European Radiology

, Volume 21, Issue 1, pp 130–136

Optimal MRI methods for direct stereotactic targeting of the subthalamic nucleus and globus pallidus

  • Ruth L. O’Gorman
  • Karin Shmueli
  • Keyoumars Ashkan
  • Michael Samuel
  • David J. Lythgoe
  • Asal Shahidiani
  • Stephen J. Wastling
  • Michelle Footman
  • Richard P. Selway
  • Jozef Jarosz
Magnetic Resonance

DOI: 10.1007/s00330-010-1885-5

Cite this article as:
O’Gorman, R.L., Shmueli, K., Ashkan, K. et al. Eur Radiol (2011) 21: 130. doi:10.1007/s00330-010-1885-5

Abstract

Objective

Reliable identification of the subthalamic nucleus (STN) and globus pallidus interna (GPi) is critical for deep brain stimulation (DBS) of these structures. The purpose of this study was to compare the visibility of the STN and GPi with various MRI techniques and to assess the suitability of each technique for direct stereotactic targeting.

Methods

MR images were acquired from nine volunteers with T2- and proton density-weighted (PD-W) fast spin echo, susceptibility-weighted imaging (SWI), phase-sensitive inversion recovery and quantitative T1, T2 and T2* mapping sequences. Contrast-to-noise ratios (CNR) for the STN and GPi were calculated for all sequences. Targeting errors on SWI were evaluated on magnetic susceptibility maps. The sequences demonstrating the best conspicuity of DBS target structures (SWI and T2*) were then applied to ten patients with movement disorders, and the CNRs for these techniques were assessed.

Results

SWI offers the highest CNR for the STN, but standard PD-W images provide the best CNR for the pallidum. Susceptibility maps indicated that the GPi margins may be shifted slightly on SWI, although no shifts were seen for the STN.

Conclusion

SWI may improve the visibility of the STN on pre-operative MRI, potentially improving the accuracy of direct stereotactic targeting.

Keywords

MRI Deep brain stimulation Direct stereotactic targeting Subthalamic nucleus Globus pallidus 

Abbreviations

CNR

contrast-to-noise ratio(s)

DBS

deep brain stimulation

DESPOT1

driven equilibrium single-pulse observation of T1

FSE

fast spin echo

GPi

globus pallidus interna

GRE

gradient echo

IR

inversion recovery

IR-FSPGR

inversion recovery prepared fast spoiled gradient echo volume

PSIR

phase sensitive inversion recovery

PD

Parkinson’s disease

PD-W

proton density-weighted

STN

subthalamic nucleus

SWI

susceptibility-weighted imaging

TE

echo time

TI

inversion time

TR

repetition time

T2-W

T2-weighted

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Ruth L. O’Gorman
    • 1
    • 2
  • Karin Shmueli
    • 3
  • Keyoumars Ashkan
    • 4
  • Michael Samuel
    • 5
  • David J. Lythgoe
    • 6
  • Asal Shahidiani
    • 6
  • Stephen J. Wastling
    • 6
    • 7
  • Michelle Footman
    • 7
  • Richard P. Selway
    • 4
  • Jozef Jarosz
    • 1
  1. 1.Department of NeuroradiologyKing’s College HospitalLondonUK
  2. 2.MR ZentrumUniversity Children’s Hospital (Kinderspital)ZurichSwitzerland
  3. 3.Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaUSA
  4. 4.Department of NeurosurgeryKing’s College HospitalLondonUK
  5. 5.Department of NeurologyKing’s College HospitalLondonUK
  6. 6.Department of Clinical NeuroscienceInstitute of PsychiatryLondonUK
  7. 7.Department of Medical Engineering and PhysicsKing’s College HospitalLondonUK