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Intraoperative cone-beam CT with metal artifact reduction for assessment of the electrode position and the intracranial structures during deep brain stimulation procedure

  • Technical Note - Functional Neurosurgery - Movement disorders
  • Published:
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Abstract

Background

In deep brain stimulation (DBS) for Parkinson’s disease (PD), the clinical outcome largely depends on the appropriate position of the electrode implanted in the targeted structure. In intraoperative cone-beam computed tomography (CT) performed for the evaluation of the electrode position, the metal artifact induced by the implanted electrode can prevent the precise localization of the electrode. Metal artifact reduction (MAR) techniques have been recently developed that can dramatically improve the visualization of objects by reducing metal artifacts after performing cone-beam CT. Hence, in this case series, we attempted to clarify the usefulness and accuracy of intraoperative cone-beam CT with MAR (intraCBCTwM) by comparing with both intraoperative cone-beam CT without MAR (intraCBCTwoM) and conventional postoperative CT (post-CT) for the assessment of the implanted electrode position and the intracranial structures during DBS procedures.

Methods

Between November 2019 and December 2020, 10 patients with PD who underwent DBS at our institution were recruited, and the images of 9 patients (bilateral: n = 8, unilateral: n = 1) were analyzed. The artifact index (AI) in intraCBCTwM or intraCBCTwoM, and conventional post-CT were retrospectively assessed using the standard deviation of the region-of-interest around the implanted electrodes and background noise. Additionally, the Euclidean distances gap of electrode tip based on post-CT in each fusion image was compared between intraCBCTwM and intraCBCTwoM.

Results

The AI was significantly lower in intraCBCTwM than in intraCBCTwoM (P < 0.01). The mean Euclidean distance between the tip of the electrode in intraCBCTwM and in post-CT was significantly shorter compared to that in intraCBCTwoM (P < 0.05).

Conclusions

The results reported here suggest that intraCBCTwM is a more useful and accurate method than intraCBCTwoM to assess the implanted electrode position and intracranial structures during DBS.

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Abbreviations

AC-PC:

Anterior commissure–posterior commissure

MCP:

Midcommissural point

CT:

Computed tomography

DBS:

Deep brain stimulation

PD:

Parkinson’s disease

CBCT:

Cone-beam computed tomography

MAR:

Metal artifact reduction

AI:

Artifact index

SD:

Standard deviation

STN:

Subthalamic nucleus

IntraCBCTwM:

Intraoperative cone-beam CT with MAR

IntraCBCTwoM:

Intraoperative cone-beam CT without MAR

Post-CT:

Postoperative CT

Pre-MRI:

Preoperative MRI

ROI:

Region of interest

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Acknowledgements

We acknowledge the support of the radiological technicians at our institution.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan

    Toshinari Kawasaki, Takayuki Kikuchi, Yuto Mitsuno, Yukihiro Yamao & Susumu Miyamoto

  2. Department of Neurosurgery, Otsu City Hospital, Shiga, Japan

    Toshinari Kawasaki

  3. Siemens Healthcare K.K., Tokyo, Japan

    Katharina Otani

  4. Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Nobukatsu Sawamoto

  5. Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Ryosuke Takahashi

Authors
  1. Toshinari Kawasaki
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  2. Takayuki Kikuchi
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  3. Katharina Otani
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  4. Yuto Mitsuno
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  5. Yukihiro Yamao
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  6. Nobukatsu Sawamoto
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  7. Ryosuke Takahashi
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  8. Susumu Miyamoto
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Corresponding author

Correspondence to Takayuki Kikuchi.

Ethics declarations

Ethics approval and consent to participate

The study was conducted ethically and in accordance with the World Medical Association Declaration of Helsinki. This study protocol was reviewed and approval by hospital ethics committee, approval number R2036. Written informed consent was obtained from all participants.

Conflict of interest

This is the collaborative study of Kyoto University and Siemens Healthcare K.K. Siemens Healthcare K.K. provided a software license (syngo DynaCT SMART) for research use for the duration of the study. K.O. is a full-time employee of Siemens Healthcare K.K. The other authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. K.O. was not involved in the data acquisition and evaluation and did not have direct control of the data. In this study, the data were assessed from a neutral scientific perspective using the device and materials for the clinical use.

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

Supplementary Information

Below is the link to the electronic supplementary material.

701_2022_5313_MOESM1_ESM.pdf

Supplementary Fig. 1 The distance gaps in the mediolateral (A), anteroposterior (B), and craniocaudal (C) from the intracranial landmark to the electrode tip between intraCBCTwM-post-CT and intraCBCTwoM-post-CT. The distance gaps in the three directions were not significantly different between groups (X direction: P = 0.27, Y direction: P = 0.46, Z direction: P = 0.05). CT: computed tomography; post-CT: postoperative CT; intraCBCTwM: intraoperative cone-beam computed tomography with metal artifact reduction; intraCBCTwM: intraoperative cone-beam computed tomography without metal artifact reduction;ROI: region of interest. (PDF 367 KB)

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Kawasaki, T., Kikuchi, T., Otani, K. et al. Intraoperative cone-beam CT with metal artifact reduction for assessment of the electrode position and the intracranial structures during deep brain stimulation procedure. Acta Neurochir 164, 2309–2316 (2022). https://doi.org/10.1007/s00701-022-05313-8

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  • DOI: https://doi.org/10.1007/s00701-022-05313-8

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