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Comparison of two segmentation software tools for deep brain stimulation of the subthalamic and ventro-intermedius nuclei

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Abstract

Purpose

Deep brain stimulation (DBS) relies on precise targeting of key structures such as the subthalamic nucleus (STN) for Parkinson’s disease (PD) and the ventro-intermedius nucleus of the thalamus (Vim) for essential tremor (ET). Segmentation software, such as GuideXT© and Suretune©, are commercially available for atlas-based identification of deep brain structures. However, no study has compared the concordance of the segmentation results between the two software.

Methods

We retrospectively compared the concordance of segmentation of GuideXT© and Suretune© software by comparing the position of the segmented key structures with clinically predicted targets obtained using the newly developed RebrAIn© software as a reference.

Results

We targeted the STN in 44 MRI from PD patients (88 hemispheres) and the Vim in 31 MRI from ET patients (62 hemispheres) who were elected for DBS. In 22 STN targeting (25%), the target positioning was not correlating between GuideXT© and Suretune©. Regarding the Vim, targets were located in the segmented Vim in 37%, the posterior subthalamic area (PSA) in 60%, and the STN in 3% of the cases using GuideXT©; the proportions were 34%, 60%, and 6%, respectively, using Suretune©. The mean distance from the centre of the RebrAIn© targeting to the segmented Vim by Suretune© was closer (0.64 mm) than with GuideXT© (0.96 mm; p = 0.0004).

Conclusion

While there is some level of concordance in the segmentation results of key structures for DBS treatment among software models, differences persist. Therefore, such software should still be considered as tools and should not replace clinician experience in DBS planning.

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Fig. 1
Fig. 2

© and Suretune©) in the upper panel and the Vim (pink in GuideXT© and dark green in Suretune©) in the lower panel. B Representative images of the RebrAIn© target (white cross) considered as “inside” (left) and “outside” (right) the segmentation (STN in the upper panel and Vim in the lower panel). The white cross represents the RebrAIn© target directly marked in the MRI using OptimDBS software developed by RebrAIn©. C Representative image of the calculation of the distance “d” (yellow line) between the centre of the RebrAIn© target (white cross) and the STN in a case considered as “outside” of the segmentation

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Data availability

The datasets generated and analysed in this study are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Funding

This research was funded using the funds dedicated to research of the Department of Neurosurgery of Bordeaux University Hospital.

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Authors and Affiliations

  1. Department of Neurosurgery, Hôpital Pellegrin, Bordeaux University Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France

    P. E. Constanthin, E. Cuny & J. Engelhardt

  2. INRIA Bordeaux Sud-Ouest Research Centre, Talence, France

    N. Zemzemi

  3. Institute of Mathematics of Bordeaux, Bordeaux INP, CNRS, Bordeaux University, Bordeaux, France

    N. Zemzemi & J. Engelhardt

Authors
  1. P. E. Constanthin
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  2. N. Zemzemi
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  3. E. Cuny
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  4. J. Engelhardt
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Contributions

Conception and design: Emmanuel Cuny.

Acquisition of samples and data: Emmanuel Cuny.

Analysis and interpretation of data: Paul Constanthin, Emmanuel Cuny, Julien Engelhardt, Nejib Zemzemi.

Statistical analysis: Paul Constanthin.

Drafting of the article: Paul Constanthin.

Critically revision of the article: all authors.

Study supervision: Emmanuel Cuny, Julien Engelhardt.

Corresponding author

Correspondence to P. E. Constanthin.

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Ethics approval

This research was carried out in compliance with the Declaration of Helsinki and was approved by the Institutional Review Board of the Collège de Neurochirurgie (IRB00011687 Collège de Neurochirurgie #1:2023/05). Written informed consent was obtained from participants (or their legal guardian) to participate in the study. All patients were over 18 years of age.

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Not applicable.

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Not applicable.

Conflict of interest

EC and NZ are shareholders and co-founders of the startup RebrAIn. The other authors report no conflicts of interest concerning the materials or methods used in this study or the findings presented in this paper.

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The funding source did not have access to the data nor did it have any influence on their analysis or the drafting of the manuscript.

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Constanthin, P.E., Zemzemi, N., Cuny, E. et al. Comparison of two segmentation software tools for deep brain stimulation of the subthalamic and ventro-intermedius nuclei. Acta Neurochir 165, 3397–3402 (2023). https://doi.org/10.1007/s00701-023-05819-9

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  • DOI: https://doi.org/10.1007/s00701-023-05819-9

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