Lead-DBS v2: Towards a comprehensive pipeline for deep brain stimulation imaging

Abstract

Deep brain stimulation (DBS) is a highly efficacious treatment option for movement disorders and a growing number of other indications are investigated in clinical trials. To ensure optimal treatment outcome, exact electrode placement is required. Moreover, to analyze the relationship between electrode location and clinical results, a precise reconstruction of electrode placement is required, posing specific challenges to the field of neuroimaging. Since 2014 the open source toolbox Lead-DBS is available, which aims at facilitating this process. The tool has since become a popular platform for DBS imaging. With support of a broad community of researchers worldwide, methods have been continuously updated and complemented by new tools for tasks such as multispectral nonlinear registration, structural / functional connectivity analyses, brain shift correction, reconstruction of microelectrode recordings and orientation detection of segmented DBS leads. The rapid development and emergence of these methods in DBS data analysis require us to revisit and revise the pipelines introduced in the original methods publication. Here we demonstrate the updated DBS and connectome pipelines of Lead-DBS using a single patient example with state-of-the-art high-field imaging as well as a retrospective cohort of patients scanned in a typical clinical setting at 1.5T. Imaging data of the 3T example patient is co-registered using five algorithms and nonlinearly warped into template space using ten approaches for comparative purposes. After reconstruction of DBS electrodes (which is possible using three methods and a specific refinement tool), the volume of tissue activated is calculated for two DBS settings using four distinct models and various parameters. Finally, four whole-brain tractography algorithms are applied to the patient’s preoperative diffusion MRI data and structural as well as functional connectivity between the stimulation volume and other brain areas are estimated using a total of eight approaches and datasets. In addition, we demonstrate impact of selected preprocessing strategies on the retrospective sample of 51 PD patients. We compare the amount of variance in clinical improvement that can be explained by the computer model depending on the method of choice. This work represents a multi-institutional collaborative effort to develop a comprehensive, open source pipeline for DBS imaging and connectomics, which has already empowered several studies, and may facilitate a variety of future studies in the field.

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

“…Inaccuracies in lead localization may result from the approach of warping electrodes into common space as done here. To minimize this issue, we used a modern neuroimaging pipeline that has been scientifically validated in numerous studies and involved advanced concepts such as brain shift correction 83 , multispectral normalization, subcortical refinement 83 and phantom-validated electrode localizations 84 . The normalization strategy that was applied was found to automatically segment the STN as precisely as manual expert segmentations 85 and each step of the pipeline was carefully assessed and corrected if needed by a team with long-standing expertise in this area 86,87 .…”

“…DBS electrodes were localized using Lead-DBS software (http://www.lead-dbs.org) as described in 86 In the Grenoble, Cologne and Madrid groups, Volumes of Tissue Activated (VTA) were estimated using a finite element method (FEM) as described in 83 For the London test cohort, we chose to use the original VTAs of the published study by Tyagi et al 16 . These had instead been processed using Medtronic SureTune™️ software and transferred into MNI space within the original study.…”

Pallidal low‐frequency activity in dystonia after cessation of long‐term deep brain stimulation

“…Overall, 3 to 12 Hz peaks occurred in 168 of 240 analyzed individual recordings. Beta peaks (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) Hz) could be detected in every patient, but not at all timepoints (range 2-16 of 30 recordings per patient), adding up to a total of 94 of 240 analyzed recordings, with overall lower amplitude. No other distinct peaks were revealed in higher frequency bands.…”

“…DBS electrodes were implanted bilaterally in the posteroventrallateral GPi according to standard procedures using preoperative magnetic resonance imaging target planning, intraoperative microelectrode recordings, and test stimulation. Implanted electrodes were localized based on the coregistration of preoperative magnetic resonance imaging and postoperative computed tomography scans and warping to standard Montreal neurological imaging (MNI) space using the extended pipeline of the Lead-DBS toolbox, 22 except for patient 8, whose imaging data were not available.…”

The Ansa Subthalamica: A Neglected Fiber Tract

“…The whole-brain connectomes were reconstructed using the Lead-Connectome pipeline (www.leadconnectome.org), following the approach described in Horn and colleages. 20 Tracts were selected from this data set using inclusion masks supplied with the DIS-TAL atlas. 21 A seed mask in the STN with a waypoint mask in the internal pallidum rendered the blue tract in Figure 2D, and the seed mask in the GPi with a waypoint mask in the thalamus generated the green tract in Figure 2D.…”