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Combination of CT angiography and MRI in surgical planning of deep brain stimulation

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

For safe deep brain stimulation (DBS) planning, an accurate visualization and localization of vessels is mandatory. Contrast enhanced (ce) MRI depicts both arteries and veins. Computed tomography angiography (CTA) detects arteries with high geometric accuracy. We routinely combine both modalities for DBS planning.

Methods

A total of 222 trajectories in a consecutive series of 113 patients who underwent DBS operations were included. In all trajectories, the number of veins and arteries in a 10-mm diameter around the planned trajectory were counted in a ceMRI and a CTA. If a vessel was visible in both modalities, the distance was measured.

Results

A total of 370 vessels were counted. Two hundred forty vessels (65%) were visible in both modalities. With 134 of the vessels, we detected a difference of the vessel’s location with an average distance of 1.24 mm (SD 0.58). Eighty vessels (22%) were visible only in the ceMRI, 50 vessels (13%) only in the CTA. We had four bleedings (1.8% per lead) of which one was symptomatic (0.45%).

Conclusion

The majority of vessels were visible in both modalities; however, in more than half of these cases, the location was not identical. Here, the location in the CTA can be regarded as the ground truth. Moreover, both the CTA and the ceMRI depicted vessels not seen in the other imaging modality. We therefore assume that the combination of both imaging modalities for DBS planning increases the chance to detect vascular conflicts along the trajectory, thus reducing the risk of intracranial bleeding.

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Acknowledgments

We thank Olivia Chorny for reviewing the manuscript and providing language support.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Marie T. Krüger

  2. Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Volker A. Coenen & Peter C. Reinacher

  3. Clinical Trials Unit, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Carolin Jenkner

  4. Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Horst Urbach & Karl Egger

Authors
  1. Marie T. Krüger
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  2. Volker A. Coenen
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  3. Carolin Jenkner
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  4. Horst Urbach
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  5. Karl Egger
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  6. Peter C. Reinacher
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Correspondence to Peter C. Reinacher.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Krüger, M.T., Coenen, V.A., Jenkner, C. et al. Combination of CT angiography and MRI in surgical planning of deep brain stimulation. Neuroradiology 60, 1151–1158 (2018). https://doi.org/10.1007/s00234-018-2079-0

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  • DOI: https://doi.org/10.1007/s00234-018-2079-0

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