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Accuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings

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Abstract

Background

Successful deep brain stimulation is mostly dependent on accurate positioning of the leads at the optimal target points. We investigated whether the identification of the subthalamic nucleus in T2-weighted 3-T MRI, fluid-attenuated inversion recovery 3-T MRI and susceptibility-weighted 3-T MRI is confirmed by intraoperative neurological microelectrode recording.

Methods

We evaluated 182 microelectrode recording leads in 21 patients with bilateral deep brain stimulation, retrospectively. Consequently, 728 electrode contact positions in T2-weighted 3-T MRI, 552 electrode contact positions in fluid-attenuated inversion recovery 3-T MRI and 490 electrode contact positions in susceptibility-weighted 3-T MRI were evaluated for a positive nucleus subthalamicus signal.

Results

The highest sensitivity was measured for fluid-attenuated inversion recovery 3-T MRI with 82.5 %, while the highest specificity was observed for susceptibility-weighted 3-T MRI with 90.6 %. The negative predictive value was nearly equal for susceptibility-weighted MRI and fluid-attenuated inversion recovery MRI with 87.5 % vs. 87.1 %, but the positive predictive value was higher in susceptibility-weighted 3-T MRI (86.0 %) than in the other MRI sequences.

Conclusions

The susceptibility-weighted 3-T MRI-based subthalamic nucleus localization shows the best accuracy compared with T2-weighted and fluid-attenuated inversion recovery 3-T MRI. Therefore, the susceptibility-weighted 3-T MRI should be preferred for surgical planning when the operation procedure is performed under general anesthesia without microelectrode recordings.

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Conflicts of interest

None.

Full Financial Disclosures of All Authors for the Past Year

Klaus D. Martin, Kay Engellandt, Rüdiger von Kummer, Lisa Klingelhoefer, Alexander Storch, Mareike Fauser, Stephan B. Sobottka and Gabriele Schackert have no financial disclosures. Witold H. Polanski have received a travel grant (10/2013-04/2014) and a poster price (08/2013) from Medtronic.

Contributorship statement

All authors contributed to the conception and design, acquisition of the data or analysis and interpretation of the data; drafting of the article or revising it critically for important intellectual content; and final approval of the version to be published.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical school ‘Carl Gustav Carus’ of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    Witold H. Polanski, Klaus D. Martin, Gabriele Schackert & Stephan B. Sobottka

  2. Department of Neuroradiology, Technical University of Dresden, Dresden, Germany

    Kay Engellandt & Rüdiger von Kummer

  3. Division of Neurodegenerative Diseases, Department of Neurology, Technical University of Dresden, Dresden, Germany

    Lisa Klingelhoefer, Mareike Fauser & Alexander Storch

Authors
  1. Witold H. Polanski
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  2. Klaus D. Martin
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Corresponding author

Correspondence to Witold H. Polanski.

Electronic supplementary material

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ESM 1

Table (suppl). MRI parameters of the used T2 3-T MRI, fluid-attenuated inversion recovery 3-T MRI and susceptibility-weighted 3-T MRI (DOC 28 kb)

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Polanski, W.H., Martin, K.D., Engellandt, K. et al. Accuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings. Acta Neurochir 157, 479–486 (2015). https://doi.org/10.1007/s00701-014-2328-x

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  • DOI: https://doi.org/10.1007/s00701-014-2328-x

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