Determining the position and size of the subthalamic nucleus based on magnetic resonance imaging results in patients with advanced Parkinson disease

Richter, Erich O.; Hoque, Tasnuva; Halliday, William; Lozano, Andrés M.; Saint‐Cyr, Jean A.

doi:10.3171/jns.2004.100.3.0541

Cited by 166 publications

(124 citation statements)

References 13 publications

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“…The center of the STN has been suggested to be represented by the anterior border of the red nucleus (Bejjani et al, 2000), or 2mm anterior to a line drawn orthogonal to the anterior border of the red nucleus (Danish et al, 2006). The size of the STN may be smaller than reported in the Talairach and Tournoux atlas, particularly in the medial-lateral direction (Richter et al, 2004).…”

Section: Stn-liesmentioning

confidence: 99%

Region of interest template for the human basal ganglia: Comparing EPI and standardized space approaches

Prodoehl

Little

et al. 2008

NeuroImage

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Identifying task related activation in the basal ganglia (BG) is an important area of interest in normal motor systems and cognitive neuroscience. The purpose of this study was to compare changes in brain activation in the BG using results obtained from two different masking methods: a mask drawn in standardized space from a T1 weighted anatomical image and individual region of interest (ROI) masks drawn from each subject's echo-planar (EPI) image from different tasks with reference to the high resolution fast spin echo image of each subject. Two standardized masks were used: a mask developed in Talairach space (Basal Ganglia Human Area Template (BGHAT)) and a mask developed in Montreal Neurological Institute space (MNI mask). Ten subjects produced fingertip force pulses in five separate contraction tasks during fMRI scanning. ROIs were the left caudate, putamen, external and internal portions of the globus pallidus, and subthalamic nucleus. ANOVA revealed a similar average number of voxels in the EPI mask across tasks in each BG region. The percent signal change (PSC) was consistent within each region regardless of which mask was used. Linear regression analyses between PSC in BGHAT and EPI masks and MNI and EPI masks yielded r² values between 0.74-0.99 and 0.70-0.99 across regions, respectively. In conclusion, PSC in different BG ROIs can be compared across studies using these different masking methods. The masking method used does not affect the overall interpretation of results with respect to the effect of task. Use of a mask drawn in standardized space is a valid and time saving method of identifying PSC in the small nuclei of the BG.

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Section: Stn-liesmentioning

confidence: 99%

Region of interest template for the human basal ganglia: Comparing EPI and standardized space approaches

Prodoehl

Little

et al. 2008

NeuroImage

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“…Assessment of localizations on postoperative structural MR imaging data in their specific anatomic context requires spatial normalization to transform individual anatomic variability [4][5][6] by geometric alignment of corresponding structures across patients (patient-to-patient) or to a standard (patient-to-atlas). Commonly, the position of the electrode is indirectly reported in coordinates along the 3 axes relative to the midcommissural point (MCP) between the anterior commissure (AC) and posterior commissure (PC) 1,[6][7][8][9][10][11] and is normalized by the individual distance from the AC to the PC in relation to a standard atlas ACPC distance.…”

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confidence: 99%

“…However, this normalization method disregards the individual mediolateral and dorsoventral dimensions, despite the substantial variability of the GPi 12,13 and the STN 8,9,14,15 with respect to the MCP. 16,17 For instance, the AC can vary in diameter from 3 to 8 mm, 18 and the inter-rater ambiguity in manual selection leads to considerable variations in assessment of the target STN and GPi.…”

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confidence: 99%

Automated Optimization of Subcortical Cerebral MR Imaging−Atlas Coregistration for Improved Postoperative Electrode Localization in Deep Brain Stimulation

Schönecker¹,

Kupsch²,

Kühn³

et al. 2009

AJNR Am J Neuroradiol

126

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BACKGROUND AND PURPOSE:The efficacy of deep brain stimulation in treating movement disorders depends critically on electrode localization, which is conventionally described by using coordinates relative to the midcommissural point. This approach requires manual measurement and lacks spatial normalization of anatomic variances. Normalization is based on intersubject spatial alignment (coregistration) of corresponding brain structures by using different geometric transformations. Here, we have devised and evaluated a scheme for automated subcortical optimization of coregistration (ASOC), which maximizes patient-to-atlas normalization accuracy of postoperative structural MR imaging into the standard Montreal Neurologic Institute (MNI) space for the basal ganglia.

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“…1 Reliable identification of the anatomic borders of the STN is thus a critical step in stereotactic procedures.…”

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confidence: 99%

Improved Visibility of the Subthalamic Nucleus on High-Resolution Stereotactic MR Imaging by Added Susceptibility (T2*) Contrast Using Multiple Gradient Echoes

Elolf¹,

Bockermann²,

Gringel³

et al. 2007

American Journal of Neuroradiology

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SUMMARY:Reliable identification of the subthalamic nucleus (STN) is a critical step in deep brain stimulation for Parkinson disease but difficult on T1-weighted stereotactic MR imaging. By simultaneous imaging of multiple gradient echoes, susceptibility contrast is added to conventional T1-weighted high-resolution MR image. Thus, the visibility of the STN is enhanced on a second colocalized dataset by exploiting the sensitivity of the T2*-relaxation to local iron deposits. The feasibility is underpinned by quantitative measurements on healthy adults.A n established neurosurgical therapy for Parkinson disease is to place electrodes for deep brain stimulation within the subthalamic nucleus (STN).1 Reliable identification of the anatomic borders of the STN is thus a critical step in stereotactic procedures.2,3 T2-weighted MR imaging showing the iron-rich structures as hypointensities has been suggested as additional information to the poor contrast of the STN on T1-weighted highresolution 3D MR imaging. 4,5 Exploiting the increased sensitivity of T2* to local iron deposits, a multigradient echo fast low-angle shot (FLASH) technique 6 is proposed to visualize the STN. This 3D MR technique enables simultaneous acquisition of T1-weighted images for stereotactic use and images with superimposed T2* contrast to localize the STN. TechniqueThe feasibility study was carried out on 16 healthy adults (8 men; age range, 23-31 years; mean age, 26 years) on a 3T MR system (Magnetom Trio; Siemens Medical Solutions, Erlangen, Germany) using an 8-channel phased-array head coil (MR Imaging Devices, Waukesha, Wis). Written informed consent as supervised by the local ethical committee was obtained.A multi-echo FLASH sequence (TR, 30 ms; flip angle, 20°) provided primarily T1-weighted 3D datasets of 0.95-mm isotropic resolution (FOV ϭ 243 mm; 176 sagittal partitions with 6/8 partial Fourier sampling in phase and section directions; 7:09 minutes). Eight gradient-echoes (TE ϭ 2.2/5.2/8.2/11.2/14.2/17.2/20.2/23.2 ms; bandwidth/pixel ϭ 370 Hz) provided additional T2*-weighted contrast increasing with TE. For comparison, multisection turbo spinecho images (TSE; 29 contiguous 2-mm axial sections; effective TE, 119 ms; TR, 3900 ms) were also obtained.The data were transferred to a stereotactic workstation (Sofamore Danek Stealth Station; Medtronic, Minneapolis, Minn) for coregistration of images with the Schaltenbrand-Wahren atlas.7 For quantitative comparison, T2* was determined in the STN and the reticulate formation by a region-of-interest analysis in 1 subject. ResultsThe T2*-signal intensity decay was markedly faster in the area of the STN than in the surrounding tissue. Figure 1 shows representative curve fits to the STN and the reference region of the reticulate formation. This corresponded with a contrast of approximately 25% at the longest TE. Thus, both STNs could be identified in all 16 of the subjects even when motion artifacts impaired the delineation (2 subjects). Figure 2 shows the midbrain region, where the solely T1-weighted...

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Determining the position and size of the subthalamic nucleus based on magnetic resonance imaging results in patients with advanced Parkinson disease

Abstract: The size and position of the STN are highly variable, appearing to be smaller and situated more posterior and lateral on MR images than in atlases. Care must be taken in relying on coordinates relative to the commissures for targeting of the STN.

Cited by 166 publications

References 13 publications

Region of interest template for the human basal ganglia: Comparing EPI and standardized space approaches

Region of interest template for the human basal ganglia: Comparing EPI and standardized space approaches

Automated Optimization of Subcortical Cerebral MR Imaging−Atlas Coregistration for Improved Postoperative Electrode Localization in Deep Brain Stimulation

Improved Visibility of the Subthalamic Nucleus on High-Resolution Stereotactic MR Imaging by Added Susceptibility (T2*) Contrast Using Multiple Gradient Echoes

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