A systematic review exploring the safety of deep brain stimulation at MRI field strengths beyond conventional field strengths: Opening the door to new imaging tools for neuromodulation

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BACKGROUND: Clinically used magnetic resonance imaging (MRI) modalities field strengths (1.5T and 3T) are not optimal for minimizing either geometric distortion nor maximizing image quality, respectively, when imaging patients with DBS. Lower and higher field strengths can be used to overcome these limitations by improving imaging resolution and reducing geometric distortion. PURPOSE: Our aim is to assess the safety and feasibility of DBS at non-conventional (not 1.5T, 3T) MRI to explore more effective options for scanning patients with DBS. DATA SOURCES: We performed a search of preclinical and human studies investigating the safety of non-conventionally used MRI field strengths (i.e., not 1.5T or 3T) for deep brain stimulation (DBS). Relevant articles were retrieved from OVID, PubMed, and Web of Science from database inception to August 25, 2025. STUDY SELECTION: Twelve studies were included. Seven studies assessed safety of DBS at ultra-high-field (UHF) MRI. Five studies assessed safety of DBS at low-field MRI. No human studies were found. DATA ANALYSIS: For in-silico and in-vitro studies, measures of radiofrequency energy deposition and heating of the hardware were recorded whereas for in-vivo studies, clinical and histological assessments were retrieved. DATA SYNTHESIS: For in-vitro and in-silico studies, heating of DBS systems were within clinically acceptable parameters for realistic configurations and intended use sequences of DBS placements in non-conventional UHF (> 3 T) and low-field MRI (< 1.5T). For in-vivo studies, no significant histological damages were observed at UHF MRI compared to 3T and 1.5T. LIMITATIONS: Our systematic review is limited by the lack of human studies and variations in scanning sequences across studies. CONCLUSIONS: Our findings comprising of pre-clinical studies provide early data on the safety of UHF and low-field MRI for DBS. At this stage, studies do not support scanning DBS patients at these field strengths, but provide a framework for developing human studies examining the safety of DBS in non-conventional MRI.

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