Direct localisation of the human pedunculopontine nucleus using MRI: a coordinate and fibre-tracking study
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To image the pedunculopontine tegmental nucleus (PPN), a deep brain stimulation (DBS) target for Parkinson disease, using MRI with validated results.
This study used the MP2RAGE sequence with high resolution and enhanced grey-white matter contrast on a 7-T ultra-high-field MRI system to image the PPN as well as a diffusion spectrum imaging method on a 3-T MRI system to reconstruct the main fibre systems surrounding the PPN. The coordinates of the rostral and caudal PPN poles of both sides were measured in relation to the third and fourth ventricular landmarks on the 7-T image.
The boundary of the PPN was delineated, and showed morphology consistent with previous histological works. The main fibres around the PPN were reconstructed. The pole coordinate results combined with the fibre spatial relationships validate the imaging results.
A practical protocol is provided to directly localise the PPN using MRI; the position and morphology of the PPN can be obtained and validated by locating its poles relative to two ventricular landmarks and by inspecting its spatial relationship with the surrounding fibre systems. This technique can be potentially used in clinics to define the boundary of the PPN before DBS surgery for treatment of Parkinson disease in a more precise and reliable manner.
• Combined information helps localise the PPN as a DBS target for PD patients
• Scan the PPN at 7 T and measure its coordinates against different ventricular landmarks
• Reconstruct the main fibres around the PPN using diffusion spectrum imaging
KeywordsPedunculopontine tegmental nucleus Parkinson disease Magnetic resonance imaging Deep brain stimulation Diffusion tensor imaging
Abbreviations and acronyms
Central tegmental tracts
Deep brain stimulation
MP2RAGE two-echo divided image
Decussation of the superior cerebellar peduncle
Diffusion spectrum imaging
DSI image with b value = 0
Diffusion tensor imaging
- Point B
Base point of the B-F coordinate
- Point F
Fastigial point of the B-F coordinate
Pedunculopontine tegmental nucleus
Mean quantitative anisotropy
Second echo of the MP2RAGE image
Superior cerebellar peduncle
Substantia nigra pars compacta
We thank Mr. Jing Luo and Ms. Hong Xu for their assistance with the experimental conditions and Dr. Penghu Wei and Dr. Xu Yan for their technical advice.
This study has received funding from the Chinese MOST (Ministry of Science and Technology of China) “973” grant (2015CB351701), NSFC (National Natural Science Foundation of China) grants (31730039, 81601060), and Beijing Municipal Commission of Science and Technology grant (Z161100000116059).
Compliance with ethical standards
The scientific guarantor of this publication is Yan Zhuo.
Conflict of interest
The author Jing An is an employee of Siemens responsible for customer research support. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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