Optimal MRI methods for direct stereotactic targeting of the subthalamic nucleus and globus pallidus

O’Gorman, Ruth L.; Shmueli, Karin; Ashkan, Keyoumars; Samuel, Michael; Lythgoe, David J.; Shahidiani, Asal; Wastling, Stephen; Footman, Michelle; Selway, Richard; Jarosz, Józef

doi:10.1007/s00330-010-1885-5

Cited by 79 publications

(61 citation statements)

References 23 publications

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“…Besides the most frequently used heavily T2-weighted fast spin-echo [20,31,38] new sequences including quantitative T1 and T2 imaging [39,40] , T2* mapping [41][42][43] and susceptibility-weighted imaging (SWI) [44] , have been proposed to improve the visibility of the target structures. For the ZI no respective data exists.…”

Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Kerl

Gerigk²,

Brockmann³

et al. 2013

WJR

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AIM:To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI). METHODS:Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen's kappa coefficient (κ ) were assessed. Contrast-tonoise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t -test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren). RESULTS:The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.

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Section: Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

Kerl

Gerigk²,

Brockmann³

et al. 2013

WJR

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“…102 The potential advantages of SWI in DBS and Gamma Knife radiosurgery, among other procedures, have led to a significant number of studies further examining the role of SWI in applications for functional neurosurgery. 1,14,22,39,43,44,55,66,74,80,91,103,106,116 Fig. 10.…”

Section: Swi In Functional Neurosurgerymentioning

confidence: 99%

“…SWI can effectively assist the neurosurgeon in providing more information for anatomical localization in functional neurosurgery, thereby providing safer and more efficient procedures for deep brain stimulation (DBS), 1,74,80 as well as for Gamma Knife radiosurgery (for example, targeting nuclei of the thalamus for tremor treatment). 102 The potential advantages of SWI in DBS and Gamma Knife radiosurgery, among other procedures, have led to a significant number of studies further examining the role of SWI in applications for functional neurosurgery.…”

Section: Swi In Functional Neurosurgerymentioning

confidence: 99%

“…14,71 Imaging of healthy volunteers and patients requiring DBS showed that SWI, relative to T1, T2, T2*, and PDweighted imaging, was most effective in depicting the STN. 80 SWI using ultrahigh magnetic fields (7 T) can provide even greater contrast between midbrain structures, allowing for differentiation between internal and external portions of the globus pallidus (GPi and GPe), along with the development of 3D SWI maps outlining the location of the SN, STN, GPi, and GPe, which can aid in electrode placement and stimulation management. 1 The benefits of applying SWI at 7 T are further observed with the delineation of blood vessels of varying sizes, including small venules as thin as 250 μm 77 and submillimeter cerebellar veins such as the central vein of the dentate nucleus.…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

“…Several studies have described the long acquisition times required to obtain an SW image, 15,31,33,50,57,65,66,80,92,99,100,115 which makes movement artifacts likely to occur because of patient discomfort, which subsequently distorts SWI findings.…”

Section: Limitations Of Swimentioning

confidence: 99%

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Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives

Ieva¹,

Lam²,

Alcaide‐Leon

et al. 2015

JNS

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T he initial development of MR venography by Reichenbach et al. 90 laid the foundation for Haacke et al. 42 to apply the principles of MR venography in conventional MRI for broader usage in clinical and research settings. By utilizing magnitude and phase information, both of which are normally acquired from conventional MRI data, susceptibility weighted imaging (SWI) has an enhanced ability to detect microhemorrhages 4,12,26 and microvasculature. 26,27,41,92 It is a highly sensitive imaging modality able to depict magnetic substances, such as deoxygenated hemoglobin, with high contrast 42 and to help investigate neurological diseases, 82 grade tumors, 25,63 and assist in determining treatment or prognosis. 18,26,37,70,71,115 Over the past years, the SWI technique has found applications in the different fields of neurosurgery, namely neurooncology, vascular neurosurgery, neurotraumatolabbreviatioNs AVM = arteriovenous malformation; CCM = cerebral cavernous malformation; CMB = cerebral microbleed; CVS = cortical vessel sign; DAI = diffuse axonal injury; DBS = deep brain stimulation; DWI = diffusion-weighted imaging; GBM = glioblastoma multiforme; GCS = Glasgow Coma Scale; GPe = external globus pallidus; GPi = internal GP; GRE = gradient-recalled echo; ITSS = intratumoral susceptibility signal; mIP = minimum intensity projection; MRA = MR angiography; MS = multiple sclerosis; PD = proton density; PQ = percentagewise quantification; PWI = perfusion-weighted imaging; SN = substantia nigra; STN = subthalamic nucleus; SWI = susceptibility weighted imaging; TBI = traumatic brain injury; VM = vascular malformation. Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is st...

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