The study demonstrates that deep-learning image reconstruction combined with dynamic parallel transmission at 7T substantially shortens scan time while improving image quality, motion robustness, and delineation of DBS targets (STN, GPi, DRT) in patients.

Enhanced high-field imaging that yields clearer, faster, and safer visualization of subcortical targets has direct translational value for Parkinson's DBS planning and may improve surgical accuracy and outcomes, though it does not introduce new disease-modifying biology.

OBJECTIVE: Precise targeting of subcortical structures is crucial for deep brain stimulation (DBS). Although 7T MRI provides superior resolution and contrast, its clinical adoption remains limited by B1+ transmit inhomogeneity, prolonged scan times, and motion sensitivity. This study applied deep learning (DL)-based image reconstruction and dynamic parallel transmission (pTx) to optimize DBS protocols and improve image quality. METHODS: Thirteen patients scanned using a conventional 7T DBS protocol were compared to 13 imaged after implementing DL reconstruction and dynamic pTx. Two readers scored image quality, motion artifact, and target conspicuity on 5-point Likert scales. Ordinal logistic regression was used to calculate odds ratios (OR) for improvements with the enhanced protocol, adjusted for multiple comparisons. RESULTS: Enhanced MP2RAGE reduced voxel volume by 65.8% and scan time by 32.9%, with improved image quality (OR = 4.4;p = 0.003), target conspicuity (OR = 3.4;p = 0.011), and reduced motion artifacts (OR = 3.8;p = 0.006). Fast gray matter acquisition T1 inversion recovery (FGATIR) scan time decreased by 45.2% with improved target delineation of both globus pallidus interna (OR = 22.9;p < 0.001) and dentato-rubro-thalamic tract (OR = 8.8;p < 0.001). T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) improved subthalamic nucleus (STN) delineation (OR = 25.3;p < 0.001). Susceptibility-weighted imaging (SWI) improved image quality (OR = 17.4;p < 0.001), STN delineation (OR = 16.9;p < 0.001), and reduced scan time by 42.6%. Enhanced 3D spoiled gradient recall echo improved image quality (OR = 17.4;p < 0.001) and vessel visualization (OR = 26.1;p < 0.001) with reduced motion artifact (OR = 8.8;p < 0.001). Scan time decreased from 4:33 to 1:35, reducing protocol duration from 42:16 to 26:40 (36.9%). CONCLUSIONS: DL reconstruction and dynamic pTx improved image quality, target definition, and motion robustness while shortening 7T DBS protocol time.