Individualized parcellation of the subthalamic nucleus in patients with Parkinson's disease with 7T MRI

Abstract

Deep brain stimulation of the subthalamic nucleus (STN) is a widely performed surgical treatment for patients with Parkinson’s disease. The goal of the surgery is to place an electrode centered in the motor region of the STN while lowering the effects of electrical stimulation on the non-motor regions. However, distinguishing the motor region from the neighboring associative and limbic areas in individual patients using imaging modalities was until recently difficult to obtain in vivo. Here, using ultra-high field MR imaging, we have performed a dissection of the subdivisions of the STN of individual Parkinson’s disease patients. We have acquired 7 T diffusion-weighted images of seventeen patients with Parkinson’s disease scheduled for deep brain stimulation surgery. Using a structural connectivity-based parcellation protocol, the STN’s connections to the motor, limbic, and associative cortical areas were used to map the individual subdivisions of the nucleus. A reproducible patient-specific parcellation of the STN into a posterolateral motor and gradually overlapping central associative area was found in all STNs, taking up on average 55.3% and 55.6% of the total nucleus volume. The limbic area was found in the anteromedial part of the nucleus. Our results suggest that 7T MR imaging may facilitate individualized and highly specific planning of deep brain stimulation surgery of the STN.

Automatic localization of the subthalamic nucleus on patient‐specific clinical MRI by incorporating 7 T MRI and machine learning: Application in deep brain stimulation

“…Similarly to the 7 T manual ground truth, the 7 T-ML based STN accurately localized and predicted the active contacts, especially in the posterior lateral region that is considered a motor territory often targeted for Parkinson’s DBS (Plantinga et al, 2016). We should stress that we analyzed the spatial relationship between contact location and the STN using the ellipsoid representation within the STN in an individual patient data space.…”

“…Furthermore, 7 T MRI has already facilitated the study of connectivity within the basal ganglia and thalamus and enabled the subdivision of the STN into motor, associative, and limbic sub-regions (Abosch et al, 2010; Lenglet et al, 2012; Plantinga et al, 2016). Keuken et al (2013) investigated structural changes of the STN using atlases based on 7 T MRI in different age groups (healthy subjects).…”

Rostro‐caudal organization of the human posterior superior temporal sulcus revealed by connectivity profiles

“…Shih et al (2011) identified three functional subdivisions in the pSTS using a data-driven approach. Furthermore, research at a fine-grained level may help in more accurately positioning the abnormal subarea of the pSTS in patients with conditions such as simultanagnosia or ASD (Jaimes et al, 2017;Plantinga et al, 2018). Comparing the two different parcellation schemes, the distribution of the subareas and the direction of the boundary are basically analogous.…”

Worsening of Verbal Fluency After Deep Brain Stimulation in Parkinson's Disease: A Focused Review

“…These advanced techniques allow for detailed delineation of the connections between the STN (and GPi), cortex and other basal ganglia structures at the individual patient level. Several studies in healthy adults have demonstrated how the STN subsections and overlaps can be delineated using tractography [1], [2], [34], [51]. Implementing state-of-the-art tractography methods, combined with VTA-modeling, may allow detailed exploration of the neural pathways stimulated with DBS in individual patients.…”