Multi-institutional recommendations on the use of 7T MRI in deep brain stimulation

J Neurosurg 143:1165–1175, 2025

This multi-institutional review presents consensus recommendations for integrating 7T ultrahigh-field MRI into deep brain stimulation (DBS) workflows, drawing on experience from over 1,000 procedures. It summarizes technical challenges—B1+ heterogeneity, susceptibility and gradient nonlinear distortions—and practical solutions for acquisition, distortion correction, and coregistration to ensure stereotactic accuracy.

The document details optimized sequences and target-specific imaging strategies (STN, GPi, thalamic nuclei, ANT, CM), advanced modalities (DTI/DiMANI, QSM, tractography), and multidisciplinary workflow considerations to improve patient-specific anatomical and connectivity-based DBS targeting and programming.

• 7T MRI Advantages: Ultrahigh-field 7T MRI provides superior spatial resolution, signal-to-noise ratio, and tissue contrast, enabling clearer visualization of deep brain structures critical for deep brain stimulation (DBS) targeting compared to 1.5T and 3T MRI.

• Improved DBS Targeting: 7T MRI enhances direct anatomical and connectivity-based targeting for DBS, supporting more precise, patient-specific electrode placement for Parkinson’s disease, essential tremor, and epilepsy.

• Key Technical Challenges: 7T MRI introduces unique challenges including B1+ transmit field inhomogeneity, increased image distortions (gradient nonlinearity and susceptibility), and chemical shift artifacts, all of which require specialized correction and protocol optimization.

• Distortion Correction and Coregistration: Accurate DBS planning with 7T MRI demands robust correction for gradient and susceptibility distortions, careful coregistration with stereotactic CT, and often manual or nonlinear registration adjustments for optimal anatomical alignment.

• Recommended Imaging Sequences: Specific 7T MRI sequences, such as T2-weighted, FGATIR, MP2RAGE, SWI, QSM, and advanced diffusion imaging (DTI/DiMANI), are recommended for visualizing common DBS targets (STN, GPi, thalamic nuclei), each offering distinct advantages for different structures.

• Connectivity and Tractography: Advanced diffusion MRI at 7T allows submillimetric tractography, enabling functional parcellation of DBS targets (e.g., STN, GPi, DRTT), which can improve patient outcomes by supporting symptom- and network-specific targeting.

• Clinical Impact: Implementation of 7T MRI in over 1000 DBS procedures across multiple centers has demonstrated that, with appropriate workflow and expertise, technical challenges can be managed and targeting accuracy and patient outcomes can be improved.

• Multidisciplinary Collaboration: Effective use of 7T MRI for DBS requires close collaboration between neurosurgeons, MR technicians, physicists, and neuroradiologists to optimize protocols and address the complexity of ultrahigh-field imaging