Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

Kerl, H; Gerigk, Lars; Huck, S.; Al-Zghloul, Mansour; Groden, Christoph; Nölte, I.

doi:10.1007/s00062-012-0136-3

Cited by 19 publications

(24 citation statements)

References 63 publications

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“…In addition, inconsistencies in the efficacy and adverse effects of ZI stimulation exist and likely reflect the inability to directly target the ZI resulting in variability of contact placement [20-23, 31, 32]. Methods for visualization of the rZI allowing direct stereotactic targeting have recently been reported [33, 34]. In addition, intraoperative microelectrode recordings may aide in direct targeting of the ZI as this region reveals a low amplitude background and a sparse cell density, as well as a lack of proprioceptive responses, which help to distinguish it from surrounding areas [24].…”

Section: Discussionmentioning

confidence: 99%

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

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Section: Discussionmentioning

confidence: 99%

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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“…In the era of 1.5 T the direct visualization failed, secondary to insufficient contrast and low resolution [27,53] . At 3.0 T initial promis- ing results for the visualization of the ZI have been presented [54] . The implementation of 7.0 T MRI is a further technical advance to a higher signal and a superior spatial resolution compared to 1.5 T and 3.0 T [27,37,55] .…”

Section: Discussionmentioning

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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“…[5][6][7] However, in SPGR, clear depiction of midbrain necessitates a relatively long TE and, thus, results in long scan time. In this study, we propose the iDESS sequence which contains three innovative parts.…”

Section: Discussionmentioning

confidence: 99%

“…4 To achieve accurate diagnosis of movement disorders, previous studies used MRI to investigate the midbrain region, which is speculated to play an important role in related neurodegenerative diseases. 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*.…”

Section: Introductionmentioning

confidence: 99%

“…9,[11][12][13] In SWI, filtered phase images are used to mask magnitude images, which increases sensitivity to tissue susceptibility changes such as from hemorrhage or from iron deposition. 1,[6][7][8][9][14][15][16] This study aims at imaging of midbrain nuclei with higher imaging efficiency compared to the T2*-weighted SPGR technique which is often regarded as the current clinical standard. To achieve this goal, an inverse double-echo steadystate (iDESS) sequence is proposed and compared with SPGR technique.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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Visualisation of the Zona Incerta for Deep Brain Stimulation at 3.0 Tesla

Abstract: The delineation of the rZI is best possible in T2*-FLASH2D (particularly coronal view) using a standard installation protocol at 3.0 T. The caudal ZI could not be discerned in any of the sequences.

Cited by 19 publications

References 63 publications

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

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

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

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