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Direct visualization of deep brain stimulation targets in patients with Parkinson’s disease via 3-T quantitative susceptibility mapping

  • Original Article - Functional Neurosurgery - Movement disorders
  • Published:
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Abstract

Background

The direct visualization of brain nuclei on magnetic resonance (MR) images is important for target localization during deep brain stimulation (DBS) in patients with Parkinson’s disease (PD). We demonstrated the superiority of 3-T high-resolution submillimeter voxel size quantitative susceptibility mapping (QSM) for delineating the subthalamic nucleus (STN) and the globus pallidus internus (GPi).

Methods

Preoperative 3-T QSM and T2 weighted (T2w) images were obtained from ten patients with PD. Qualitative visualization scores were analyzed by two neurosurgeons on both images using a 4-point and 5-point scale, respectively. Images were also compared with regard to contrast-to-noise ratios (CNRs) and edge detection power for the STN and GPi. The Wilcoxon rank-sum test and the signed-rank test were used to compare measurements between the two images.

Results

Visualization scores for the STN and GPi, the mean CNR of the STN relative to the zona incerta (ZI) and the substantia nigra, and the mean CNR of the GPi relative to the internal capsule (IC) and the globus pallidum externum, were significantly higher on QSM images than on T2w images (P < 0.01). The edge detection powers of the STN-ZI and GPi-IC on QSM were significantly larger (by 2.6- and 3.8-fold, respectively) than those on T2w images (P < 0.01). QSM detected asymmetry of the STN in two patients.

Conclusions

QSM images provided improved delineation ability for the STN and GPi when compared to T2w images. Our findings are important for patients with PD who undergo DBS surgery, particularly those with asymmetric bilateral nuclei.

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Abbreviations

PD:

Parkinson’s disease

DBS:

deep brain stimulation

STN:

subthalamic nucleus

GPi:

globus pallidus interna

ZI:

zona incerta

SN:

substantia nigra

IC:

internal capsule

GPe:

globus pallidum externum

T2w:

T2-weighted

QSM:

quantitative susceptibility mapping

GRE:

gradient recalled echo

MIL:

medial intermedullary lamina

CNR:

contrast-to-noise ratio

ROI:

regions of interest

SD:

standard deviation

MER:

microelectrode recordings

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Acknowledgements

KY, ZR, and SG collected and analyzed the data. KY drafted the manuscript. ZR, JL, and YH helped to modify the manuscript. YL contributed to the conception and the design. All authors read and approved the manuscript.

Funding

Beijing Municipal Science & Technology Commission provided financial support (Reference: Z181100001718056). The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Beijing Institute of Functional Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China

    Kaijia Yu, Zhiwei Ren, Jianyu Li, Song Guo, Yongsheng Hu & Yongjie Li

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  1. Kaijia Yu
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Correspondence to Yongjie Li.

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Comments

A nice technical study showing that 3 Tesla high-resolution quantitative susceptibility mapping MRI has potential beneficial qualitative and quantitative proporties of depicting the STN and GPi for direct targeting in DBS surgeries compared to conventional T2 MRI.

Felix Gubler

Maastricht, Netherlands

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This article is part of the Topical Collection on Functional Neurosurgery - Movement disorders

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Yu, K., Ren, Z., Li, J. et al. Direct visualization of deep brain stimulation targets in patients with Parkinson’s disease via 3-T quantitative susceptibility mapping. Acta Neurochir 163, 1335–1345 (2021). https://doi.org/10.1007/s00701-021-04715-4

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