious safety hazards that restrict the applicability of MRI for DBS patients. As a result, available MRI methodologies for DBS patients are limited in resolution and suffer from severe image artifacts that confound studies of the functional connectivity of affected brain networks. This program develops and validates novel MRI methodologies tailored and validated for patient-specific geometries, which will bring MRI to bear on the clinical questions regarding the mechanism and targeting of DBS treatment. The specific aims of this project are, therefore: (1) to develop and validate a patient-adjustable, reconfigurable MRI transmit coil, integrated with a 32-channel close-fit brain array, which enables the reduction of the unwanted interaction of RF fields and implanted electrodes up to 100-fold below levels produced by currently available systems, while increasing the signal-to-noise ratio (SNR) up to four times at the level of cortical structures; (2) the validation of developed methodologies with comprehensive electromagnetic simulations and phantom experiments to determine the safe range of imaging parameters and optimize clinical imaging protocols; and (3) devising methodologies which use the developed technology to enhance prediction of altered patterns of functional connectivity of the cortico-striatal loops in advanced Parkinson's patients. The immediate goal of this project is to develop and optimize MRI methodologies to enhance structural and functional imaging of PD-affected brain networks at field intensities that are FDA approved for DBS imaging and to apply these methodologies for enhanced functional mapping of cortico-striatal loops in advanced PD patients. The outcome serves as the launching point for the long-term goal of enabling the study of dynamic DBS-induced changes in the functional architecture of the brain.