A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets

Boutet, Alexandre; Loh, Aaron; Chow, Chung‐Wai; Taha, Alaa; Elias, Gavin J B; Neudorfer, Clemens; Germann, Jürgen; Paff, Michelle; Zrinzo, Ludvic; Fasano, Alfonso; Kalia, Suneil K.; Steele, Christopher; Mikulis, David; Kucharczyk, Walter; Lozano, Andrés M.

doi:10.3171/2020.8.jns201125

Cited by 17 publications

(17 citation statements)

References 98 publications

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“…Direct visualization of deep brain structures and DBS targets has markedly improved in recent years. In addition to increases in magnetic field strength, this is owing to optimized acquisition protocols and postprocessing pipelines that improve gray/white matter contrast or leverage differences in tissue composition, such as iron content 1 . The resulting sequences—including susceptibility‐based techniques 10 and inversion recovery sequences 11,12 —have already been adopted in clinical practice by individual groups; a broad implementation across DBS centers is, however, currently lacking 1 .…”

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confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

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Objective: With a growing appreciation for interindividual anatomical variability and patient-specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. Methods: Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity, we retrospectively analyzed 65 patients (26 female, mean age = 69.1 AE 12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity's ability to predict clinical outcome using stimulation volume modeling and voxelwise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient-specific level. Results: Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentatorubrothalamic tract. Overlap between DBS stimulation volumes and the hypointensity in standard space significantly correlated with tremor improvement (R 2 = 0.16, p = 0.017) and distance to hotspots previously reported in the literature (R 2 = 0.49, p = 7.9e-4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R 2 = 0.37, p = 0.002). Interpretation: Our findings introduce and validate a novel imaging-based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor.

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confidence: 99%

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2022

Annals of Neurology

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“…Advanced imaging sequences – such as FGATIR or related sequences 1 – could overcome several limitations associated with tractography in clinical practice. First, FGATIR allows high-resolution, isotropic, single-millimeter (3D) slice visualization of DBS targets with increased contrast-to-noise ratio.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to increases in magnetic field strength, this is owing to optimized acquisition protocols and postprocessing pipelines that improve gray/white-matter contrast or leverage differences in tissue composition, such as iron content. 1 The resulting sequences -including susceptibility-based techniques 10 and inversion recovery sequences 11,12 -have already been All rights reserved. No reuse allowed without permission.…”

Section: Introductionmentioning

confidence: 99%

“…These sequences have proven effective in clinical practice for the diagnosis and management of neurological conditions, but suffer from inherent shortcomings that impede the reliable visualization of DBS targets. 1 This holds especially true for the ventral intermediate (VIM) nucleus of the thalamus, which is not readily visible on MRI. In addition, there is mounting evidence that not stimulation of VIM proper, but the ascending dentato-rubro-thalamic (DRT) tract is primarily associated with symptom improvement in ET.…”

Section: Introductionmentioning

confidence: 99%

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Personalizing deep brain stimulation using advanced imaging sequences

Neudorfer

Kroneberg

Al‐Fatly

et al. 2021

Preprint

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Objective: With a growing appreciation for interindividual anatomical variability and patient-specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. Methods: Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity we retrospectively analyzed 65 patients (26 female, mean age: 69.1±12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity′s ability to predict clinical outcome using stimulation volume modeling and voxel-wise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient-specific level. Results: Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentato-rubro-thalamic tract. Overlap between DBS stimulation volumes and the hypointensity in common space significantly correlated with tremor improvement (R2=0.16, p=0.017) and distance to hotspots previously reported in the literature (R2=0.49, p=7.9e-4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R2=0.37, p=0.002). Interpretation: Our findings introduce and validate a novel imaging-based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor.

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“…Thanks to their co-registration properties, the FLAWS1 and FLAWS2 images can be combined with a voxel-wise minimum computation to provide a GM-specific contrast named FLAWS-min [3]. The aforementioned contrasts provided by the FLAWS sequence were shown to be of interest for multiple brain imaging applications, such as epilepsy lesion detection [4][5][6], deep brain structures visualization for DBS surgery planning [7,8] and brain tissue segmentation [9].…”

Section: Introductionmentioning

confidence: 99%

Multi T1-weighted contrast imaging and T1 mapping with Compressed sensing FLAWS at 3T

Beaumont

Fripp

Raniga

et al. 2021

Preprint

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The Fluid And White matter Suppression (FLAWS) MRI sequence allows for the acquisition of multiple T1-weighted contrasts in a single sequence acquisition. However, its acquisition time is prohibitive for use in clinical practice when the k-space is linearly downsampled and reconstructed using the Generalized Autocalibrating Partially Parallel Acquisition (GRAPPA) technique. This study proposes a FLAWS sequence optimization tailored to allow for the acquisition of FLAWS images with a Cartesian phyllotaxis k-space undersampling and compressed sensing (CS) reconstruction at 3T. The CS FLAWS sequence parameters were determined using a method previously employed to optimize FLAWS imaging at 1.5T and 7T. In-vivo experiments show that the proposed CS FLAWS optimization allows to reduce the FLAWS sequence acquisition time from 8 mins to 6 mins without decreasing the FLAWS image quality. In addition, this study demonstrates for the first time that T1-weighted imaging with low B1 sensitivity and T1 mapping can be performed with the FLAWS sequence at 3T for both GRAPPA and CS reconstructions. The FLAWS T1 mapping was validated using in-silico, in-vitro and in-vivo experiments with comparison against the inversion recovery turbo spin echo and MP2RAGE T1 mappings. These new results suggest that the recent advances in FLAWS imaging allow to combine the MP2RAGE imaging benefits (T1-weigthed imaging with low B1 sensitivity and T1 mapping) and with the previous version of FLAWS imaging benefits (multi T1-weighted contrast imaging) in a single 6 mins sequence acquisition.

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A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets

Cited by 17 publications

References 98 publications

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences

Personalizing deep brain stimulation using advanced imaging sequences

Multi T1-weighted contrast imaging and T1 mapping with Compressed sensing FLAWS at 3T

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