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Middlebrooks EH et al. Mayo Clinic, Jacksonville; Amsterdam UMC; University of Minnesota, Minneapolis; Western University, London (ON)

Published in the Journal of Neurosurgery ¹⁾

A Consensus/Technique article presenting multi-institutional expert consensus on the clinical application and technical optimization of 7‑Tesla MRI in deep brain stimulation (DBS) planning.

7T MRI enables superior visualization of DBS targets—subthalamic nucleus, globus pallidus internus (GPi), and thalamus—due to increased spatial resolution, enhanced contrast, and higher signal-to-noise ratio.

The paper outlines:

• Standardized imaging sequences
• Distortion correction methods
• Artifact mitigation strategies
• Post‑processing workflows

All recommendations are grounded in experience across >1000 DBS cases.

➕ Strengths

• Extensive real‑world experience from multiple high‑volume centers (>1 000 cases)
• Provides reproducible and practical imaging protocols
• Addresses technical pitfalls specific to ultrahigh‑field MRI (e.g., geometric distortion, susceptibility artifacts)
• Multi‑institutional consensus improves external validity

➖ Weaknesses

• No comparative clinical outcome data (7T vs. 1.5T/3T)
• Potential selection bias—centers with 7T access may not reflect broader clinical reality
• Sparse discussion on cost, accessibility, and logistical constraints of 7T
• No standardized safety reporting (e.g., implant interactions with 7T environment)

Score: '7/10' Technically rigorous and informative, yet limited by absence of clinical outcome validation and economic analysis.

If working within a center equipped with 7T MRI and multidisciplinary support, adopting these consensus protocols can sharpen anatomical targeting accuracy for DBS. However, clinical superiority over standard-field MRI remains to be definitively proven.

A valuable, experience-based roadmap for integrating 7T MRI into the DBS workflow—methodologically sound, but awaiting evidence of outcome benefit and cost-effectiveness.

• Title: Multi‑institutional recommendations on the use of 7T MRI in deep brain stimulation
• Authors: Middlebrooks EH et al.
• Journal: Journal of Neurosurgery
• Date: July 4, 2025 (Online ahead of print)
• DOI: 10.3171/2025.3.JNS243024
• PMID: 40614283