Optimization of postoperative computerized tomographic imaging in patients with the implanted responsive neurostimulation system™

The Responsive Neurostimulation System™ is currently under investigation as a neurosurgical option for medically refractory epilepsy. The device produces significant metallic artifact on conventional axial CT scans, resulting in limited diagnostic imaging options for implanted patients. We have developed a strategy to overcome this technical difficulty utilizing optimized patient positioning, thin-slice image acquisition, and postprocessing image reconstruction with commercially available software. Significant improvements were noted in the severity of device-related metallic streak artifact on reconstructed axial images. In addition, thin-section data were successfully used to generate detailed three-dimensional reconstructions, providing for improved visualization of the stimulator and the intracranial position of attached electrodes.