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The subthalamic nucleus at 7.0 Tesla: evaluation of sequence and orientation for deep-brain stimulation

  • Experimental research
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Abstract

Background

Deep-brain stimulation (DBS) of the subthalamic nucleus (STN) is an accepted neurosurgical technique for the treatment of medication-resistant Parkinson’s disease and other neurological disorders. The accurate targeting of the STN is facilitated by precise and reliable identification in pre-stereotactic magnetic resonance imaging (MRI).

The aim of the study was to compare and evaluate different promising MRI methods at 7.0 T for the pre-stereotactic visualisation of the STN

Methods

MRI (T2-turbo spin-echo [TSE], T1-gradient echo [GRE], fast low-angle shot [FLASH] two-dimensional [2D] T2* and susceptibility-weighted imaging [SWI]) was performed in nine healthy volunteers. Delineation and image quality for the STN were independently evaluated by two neuroradiologists using a six-point grading system. Inter-rater reliability, contrast-to-noise ratios (CNRs) and signal-to-noise ratios (SNRs) for the STN were calculated. For the anatomical validation, the coronal FLASH 2D T2* images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren).

Results

The STN was clearly and reliably visualised in FLASH 2D T2* imaging (particularly coronal view), with a sharp delineation between the STN, the substantia nigra and the zona incerta. No major artefacts in the STN were observed in any of the sequences. FLASH 2D T2* and SWI images offered significantly higher CNR for the STN compared with T2-TSE. The co-registration of the coronal FLASH 2D T2* images with the stereotactic atlas affirmed the correct localisation of the STN in all cases.

Conclusion

The STN is best and reliably visualised in FLASH 2D T2* imaging (particularly coronal orientation) at 7.0-T MRI.

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Authors and Affiliations

  1. Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Hans U. Kerl, Mansour Al-Zghloul, Christoph Groden & Ingo S. Nölte

  2. Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Lars Gerigk

  3. Department of Neurosurgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Ioannis Pechlivanis

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  1. Hans U. Kerl
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  2. Lars Gerigk
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  3. Ioannis Pechlivanis
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Correspondence to Ingo S. Nölte.

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Hans U. Kerl and Lars Gerigk contributed equally to this article

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Kerl, H.U., Gerigk, L., Pechlivanis, I. et al. The subthalamic nucleus at 7.0 Tesla: evaluation of sequence and orientation for deep-brain stimulation. Acta Neurochir 154, 2051–2062 (2012). https://doi.org/10.1007/s00701-012-1476-0

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