The subthalamic nucleus at 3.0 Tesla: choice of optimal sequence and orientation for deep brain stimulation using a standard installation protocol

Kerl, H; Gerigk, Lars; Pechlivanis, Ioannis; Al-Zghloul, Mansour; Groden, Christoph; Nölte, I.

doi:10.3171/2012.8.jns111930

Cited by 39 publications

(38 citation statements)

References 54 publications

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“…Direct comparison of SWI with T2* FLASH images at 3 T and 7 T showed T2* FLASH 2D provided superior contrast for the STN. 22,23 Phase images have also been shown to provide better delineation of the STN, with visualization scores of 3.47 and 2.03 out of 5 for phase images and SWI, respectively. 57 Quantitative analysis demonstrates a higher CNR for phase imaging in comparison with SWI when viewing the STN and SN.…”

Section: Susceptibility-based Sequencesmentioning

confidence: 99%

“…16 T2* FLASH has been compared directly to various T1 and T2 sequences and to SWI at both 3 T and 7 T. 22,23 The ability to delineate the STN, in particular, from the ZI and the SN was assessed. At both 3 T and 7 T, coronal T2* FLASH sequences provided the best visualization of the STN.…”

Section: Susceptibility-based Sequencesmentioning

confidence: 99%

“…9 Although T2WI is useful, it is difficult to clearly delineate the STN from the SN and, to a lesser extent, the zona incerta (ZI). 22,32,37 abbreviatioNs CNR = contrast-to-noise ratio; DBS = deep brain stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; FGATIR = fast gray matter acquisition T1 IR; FLAIR = fluid attenuated IR; FLASH = fast low-angle shot; FSE = fast spin echo; GRE = gradient echo; IR = inversion recovery; NSA = number of signal averages; PSIR = phase-sensitive IR; QSM = quantitative susceptibility mapping; SE = spin echo; SN = substantia nigra; SNR = signal-to-noise ratio; STIR = short tau IR; STN = subthalamic nucleus; SWI = susceptibility-weighted imaging; SWPI = susceptibility-weighted phase imaging; T = tesla; T2WI = T2-weighted imaging; T2*WI = T2-weighted magnitude imaging; TI = inversion time; TR = relaxation time; ZI = zona incerta. Native and reconstructed MRI pulse sequences are being investigated to more clearly define the STN.…”

mentioning

confidence: 99%

“…Recent comparison of FLAIR with newer susceptibility sequences showed limited delineation of the STN on axial sequences at 3 T. SWI had a statistically significant higher CNR than FLAIR. 22 The prevalence of use of FLAIR among neurosurgeons may be due to the ready availability and rapid acquisition time, but, perhaps more importantly, it gives the STN an appearance of large mass. There are difficulties, however, with border delineation, especially adjacent to the SN.…”

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confidence: 99%

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Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Chandran¹,

Bynevelt

Lind

2016

JNS

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F uture progress to refine targets for deep brain stimulation (DBS) is critically dependent on precise placement and verification of electrodes in the brain. No stereotactic target is of more clinical importance or more nuanced regarding its imaging than the subthalamic nucleus (STN). The STN is difficult to image because of its biconvex shape, small size, oblique spatial orientation in 3 planes, and its close proximity to the substantia nigra (SN).3 A high level of accuracy is required as the motor region of the STN is posterolateral, and unwanted stimulation side effects may occur as a result of direct stimulation or spread to the anteromedial nonmotor area and the adjacent corticospinal tract. 9,18,31,56 Current imaging of STN borders is difficult.Targeting of the STN has historically been performed indirectly; the neurosurgeon predicts the location of the STN based on coordinates derived from atlases. These coordinates have often been related to the midcommissural point, which was derived from x-ray ventriculography but also from CT and MRI. Retaining this indirect, coordinate-based approach has been attractive to neurosurgeons. Experience in using this approach has been handed down from the past and can be used even with modern noninvasive imaging, and targeting preferences can be easily communicated between surgeons. The problem with indirect targeting is that different patients have different STN sizes, shapes, and positions.38 Direct targeting is an attempt to locate the STN in each individual patient.Poor image quality on traditional 1.5 tesla (T) scanners and primitive pulse sequences that do not provide adequate contrast at the level of the STN have limited the progression of direct targeting in some centers. Also hindering the development of stereotactic MRI are concerns about image distortion with higher field strength; traditional stereotactic head frames and localizers are too bulky to permit the use of high-quality, multichannel MRI head coils.Despite these challenges, higher field strength scanners and new pulse sequences have improved image quality to a point that some groups have adopted direct targeting of the STN, based on MRI.3,9,37 Difficulty delineating the STN and spatial inaccuracy has resulted in reluctance from others to abandon adjuncts such as CT/MRI merge and intraoperative electrophysiology.Traditionally, T2-weighted imaging (T2WI) has been used to plan for direct targeting of the STN using a variety of imaging parameters (Fig. 1).9 Although T2WI is useful, it is difficult to clearly delineate the STN from the SN and, to a lesser extent, the zona incerta (ZI). 22,32,37 abbreviatioNs CNR = contrast-to-noise ratio; DBS = deep brain stimulation; DTI = diffusion tensor imaging; FA = fractional anisotropy; FGATIR = fast gray matter acquisition T1 IR; FLAIR = fluid attenuated IR; FLASH = fast low-angle shot; FSE = fast spin echo; GRE = gradient echo; IR = inversion recovery; NSA = number of signal averages; PSIR = phase-sensitive IR; QSM = quantitative susceptibility mapping; SE = spin ...

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Section: Susceptibility-based Sequencesmentioning

confidence: 99%

Section: Susceptibility-based Sequencesmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Chandran¹,

Bynevelt

Lind

2016

JNS

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“…5,6 In addition to clinical diagnosis, MRI is also used in surgical planning of deep brain stimulation (DBS) in Parkinson's disease. [7][8][9][10] Conventionally, T2-and T2*-weighted MRI can be used to image midbrain nuclei because iron deposition in the brain is paramagnetic and leads to shortened T2 and T2*. In T2*-weighted spoiled gradient-echo (SPGR) images, midbrain nuclei present hypointense signal.…”

Section: Introductionmentioning

confidence: 99%

Efficient imaging of midbrain nuclei using inverse double‐echo steady‐state acquisition a)

Chang

Chao

et al. 2015

Medical Physics

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Purpose: Imaging of midbrain nuclei using T2-or T2*-weighted MRI often entails long echo time, leading to long scan time. In this study, an inverse double-echo steady-state (iDESS) technique is proposed for efficiently depicting midbrain nuclei. Methods: Thirteen healthy subjects participated in this study. iDESS was performed along with two sets of T2*-weighted spoiled gradient-echo images (SPGR1, with scan time identical to iDESS and SPGR2, using clinical scanning parameters as a reference standard) for comparison. Generation of iDESS composite images combining two echo signals was optimized for maximal contrast-to-noise ratio (CNR) between the red nuclei and surrounding tissues. Signal-to-noise ratios (SNRs) were calculated from the occipital lobe. Comparison was also made using phase-enhanced images as in standard susceptibility-weighted imaging (SWI). Results: The iDESS images present significantly higher SNR efficiency (171.3) than SPGR1 (158.7, p = 0.013) and SPGR2 (95.5, p < 10 −8). iDESS CNR efficiency (19.2) is also significantly greater than SPGR1 (6.9, p < 10) and SPGR2 (14.3, p = 0.0016). Compared with DESS, iDESS provides further advantage on enhanced phase information and hence improved contrast on SWI-processed images. Conclusions: iDESS efficiently depicts midbrain nuclei with improved CNR efficiency, increased SNR efficiency, and reduced scan time and is less prone to susceptibility signal loss from air-tissue interfaces. C 2015 American Association of Physicists in Medicine.

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Direct localization and delineation of human pedunculopontine nucleus based on a self‐supervised magnetic resonance image super‐resolution method

Guan

et al. 2023

Human Brain Mapping

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The pedunculopontine nucleus (PPN) is a small brainstem structure and has attracted attention as a potentially effective deep brain stimulation (DBS) target for the treatment of Parkinson's disease (PD). However, the in vivo location of PPN remains poorly described and barely visible on conventional structural magnetic resonance (MR) images due to a lack of high spatial resolution and tissue contrast. This study aims to delineate the PPN on a high‐resolution (HR) atlas and investigate the visibility of the PPN in individual quantitative susceptibility mapping (QSM) images. We combine a recently constructed Montreal Neurological Institute (MNI) space unbiased QSM atlas (MuSus‐100), with an implicit representation‐based self‐supervised image super‐resolution (SR) technique to achieve an atlas with improved spatial resolution. Then guided by a myelin staining histology human brain atlas, we localize and delineate PPN on the atlas with improved resolution. Furthermore, we examine the feasibility of directly identifying the approximate PPN location on the 3.0‐T individual QSM MR images. The proposed SR network produces atlas images with four times the higher spatial resolution (from 1 to 0.25 mm isotropic) without a training dataset. The SR process also reduces artifacts and keeps superb image contrast for further delineating small deep brain nuclei, such as PPN. Using the myelin staining histological atlas as guidance, we first identify and annotate the location of PPN on the T1‐weighted (T1w)‐QSM hybrid MR atlas with improved resolution in the MNI space. Then, we relocate and validate that the optimal targeting site for PPN‐DBS is at the middle‐to‐caudal part of PPN on our atlas. Furthermore, we confirm that the PPN region can be identified in a set of individual QSM images of 10 patients with PD and 10 healthy young adults. The contrast ratios of the PPN to its adjacent structure, namely the medial lemniscus, on images of different modalities indicate that QSM substantially improves the visibility of the PPN both in the atlas and individual images. Our findings indicate that the proposed SR network is an efficient tool for small‐size brain nucleus identification. HR QSM is promising for improving the visibility of the PPN. The PPN can be directly identified on the individual QSM images acquired at the 3.0‐T MR scanners, facilitating a direct targeting of PPN for DBS surgery.

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The subthalamic nucleus at 3.0 Tesla: choice of optimal sequence and orientation for deep brain stimulation using a standard installation protocol

Abstract: For 3.0-T MRI, T2*-FLASH2D (particularly the coronal view) provides optimal delineation of the STN using a standard installation protocol.

Cited by 39 publications

References 54 publications

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Magnetic resonance imaging of the subthalamic nucleus for deep brain stimulation

Efficient imaging of midbrain nuclei using inverse double‐echo steady‐state acquisition a)

Direct localization and delineation of human pedunculopontine nucleus based on a self‐supervised magnetic resonance image super‐resolution method

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