Localization of Deep Brain Stimulation Electrode by Image Registration Is Software Dependent: A Comparative Study between Four Widely Used Software Programs

Abstract

Background: The control of the anatomic position of the active contacts is essential to understand the effects and adapt the settings of the neurostimulation. The localization is commonly assessed by a registration between the preoperative MRI and the postoperative CT scan. However, its accuracy depends on the quality of the registration algorithm and many software programs are available. Objective: To compare the localization of implanted deep brain stimulation (DBS) leads in the subthalamic nucleus (STN) between four registration devices. Methods: The preoperative stereotactic MRI was co-registered and fused with the 3-month postoperative CT scan in 27 patients implanted in the STN for Parkinson’s disease (53 leads). Localizations of the active contacts were calculated in the stereotactic frame space and compared between software programs. Results: The coordinates of the active contacts were different between software programs in the 3 axes (p < 0.001) with a mean vectorial error between the deepest contact locations of 1.17 mm (95% CI 1.09–1.25). Conclusion: We found a small but significant difference in the coordinates calculated on four different devices. These results have to be considered when performing studies comparing active contact locations or when following patients with an implanted DBS lead.

A Phase 2 Randomized Trial of Asleep versus Awake Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease

“…Indeed, outcomes after STN-DBS are not well predicted by the classical clinical criteria required for a DBS procedure for PD patients [48], nor by the DBS-lead positioning in the so-called subthalamus nucleus target whose exact nature remains controversial (the STN [10] itself, the border of the STN [49][50][51], and the zona incerta and posterior subthalamic area [52][53][54][55][56][57]). These difficulties could be explained by the limits of the methods used to select the patients for STN-DBS (clinical criteria) and to control DBS-lead anatomical location on postoperative imaging [58,59]. To try to overcome these difficulties, we described a clinical-based STN target based on the resolution of what is called in mathematics an inverse problem (for further details on the definition of the target, see reference [33]).…”

Prediction of Clinical Deep Brain Stimulation Target for Essential Tremor From 1.5 Tesla MRI Anatomical Landmarks

“…with D being the distance between A and M and the unitary director vector of the lead, calculated from the coordinates of A and J, see reference ( 26 ) for more details. The data were systematically confirmed by manual analysis of the coordinates given by the middle of each hypo-intensity shadow representing each contact.…”

Therapies to Restore Consciousness in Patients with Severe Brain Injuries: A Gap Analysis and Future Directions

“…Even if an optimal target for an individual patient were identified, ensuring accurate electrode placement, especially in areas with poor intrinsic MRI contrast, such as the thalamus, remains challenging [171][172][173]. Furthermore, contact localization remains a challenge, with many available tools but no consensus on assessing anatomic accuracy, especially in patients with preexisting structural brain injury causing distorted anatomy [174][175][176][177]. Similarly, for noninvasive brain stimulation techniques, the stimulation site should account for the individual patient's underlying brain lesions and their associated network disconnections [178].…”