Comparative study of microelectrode recording-based STN location and MRI-based STN location in low to ultra-high field (7.0 T) T2-weighted MRI images

Verhagen, Rens; Schuurman, P. Richard; Munckhof, Pepijn van den; Contarino, Maria Fiorella; Bie, Rob M.A. de; Bour, L.J.

doi:10.1088/1741-2560/13/6/066009

Cited by 22 publications

(21 citation statements)

References 61 publications

(102 reference statements)

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“…Note that in this study the entry and exit points from the STN, observed using MER, were determined by the neurophysiologist based on subjective estimate of the point where the STN neural activity is above the baseline noise. Previous studies reported that the STN extends further in the dorsal direction than is measured by MER [ 30 ]. However, we did not find such a bias in this study.…”

Section: Discussionmentioning

confidence: 98%

“…However, the image resolution and the low signal-to-noise-ratio usually does not allow for clear identification of the target or its borders. For example, Verhagen et al [ 30 ] observed significant difference between the anatomical STN borders (lateral and dorsal) as defined by 1.5T and 3T MRI and the borders as defined by neurophysiology as measured by MER. As shown here, the variability of the location, shape and size of the STN is significant between individual patients (see Fig 5 ).…”

Section: Discussionmentioning

confidence: 99%

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Patient-specific anatomical model for deep brain stimulation based on 7 Tesla MRI

Duchin

Shamir²,

Patriat

et al. 2018

PLoS ONE

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ObjectiveDeep brain stimulation (DBS) requires accurate localization of the anatomical target structure, and the precise placement of the DBS electrode within it. Ultra-high field 7 Tesla (T) MR images can be utilized to create patient-specific anatomical 3D models of the subthalamic nuclei (STN) to enhance pre-surgical DBS targeting as well as post-surgical visualization of the DBS lead position and orientation. We validated the accuracy of the 7T imaging-based patient-specific model of the STN and measured the variability of the location and dimensions across movement disorder patients.Methods72 patients who underwent DBS surgery were scanned preoperatively on 7T MRI. Segmentations and 3D volume rendering of the STN were generated for all patients. For 21 STN-DBS cases, microelectrode recording (MER) was used to validate the segmentation. For 12 cases, we computed the correlation between the overlap of the STN and volume of tissue activated (VTA) and the monopolar review for a further validation of the model’s accuracy and its clinical relevancy.ResultsWe successfully reconstructed and visualized the STN in all patients. Significant variability was found across individuals regarding the location of the STN center of mass as well as its volume, length, depth and width. Significant correlations were found between MER and the 7T imaging-based model of the STN (r = 0.86) and VTA-STN overlap and the monopolar review outcome (r = 0.61).ConclusionThe results suggest that an accurate visualization and localization of a patient-specific 3D model of the STN can be generated based on 7T MRI. The imaging-based 7T MRI STN model was validated using MER and patient’s clinical outcomes. The significant variability observed in the STN location and shape based on a large number of patients emphasizes the importance of an accurate direct visualization of the STN for DBS targeting. An accurate STN localization can facilitate postoperative stimulation parameters for optimized patient outcome.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Patient-specific anatomical model for deep brain stimulation based on 7 Tesla MRI

Duchin

Shamir²,

Patriat

et al. 2018

PLoS ONE

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“…Recently, inconsistencies between the STN borders estimated on T2w images, histology, and intraoperative microelectrode recordings (MERs) have been reported in multiple studies. 12,16,18,33,39,42 One of the sources for these inconsistences is thought to be the inhomogeneous distribution of iron within the STN, 13,16 with the lowest iron concentration typically observed in the dorsolateral region usually targeted in PD patients due to its correspondence to the sensorimotor area. 34,36,41 This heterogeneous iron distribution in the STN is blurred on T2w MRI (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…High-resolution QSM-based estimation of STN dimensions (~ 3 × 5 × 12 mm 3 ) agree with histological studies and microelectrode recordings. 10,27,28,42,49 QSM with submillimeter resolution can provide adequate spatial resolution to guide the DBS electrode that is typically 1.3 mm in diameter and 1.5 mm in height. MER is arguably the reference standard for measuring STN dimensions in vivo, but it is invasive and may only provide 2-dimensional information, requiring multiple electrode insertions.…”

Section: Discussionmentioning

confidence: 99%

High-resolution QSM for functional and structural depiction of subthalamic nuclei in DBS presurgical mapping

Dimov

Gupta

Kopell

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Faithful depiction of the subthalamic nucleus (STN) is critical for planning deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). Quantitative susceptibility mapping (QSM) has been shown to be superior to traditional T2-weighted spin echo imaging (T2w). The aim of the study was to describe submillimeter QSM for preoperative imaging of the STN in planning of DBS. METHODS Seven healthy volunteers were included in this study. T2w and QSM were obtained for all healthy volunteers, and images of different resolutions were reconstructed. Image quality and visibility of STN anatomical features were analyzed by a radiologist using a 5-point scale, and contrast properties of the STN and surrounding tissue were calculated. Additionally, data from 10 retrospectively and randomly selected PD patients who underwent 3-T MRI for DBS were analyzed for STN size and susceptibility gradient measurements. RESULTS Higher contrast-to-noise ratio (CNR) values were observed in both high-resolution and low-resolution QSM images. Inter-resolution comparison demonstrated improvement in CNR for QSM, but not for T2w images. QSM provided higher inter-quadrant contrast ratios (CR) within the STN, and depicted a gradient in the distribution of susceptibility sources not visible in T2w images. CONCLUSIONS For 3-T MRI, submillimeter QSM provides accurate delineation of the functional and anatomical STN features for DBS targeting.

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“…At present, MRI-conditional DBS neuromodulation systems from Medtronic (Minneapolis, Minn) (7), Boston Scientific (Marlborough, Mass) (6), and Abbott (Chicago, Ill) (8) have been approved by the U.S. Food and Drug Administration for MRI at specific magnetic field strengths (ie, 1.5 T) and with specific heating-related thresholds (eg, specific absorption rate [SAR]). However, there is considerable interest in investigating the safety of MRI at higher magnetic fields (eg, 3 T, 7 T) and of the less commonly used experimental sequences given their potential as future clinical tools (12,13).…”

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confidence: 99%

Functional MRI Safety and Artifacts during Deep Brain Stimulation: Experience in 102 Patients

Boutet¹,

Rashid²,

Hancu³

et al. 2019

Radiology

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ultiple neurologic disorders are thought to arise from dysfunctional neuronal circuits. Modulation of malfunctioning circuits can be achieved with therapies such as deep brain stimulation (DBS) (1). In DBS, electrical stimulation is delivered through implanted brain electrodes (2,3). DBS is best established as a therapeutic tool for movement disorders such as Parkinson disease, essential tremor, and dystonia (1,3). DBS is also being investigated as a treatment for psychiatric (4) and cognitive disorders (3). To date, more than 150 000 individuals have been implanted with DBS worldwide (5). Due to safety concerns, the ability to undergo MRI following DBS implantation is highly restricted. Because patients receiving DBS may require a wide range of MRI sequences for clinical purposes, and because MRI has been shown to be a valuable research tool in this population, additional data expounding the safety profile of MRI in individuals receiving DBS would be beneficial. Owing to safety concerns, MRI guidelines for scanning individuals receiving DBS are restrictive, largely limiting diagnostic uses. Strict safety guidelines (6-8) have been implemented after MRI-related adverse events (9): two cases of implantable pulse generator (IPG) failure during 1.5-T brain MRI; one case of temporary peri-electrode edema

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Comparative study of microelectrode recording-based STN location and MRI-based STN location in low to ultra-high field (7.0 T) T2-weighted MRI images

Cited by 22 publications

References 61 publications

Patient-specific anatomical model for deep brain stimulation based on 7 Tesla MRI

Patient-specific anatomical model for deep brain stimulation based on 7 Tesla MRI

High-resolution QSM for functional and structural depiction of subthalamic nuclei in DBS presurgical mapping

Functional MRI Safety and Artifacts during Deep Brain Stimulation: Experience in 102 Patients

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