1
|
Neudorfer C, Kroneberg D, Al-Fatly B, Goede L, Kübler D, Faust K, van Rienen U, Tietze A, Picht T, Herrington TM, Middlebrooks EH, Kühn A, Schneider GH, Horn A. Personalizing Deep Brain Stimulation Using Advanced Imaging Sequences. Ann Neurol 2022; 91:613-628. [PMID: 35165921 DOI: 10.1002/ana.26326] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE With a growing appreciation for interindividual anatomical variability and patient-specific brain connectivity, advanced imaging sequences offer the opportunity to directly visualize anatomical targets for deep brain stimulation (DBS). The lack of quantitative evidence demonstrating their clinical utility, however, has hindered their broad implementation in clinical practice. METHODS Using fast gray matter acquisition T1 inversion recovery (FGATIR) sequences, the present study identified a thalamic hypointensity that holds promise as a visual marker in DBS. To validate the clinical utility of the identified hypointensity, we retrospectively analyzed 65 patients (26 female, mean age = 69.1 ± 12.7 years) who underwent DBS in the treatment of essential tremor. We characterized its neuroanatomical substrates and evaluated the hypointensity's ability to predict clinical outcome using stimulation volume modeling and voxelwise mapping. Finally, we determined whether the hypointensity marker could predict symptom improvement on a patient-specific level. RESULTS Anatomical characterization suggested that the identified hypointensity constituted the terminal part of the dentatorubrothalamic tract. Overlap between DBS stimulation volumes and the hypointensity in standard space significantly correlated with tremor improvement (R2 = 0.16, p = 0.017) and distance to hotspots previously reported in the literature (R2 = 0.49, p = 7.9e-4). In contrast, the amount of variance explained by other anatomical atlas structures was reduced. When accounting for interindividual neuroanatomical variability, the predictive power of the hypointensity increased further (R2 = 0.37, p = 0.002). INTERPRETATION Our findings introduce and validate a novel imaging-based marker attainable from FGATIR sequences that has the potential to personalize and inform targeting and programming in DBS for essential tremor. ANN NEUROL 2022;91:613-628.
Collapse
Affiliation(s)
- Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany.,MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR), MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Kroneberg
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Bassam Al-Fatly
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Lukas Goede
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Dorothee Kübler
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Ursula van Rienen
- Institute of General Electrical Engineering, University of Rostock, Rostock, Germany.,Department Life, Light, and Matter, University of Rostock, Rostock, Germany.,Department of Ageing of Individuals and Society, University of Rostock, Rostock, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Boston, MA.,Department of Neurology, Harvard Medical School, Boston, MA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL.,Department of Neurosurgery, Mayo Clinic, Jacksonville, FL
| | - Andrea Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany.,MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR), MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Malvea A, Babaei F, Boulay C, Sachs A, Park J. Deep brain stimulation for Parkinson’s Disease: A Review and Future Outlook. Biomed Eng Lett 2022; 12:303-316. [PMID: 35892031 PMCID: PMC9308849 DOI: 10.1007/s13534-022-00226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 12/29/2021] [Accepted: 04/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinson's Disease (PD) is a neurodegenerative disorder that manifests as an impairment of motor and non-motor abilities due to a loss of dopamine input to deep brain structures. While there is presently no cure for PD, a variety of pharmacological and surgical therapeutic interventions have been developed to manage PD symptoms. This review explores the past, present and future outlooks of PD treatment, with particular attention paid to deep brain stimulation (DBS), the surgical procedure to deliver DBS, and its limitations. Finally, our group's efforts with respect to brain mapping for DBS targeting will be discussed.
Collapse
Affiliation(s)
- Anahita Malvea
- Faculty of Medicine, University of Ottawa, K1H 8M5 Ottawa, ON Canada
| | - Farbod Babaei
- School of Electrical Engineering and Computer Science, University of Ottawa, K1N 6N5 Ottawa, ON Canada
| | - Chadwick Boulay
- The Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- The University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario Canada
| | - Adam Sachs
- The Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- The University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario Canada
| | - Jeongwon Park
- School of Electrical Engineering and Computer Science, University of Ottawa, K1N 6N5 Ottawa, ON Canada
- Department of Electrical and Biomedical Engineering, University of Nevada, 89557 Reno, NV USA
| |
Collapse
|
3
|
Nikparast F, Ganji Z, Danesh Doust M, Faraji R, Zare H. Brain pathological changes during neurodegenerative diseases and their identification methods: How does QSM perform in detecting this process? Insights Imaging 2022; 13:74. [PMID: 35416533 PMCID: PMC9008086 DOI: 10.1186/s13244-022-01207-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/13/2022] [Indexed: 12/14/2022] Open
Abstract
The presence of iron is essential for many biological processes in the body. But sometimes, for various reasons, the amount of iron deposition in different areas of the brain increases, which leads to problems related to the nervous system. Quantitative susceptibility mapping (QSM) is one of the newest magnetic resonance imaging (MRI)-based methods for assessing iron accumulation in target areas. This Narrative Review article aims to evaluate the performance of QSM compared to other methods of assessing iron deposition in the clinical field. Based on the results, we introduced related basic definitions, some neurodegenerative diseases, methods of examining iron deposition in these diseases, and their advantages and disadvantages. This article states that the QSM method can be introduced as a new, reliable, and non-invasive technique for clinical evaluations.
Collapse
Affiliation(s)
- Farzaneh Nikparast
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zohreh Ganji
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Danesh Doust
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhane Faraji
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoda Zare
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. .,Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
4
|
Boutet A, Loh A, Chow CT, Taha A, Elias GJB, Neudorfer C, Germann J, Paff M, Zrinzo L, Fasano A, Kalia SK, Steele CJ, Mikulis D, Kucharczyk W, Lozano AM. A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets. J Neurosurg 2021; 135:1445-1458. [PMID: 33770759 DOI: 10.3171/2020.8.jns201125] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Historically, preoperative planning for functional neurosurgery has depended on the indirect localization of target brain structures using visible anatomical landmarks. However, recent technological advances in neuroimaging have permitted marked improvements in MRI-based direct target visualization, allowing for refinement of "first-pass" targeting. The authors reviewed studies relating to direct MRI visualization of the most common functional neurosurgery targets (subthalamic nucleus, globus pallidus, and thalamus) and summarize sequence specifications for the various approaches described in this literature. METHODS The peer-reviewed literature on MRI visualization of the subthalamic nucleus, globus pallidus, and thalamus was obtained by searching MEDLINE. Publications examining direct MRI visualization of these deep brain stimulation targets were included for review. RESULTS A variety of specialized sequences and postprocessing methods for enhanced MRI visualization are in current use. These include susceptibility-based techniques such as quantitative susceptibility mapping, which exploit the amount of tissue iron in target structures, and white matter attenuated inversion recovery, which suppresses the signal from white matter to improve the distinction between gray matter nuclei. However, evidence confirming the superiority of these sequences over indirect targeting with respect to clinical outcome is sparse. Future targeting may utilize information about functional and structural networks, necessitating the use of resting-state functional MRI and diffusion-weighted imaging. CONCLUSIONS Specialized MRI sequences have enabled considerable improvement in the visualization of common deep brain stimulation targets. With further validation of their ability to improve clinical outcomes and advances in imaging techniques, direct visualization of targets may play an increasingly important role in preoperative planning.
Collapse
Affiliation(s)
- Alexandre Boutet
- 1University Health Network, Toronto
- 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Ludvic Zrinzo
- 3Functional Neurosurgery Unit, Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Alfonso Fasano
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 5Krembil Brain Institute, Toronto, Ontario
| | | | - Christopher J Steele
- 6Department of Psychology, Concordia University, Montreal, Quebec, Canada; and
- 7Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - David Mikulis
- 1University Health Network, Toronto
- 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Walter Kucharczyk
- 1University Health Network, Toronto
- 2Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | | |
Collapse
|
5
|
Improved targeting of the globus pallidus interna using quantitative susceptibility mapping prior to MR-guided focused ultrasound ablation in Parkinson's disease. Clin Imaging 2020; 68:94-98. [DOI: 10.1016/j.clinimag.2020.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022]
|
6
|
Cong F, Liu X, Liu CSJ, Xu X, Shen Y, Wang B, Zhuo Y, Yan L. Improved depiction of subthalamic nucleus and globus pallidus internus with optimized high-resolution quantitative susceptibility mapping at 7 T. NMR IN BIOMEDICINE 2020; 33:e4382. [PMID: 32686241 DOI: 10.1002/nbm.4382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
The subthalamic nucleus (STN) and globus pallidus internus (GPi) are commonly used targets in deep-brain stimulation (DBS) surgery for the treatment of movement disorders. The success of DBS critically depends on the spatial precision of stimulation. By taking advantage of good contrast between iron-rich deep-brain nuclei and surrounding tissues, quantitative susceptibility mapping (QSM) has shown promise in differentiating the STN and GPi from the adjacent substantia nigra and globus pallidus externus, respectively. Nonlinear morphology-enabled dipole inversion (NMEDI) is a widely used QSM algorithm, but the image quality of reconstructed susceptibility maps relies on the regularization parameter selection. To date, few studies have systematically optimized the regularization parameter at the ultra-high field of 7 T. In this study, we optimized the regularization parameter in NMEDI to improve the depiction of STN and GPi at different spatial resolutions at both 3 T and 7 T. The optimized QSM images were further compared with other susceptibility-based images, including T2*-weighted (T2*w), R2*, susceptibility-weighted, and phase images. QSM showed better depiction of deep-brain nuclei with clearer boundaries compared with the other methods, and 7 T QSM at 0.35 × 0.35 × 1.0 mm3 demonstrated superior performance to the others. Our findings suggest that optimized high-resolution QSM at 7 T allows for improved delineation of deep-brain nuclei with clear and sharp borders between nuclei, which may become a promising tool for DBS nucleus preoperative localization.
Collapse
Affiliation(s)
- Fei Cong
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xueru Liu
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chia-Shang Jason Liu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Xin Xu
- Department of Neurosurgery, General Hospital of PLA, Beijing, China
| | - Yelong Shen
- Shandong Provincial Hospital affiliated to Shandong First Medical University, Shandong, China
| | - Bo Wang
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yan Zhuo
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Lirong Yan
- Stevens Neuroimaging and Informatics Institute, Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
7
|
Popov VA, Tomskiy AA, Gamaleya AA, Sedov AS. [Historical view on the pathogenesis and surgical treatment of cervical dystonia]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:128-133. [PMID: 32790987 DOI: 10.17116/jnevro2020120071128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the past few decades, approaches to surgical treatment of dystonia passed through paradigmatic shift. Intradural upper cervical anterior rhizotomy was replaced by selective peripheral denervation with lesser spectrum of side-effects. Such techniques as microvascular decompression of accessory nerve or spinal cord stimulation for cervical dystonia were abandoned due to lack of proven efficacy. Introducing globus pallidus interna (GPi) DBS in 1990's to treat all types of dystonia, including cervical dystonia, was a fundamental factor. With the growing body of knowledge on the pathophysiology of dystonia, GPi DBS appears to be the most expedient, effective and safe method with limited indications to peripheral destructive procedures.
Collapse
Affiliation(s)
- V A Popov
- Burdenko Neurosurgical Institute, Moscow, Russia.,Human Cell Neurophysiology Laboritory, N.N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - A A Tomskiy
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A A Gamaleya
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A S Sedov
- Human Cell Neurophysiology Laboritory, N.N. Semenov Institute of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| |
Collapse
|
8
|
Maruyama S, Fukunaga M, Fautz HP, Heidemann R, Sadato N. Comparison of 3T and 7T MRI for the visualization of globus pallidus sub-segments. Sci Rep 2019; 9:18357. [PMID: 31797993 PMCID: PMC6892946 DOI: 10.1038/s41598-019-54880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022] Open
Abstract
The success of deep brain stimulation (DBS) targeting the internal globus pallidus (GPi) depends on the accuracy of electrode localization inside the GPi. In this study, we sought to compare visualization of the medial medullary lamina (MML) and accessory medullary lamina (AML) between proton density-weighted (PDW) and T2-weighted (T2W) sequences on 3T and 7T MRI scanners. Eleven healthy participants (five men and six women; age, 19–28 years; mean, 21.5) and one 61-year-old man were scanned using two-dimensional turbo spin-echo PDW and T2W sequences on 3T and 7T MRI scanners with a 32-channel receiver head coil and a single-channel transmission coil. Profiles of signal intensity were obtained from the pixel values of straight lines over the GP regions crossing the MML and AML. Contrast ratios (CRs) for GPe/MML, GPie/MML, GPie/AML, and GPii/AML were calculated. Qualitatively, 7T visualized both the MML and AML, whereas 3T visualized the MML less clearly and hardly depicted the AML. The T2W sequence at 7T yielded significantly higher CRs for GPie/MML, GPie/AML, and GPii/AML than the PDW sequence at 7T or 3T. The T2W sequence at 7T allows visualization of the internal structures of GPi segments with high signal intensity and contrast.
Collapse
Affiliation(s)
- Shuki Maruyama
- Department of System Neuroscience, Division of Cerebral Integration, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka, Myodaiji, Okazaki, Aichi, 444-8585, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Shonan Village, Hayama, Kanagawa, 240-0193, Japan
| | - Masaki Fukunaga
- Department of System Neuroscience, Division of Cerebral Integration, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka, Myodaiji, Okazaki, Aichi, 444-8585, Japan.,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Shonan Village, Hayama, Kanagawa, 240-0193, Japan
| | - Hans-Peter Fautz
- Siemens Healthineers, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Robin Heidemann
- Siemens Healthineers, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Norihiro Sadato
- Department of System Neuroscience, Division of Cerebral Integration, National Institute for Physiological Sciences (NIPS), 38 Nishigonaka, Myodaiji, Okazaki, Aichi, 444-8585, Japan. .,Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Shonan Village, Hayama, Kanagawa, 240-0193, Japan.
| |
Collapse
|
9
|
Straub S, Knowles BR, Flassbeck S, Steiger R, Ladd ME, Gizewski ER. Mapping the human brainstem: Brain nuclei and fiber tracts at 3 T and 7 T. NMR IN BIOMEDICINE 2019; 32:e4118. [PMID: 31286600 DOI: 10.1002/nbm.4118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 06/09/2023]
Abstract
Structural high-resolution imaging of the brainstem can be of high importance in clinical practice. However, ultra-high field magnetic resonance imaging (MRI) is still restricted in use due to limited availability. Therefore, quantitative MRI techniques (quantitative susceptibility mapping [QSM], relaxation measurements [ R2* , R1 ], diffusion tensor imaging [DTI]) and T2 - and proton density (PD)-weighted imaging in the human brainstem at 3 T and 7 T are compared. Five healthy volunteers (mean age: 21.5 ± 1.9 years) were measured at 3 T and 7 T using multi-echo gradient echo sequences for susceptibility mapping and R2* relaxometry, magnetization-prepared 2 rapid acquisition gradient echo sequences for R1 relaxometry, turbo-spin echo sequences for PD- and T2 -weighted imaging and readout-segmented echo planar sequences for DTI. Susceptibility maps were computed using Laplacian-based phase unwrapping, V-SHARP for background field removal and the streaking artifact reduction for QSM algorithm for dipole inversion. Contrast-to-noise ratios (CNRs) were determined at 3 T and 7 T in ten volumes of interest (VOIs). Data acquired at 7 T showed higher CNR. However, in four VOIs, lower CNR was observed for R2* at 7 T. QSM was shown to be the contrast with which the highest number of structures could be identified. The depiction of very fine tracts such as the medial longitudinal fasciculus throughout the brainstem was only possible in susceptibility maps acquired at 7 T. DTI effectively showed the main tracts (crus cerebri, transverse pontine fibers, corticospinal tract, middle and superior cerebellar peduncle, pontocerebellar tract, and pyramid) at both field strengths. Assessing the brainstem with quantitative MRI methods such as QSM, R2* , as well as PD- and T2 -weighted imaging with great detail, is also possible at 3 T, especially when using susceptibility mapping calculated from a gradient echo sequence with a wide range of echo times from 10.5 to 52.5 ms. However, tracing smallest structures strongly benefits from imaging at ultra-high field.
Collapse
Affiliation(s)
- Sina Straub
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Benjamin R Knowles
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Flassbeck
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Ruth Steiger
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
- Neuroimaging Core Facility, Medical University Innsbruck, Austria
| | - Mark E Ladd
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Neuroimaging Technological Advancements for Targeting in Functional Neurosurgery. Curr Neurol Neurosci Rep 2019; 19:42. [DOI: 10.1007/s11910-019-0961-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
11
|
Ide S, Kakeda S, Yoneda T, Moriya J, Watanabe K, Ogasawara A, Futatsuya K, Ohnari N, Sato T, Hiai Y, Matsuyama A, Fujiwara H, Hisaoka M, Korogi Y. Internal Structures of the Globus Pallidus in Patients with Parkinson's Disease: Evaluation with Phase Difference-enhanced Imaging. Magn Reson Med Sci 2017; 16:304-310. [PMID: 28003623 PMCID: PMC5743521 DOI: 10.2463/mrms.mp.2015-0091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: The medial medullary lamina (MML) separates the medial globus pallidus (GPm) from the lateral. The aim of this study was to assess the changes in appearance of MML related to age using the phase difference-enhanced (PADRE) imaging and to determine whether PADRE can depict the MML in the patients with Parkinson’s disease (PD). Materials and Methods: We enrolled 20 patients with PD and 50 normal control subjects (NC). First, for the visualization of the MML in the NC, we compared the PADRE, susceptibility-weighted imaging (SWI)-like images and T2weighted imaging (WI) by using multiple comparison. The grading methods are as follows: grade 1; MML was not delineated, grade 2; less than half of MML was delineated, grade 3; more than half of MML was delineated and grade 4; whole MML was clearly delineated. We determined grade 3 and 4 as good depiction, delineating the GPm. Then, we evaluated patients with PD using the same method. Results: In NC, the delineation of MML was good in 84% of cases on PADRE, but only 34% of cases showed a good depiction on SWI-like images (average grading score 3.31 vs 2.11, P < 0.05). No MML was delineated in all cases on T2WI. Although younger subjects tended to show whole MML clearly, a part of MML tends to be obscured with age on PADRE. In patients with PD the depiction of MML on PADRE was also good in 90% of cases. Conclusion: The PADRE technique facilitates the depiction of the MML within globus pallidus (GP) on a broad range of age NC and patients with PD and it is superior to SWI-like images and T2WI.
Collapse
Affiliation(s)
- Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Shingo Kakeda
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Tetsuya Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences, Faculty of Life Sciences, Kumamoto University
| | - Junji Moriya
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Keita Watanabe
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Atsushi Ogasawara
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Koichiro Futatsuya
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Norihiro Ohnari
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Toru Sato
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| | - Yasuhiro Hiai
- Department of Medical Physics in Advanced Biomedical Sciences, Faculty of Life Sciences, Kumamoto University
| | - Atsuji Matsuyama
- Department of Pathology and Oncology, University of Occupational and Environmental Health, School of Medicine
| | - Hitoshi Fujiwara
- Department of Surgical Pathology, University of Occupational and Environmental Health, School of Medicine
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health, School of Medicine
| | - Yukunori Korogi
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine
| |
Collapse
|
12
|
Thompson JA, Yin D, Ojemann SG, Abosch A. Use of the Putamen as a Surrogate Anatomical Marker for the Internal Segment of the Globus Pallidus in Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2017; 95:229-235. [DOI: 10.1159/000478105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/08/2017] [Indexed: 12/25/2022]
|
13
|
Feng X, Deistung A, Dwyer MG, Hagemeier J, Polak P, Lebenberg J, Frouin F, Zivadinov R, Reichenbach JR, Schweser F. An improved FSL-FIRST pipeline for subcortical gray matter segmentation to study abnormal brain anatomy using quantitative susceptibility mapping (QSM). Magn Reson Imaging 2017; 39:110-122. [PMID: 28188873 DOI: 10.1016/j.mri.2017.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/05/2017] [Accepted: 02/05/2017] [Indexed: 12/13/2022]
Abstract
Accurate and robust segmentation of subcortical gray matter (SGM) nuclei is required in many neuroimaging applications. FMRIB's Integrated Registration and Segmentation Tool (FIRST) is one of the most popular software tools for automated subcortical segmentation based on T1-weighted (T1w) images. In this work, we demonstrate that FIRST tends to produce inaccurate SGM segmentation results in the case of abnormal brain anatomy, such as present in atrophied brains, due to a poor spatial match of the subcortical structures with the training data in the MNI space as well as due to insufficient contrast of SGM structures on T1w images. Consequently, such deviations from the average brain anatomy may introduce analysis bias in clinical studies, which may not always be obvious and potentially remain unidentified. To improve the segmentation of subcortical nuclei, we propose to use FIRST in combination with a special Hybrid image Contrast (HC) and Non-Linear (nl) registration module (HC-nlFIRST), where the hybrid image contrast is derived from T1w images and magnetic susceptibility maps to create subcortical contrast that is similar to that in the Montreal Neurological Institute (MNI) template. In our approach, a nonlinear registration replaces FIRST's default linear registration, yielding a more accurate alignment of the input data to the MNI template. We evaluated our method on 82 subjects with particularly abnormal brain anatomy, selected from a database of >2000 clinical cases. Qualitative and quantitative analyses revealed that HC-nlFIRST provides improved segmentation compared to the default FIRST method.
Collapse
Affiliation(s)
- Xiang Feng
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
| | - Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany; Section of Experimental Neurology, Department of Neurology, Essen University Hospital, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
| | - Paul Polak
- Buffalo Neuroimaging Analysis Center, Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States
| | - Jessica Lebenberg
- UNATI, CEA DRF/I2BM, INSERM, Université Paris-Sud, Université Paris-Saclay, NeuroSpin Center, Gif/Yvette, France
| | - Frédérique Frouin
- Inserm/CEA/Université Paris Sud/CNRS, CEA/I2BM/SHFJ, Laboratoire IMIV, Orsay, France
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States; MRI Molecular and Translational Imaging Center, Buffalo CTRC, State University of New York at Buffalo, Buffalo, NY, United States
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany; Center of Medical Optics and Photonics, Friedrich Schiller University Jena, Germany; Michael Stifel Center for Data-driven and Simulation Science Jena, Friedrich Schiller University Jena, Germany
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Dept. of Neurology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States; MRI Molecular and Translational Imaging Center, Buffalo CTRC, State University of New York at Buffalo, Buffalo, NY, United States
| |
Collapse
|
14
|
Saleh C, Dooms G, Berthold C, Hertel F. Post-operative imaging in deep brain stimulation: A controversial issue. Neuroradiol J 2016; 29:244-9. [PMID: 27029393 PMCID: PMC4978322 DOI: 10.1177/1971400916639960] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In deep brain stimulation (DBS), post-operative imaging has been used on the one hand to assess complications, such as haemorrhage; and on the other hand, to detect misplaced contacts. The post-operative determination of the accurate location of the final electrode plays a critical role in evaluating the precise area of effective stimulation and for predicting the potential clinical outcome; however, safety remains a priority in postoperative DBS imaging. A plethora of diverse post-operative imaging methods have been applied at different centres. There is neither a consensus on the most efficient post-operative imaging methodology, nor is there any standardisation for the automatic or manual analysis of the images within the different imaging modalities. In this article, we give an overview of currently applied post-operative imaging modalities and discuss the current challenges in post-operative imaging in DBS.
Collapse
Affiliation(s)
- Christian Saleh
- Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg
| | - Georges Dooms
- Department of Neuroradiology, Centre Hospitalier de Luxembourg, Luxembourg
| | | | - Frank Hertel
- Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg
| |
Collapse
|
15
|
Zitella LM, Xiao Y, Teplitzky BA, Kastl DJ, Duchin Y, Baker KB, Vitek JL, Adriany G, Yacoub E, Harel N, Johnson MD. In Vivo 7T MRI of the Non-Human Primate Brainstem. PLoS One 2015; 10:e0127049. [PMID: 25965401 PMCID: PMC4428864 DOI: 10.1371/journal.pone.0127049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/11/2015] [Indexed: 12/28/2022] Open
Abstract
Structural brain imaging provides a critical framework for performing stereotactic and intraoperative MRI-guided surgical procedures, with procedural efficacy often dependent upon visualization of the target with which to operate. Here, we describe tools for in vivo, subject-specific visualization and demarcation of regions within the brainstem. High-field 7T susceptibility-weighted imaging and diffusion-weighted imaging of the brain were collected using a customized head coil from eight rhesus macaques. Fiber tracts including the superior cerebellar peduncle, medial lemniscus, and lateral lemniscus were identified using high-resolution probabilistic diffusion tractography, which resulted in three-dimensional fiber tract reconstructions that were comparable to those extracted from sequential application of a two-dimensional nonlinear brain atlas warping algorithm. In the susceptibility-weighted imaging, white matter tracts within the brainstem were also identified as hypointense regions, and the degree of hypointensity was age-dependent. This combination of imaging modalities also enabled identifying the location and extent of several brainstem nuclei, including the periaqueductal gray, pedunculopontine nucleus, and inferior colliculus. These clinically-relevant high-field imaging approaches have potential to enable more accurate and comprehensive subject-specific visualization of the brainstem and to ultimately improve patient-specific neurosurgical targeting procedures, including deep brain stimulation lead implantation.
Collapse
Affiliation(s)
- Laura M. Zitella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - YiZi Xiao
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Benjamin A. Teplitzky
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Daniel J. Kastl
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Yuval Duchin
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kenneth B. Baker
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Gregor Adriany
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Essa Yacoub
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matthew D. Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, United States of America
- Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota, United States of America
| |
Collapse
|
16
|
Plantinga BR, Temel Y, Roebroeck A, Uludağ K, Ivanov D, Kuijf ML, Ter Haar Romenij BM. Ultra-high field magnetic resonance imaging of the basal ganglia and related structures. Front Hum Neurosci 2014; 8:876. [PMID: 25414656 PMCID: PMC4220687 DOI: 10.3389/fnhum.2014.00876] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation is a treatment for Parkinson's disease and other related disorders, involving the surgical placement of electrodes in the deeply situated basal ganglia or thalamic structures. Good clinical outcome requires accurate targeting. However, due to limited visibility of the target structures on routine clinical MR images, direct targeting of structures can be challenging. Non-clinical MR scanners with ultra-high magnetic field (7T or higher) have the potential to improve the quality of these images. This technology report provides an overview of the current possibilities of visualizing deep brain stimulation targets and their related structures with the aid of ultra-high field MRI. Reviewed studies showed improved resolution, contrast- and signal-to-noise ratios at ultra-high field. Sequences sensitive to magnetic susceptibility such as T2* and susceptibility weighted imaging and their maps in general showed the best visualization of target structures, including a separation between the subthalamic nucleus and the substantia nigra, the lamina pallidi medialis and lamina pallidi incompleta within the globus pallidus and substructures of the thalamus, including the ventral intermediate nucleus (Vim). This shows that the visibility, identification, and even subdivision of the small deep brain stimulation targets benefit from increased field strength. Although ultra-high field MR imaging is associated with increased risk of geometrical distortions, it has been shown that these distortions can be avoided or corrected to the extent where the effects are limited. The availability of ultra-high field MR scanners for humans seems to provide opportunities for a more accurate targeting for deep brain stimulation in patients with Parkinson's disease and related disorders.
Collapse
Affiliation(s)
- Birgit R Plantinga
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Neuroscience, Maastricht University Maastricht, Netherlands
| | - Yasin Temel
- Department of Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Alard Roebroeck
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Kâmil Uludağ
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Dimo Ivanov
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Mark L Kuijf
- Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands
| | - Bart M Ter Haar Romenij
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Biomedical and Information Engineering, Northeastern University Shenyang, China
| |
Collapse
|
17
|
Internal structures of the globus pallidus in patients with Parkinson’s disease: evaluation with quantitative susceptibility mapping (QSM). Eur Radiol 2014; 25:710-8. [DOI: 10.1007/s00330-014-3472-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/08/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
|
18
|
Patch-based label fusion segmentation of brainstem structures with dual-contrast MRI for Parkinson's disease. Int J Comput Assist Radiol Surg 2014; 10:1029-41. [PMID: 25249471 DOI: 10.1007/s11548-014-1119-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/10/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE Parkinson's disease (PD) is a neurodegenerative disorder that impairs the motor functions. Both surgical treatment and study of PD require delineation of basal ganglia nuclei morphology. While many automatic volumetric segmentation methods have been proposed for the lentiform nucleus, few have attempted to identify the key brainstem substructures including the subthalamic nucleus (STN), substantia nigra (SN), and red nucleus (RN) due to their small size and poor contrast in conventional T1W MRI. METHODS A dual-contrast patch-based label fusion method was developed to segment the SN, STN, and RN using multivariate cross-correlation. Two different MRI contrasts (T2*w and phase) are produced from a multi-contrast multi-echo FLASH MRI sequence, enabling visualization of these nuclei. T1-T2* fusion MRI was used to resolve the issue of poor nuclei (i.e., the STN, SN, and RN) contrast on T1w MRI, and to mitigate susceptibility artifacts that may hinder accurate nonlinear registration on T2*w MRI. Unbiased group-wise registration was used for anatomical normalization between the atlas library and the target subject. The performance of the proposed method was compared with a state-of-the-art single-contrast label fusion technique. RESULTS The proposed method outperformed a state-of-the-art single-contrast patch-based method in segmenting the STN, RN and SN, and the results were better than those reported in previous literature. CONCLUSION Our dual-contrast patch-based label fusion method was superior to a single-contrast method for segmenting brainstem nuclei using a multi-contrast multi-echo FLASH MRI sequence. The method is promising for the treatment and research of Parkinson's disease. This method can be extended for multiple alternative image contrasts and other fields of applications.
Collapse
|
19
|
Mahvash M, Pechlivanis I, Charalampaki P, Jansen O, Mehdorn HM. Visualization of small veins with Susceptibility-Weighted Imaging for stereotactic trajectory planning in Deep Brain Stimulation. Clin Neurol Neurosurg 2014; 124:151-5. [DOI: 10.1016/j.clineuro.2014.06.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/19/2014] [Accepted: 06/29/2014] [Indexed: 11/29/2022]
|
20
|
Gizewski ER, Maderwald S, Linn J, Dassinger B, Bochmann K, Forsting M, Ladd ME. High-resolution anatomy of the human brain stem using 7-T MRI: improved detection of inner structures and nerves? Neuroradiology 2013; 56:177-86. [PMID: 24357075 DOI: 10.1007/s00234-013-1312-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/04/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The purpose of this paper is to assess the value of 7 Tesla (7 T) MRI for the depiction of brain stem and cranial nerve (CN) anatomy. METHODS Six volunteers were examined at 7 T using high-resolution SWI, MPRAGE, MP2RAGE, 3D SPACE T2, T2, and PD images to establish scanning parameters targeted at optimizing spatial resolution. Direct comparisons between 3 and 7 T were performed in two additional subjects using the finalized sequences (3 T: T2, PD, MPRAGE, SWAN; 7 T: 3D T2, MPRAGE, SWI, MP2RAGE). Artifacts and the depiction of structures were evaluated by two neuroradiologists using a standardized score sheet. RESULTS Sequences could be established for high-resolution 7 T imaging even in caudal cranial areas. High in-plane resolution T2, PD, and SWI images provided depiction of inner brain stem structures such as pons fibers, raphe, reticular formation, nerve roots, and periaqueductal gray. MPRAGE and MP2RAGE provided clear depiction of the CNs. 3D T2 images improved depiction of inner brain structure in comparison to T2 images at 3 T. Although the 7-T SWI sequence provided improved contrast to some inner structures, extended areas were influenced by artifacts due to image disturbances from susceptibility differences. CONCLUSIONS Seven-tesla imaging of basal brain areas is feasible and might have significant impact on detection and diagnosis in patients with specific diseases, e.g., trigeminal pain related to affection of the nerve root. Some inner brain stem structures can be depicted at 3 T, but certain sequences at 7 T, in particular 3D SPACE T2, are superior in producing anatomical in vivo images of deep brain stem structures.
Collapse
Affiliation(s)
- Elke R Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria,
| | | | | | | | | | | | | |
Collapse
|
21
|
Deistung A, Schäfer A, Schweser F, Biedermann U, Güllmar D, Trampel R, Turner R, Reichenbach JR. High-Resolution MR Imaging of the Human Brainstem In vivo at 7 Tesla. Front Hum Neurosci 2013; 7:710. [PMID: 24194710 PMCID: PMC3810670 DOI: 10.3389/fnhum.2013.00710] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/07/2013] [Indexed: 12/11/2022] Open
Abstract
The human brainstem, which comprises a multitude of axonal nerve fibers and nuclei, plays an important functional role in the human brain. Depicting its anatomy non-invasively with high spatial resolution may thus in turn help to better relate normal and pathological anatomical variations to medical conditions as well as neurological and peripheral functions. We explored the potential of high-resolution magnetic resonance imaging (MRI) at 7 T for depicting the intricate anatomy of the human brainstem in vivo by acquiring and generating images with multiple contrasts: T 2-weighted images, quantitative maps of longitudinal relaxation rate (R 1 maps) and effective transverse relaxation rate ([Formula: see text] maps), magnetic susceptibility maps, and direction-encoded track-density images. Images and quantitative maps were compared with histological stains and anatomical atlases to identify nerve nuclei and nerve fibers. Among the investigated contrasts, susceptibility maps displayed the largest number of brainstem structures. Contrary to R 1 maps and T 2-weighted images, which showed rather homogeneous contrast, [Formula: see text] maps, magnetic susceptibility maps, and track-density images clearly displayed a multitude of smaller and larger fiber bundles. Several brainstem nuclei were identifiable in sections covering the pons and medulla oblongata, including the spinal trigeminal nucleus and the reticulotegmental nucleus on magnetic susceptibility maps as well as the inferior olive on R 1, [Formula: see text], and susceptibility maps. The substantia nigra and red nuclei were visible in all contrasts. In conclusion, high-resolution, multi-contrast MR imaging at 7 T is a versatile tool to non-invasively assess the individual anatomy and tissue composition of the human brainstem.
Collapse
Affiliation(s)
- Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology I, Center of Radiology, Jena University Hospital - Friedrich Schiller University Jena , Jena , Germany
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Anderson D, Kartha N. Deep Brain Stimulation in Nonparkinsonian Movement Disorders and Emerging Technologies, Targets, and Therapeutic Promises in Deep Brain Stimulation. Neurol Clin 2013; 31:809-26. [DOI: 10.1016/j.ncl.2013.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
23
|
Abstract
Technological innovations have driven the advancement of the surgical treatment of movement disorders, from the invention of the stereotactic frame to the adaptation of deep brain stimulation (DBS). Along these lines, this review will describe recent advances in inserting neuromodulation modalities, including DBS, to the target, and in the delivery of therapy at the target. Recent radiological advances are altering the way that DBS leads are targeted and inserted, by refining the ability to visualize the subcortical targets using high-field strength magnetic resonance imaging and other innovations, such as diffusion tensor imaging, and the development of novel targeting devices enabling purely anatomical implantations without the need for neurophysiological monitoring. New portable computed tomography scanners also are facilitating lead implantation without monitoring, as well as improving radiological verification of DBS lead location. Advances in neurophysiological mapping include efforts to develop automatic target verification algorithms, and probabilistic maps to guide target selection. The delivery of therapy at the target is being improved by the development of the next generation of internal pulse generators (IPGs). These include constant current devices that mitigate the variability introduced by impedance changes of the stimulated tissue and, in the near future, devices that deliver novel stimulation patterns with improved efficiency. Closed-loop adaptive IPGs are being tested, which may tailor stimulation to ongoing changes in the nervous system, reflected in biomarkers continuously recorded by the devices. Finer-grained DBS leads, in conjunction with new IPGs and advanced programming tools, may offer improved outcomes via current steering algorithms. Finally, even thermocoagulation-essentially replaced by DBS-is being advanced by new minimally-invasive approaches that may improve this therapy for selected patients in whom it may be preferred. Functional neurosurgery has a history of being driven by technological innovation, a tradition that continues into its future.
Collapse
Affiliation(s)
- Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road, NE Suite 6200, Atlanta, GA 30322, USA.
| | | |
Collapse
|
24
|
Kerl HU, Gerigk L, Brockmann MA, Huck S, Al-Zghloul M, Groden C, Hauser T, Nagel AM, Nölte IS. Imaging for deep brain stimulation: The zona incerta at 7 Tesla. World J Radiol 2013; 5:5-16. [PMID: 23494089 PMCID: PMC3596566 DOI: 10.4329/wjr.v5.i1.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 10/24/2012] [Accepted: 01/21/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI).
METHODS: Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen’s kappa coefficient (κ) were assessed. Contrast-to-noise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t-test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren).
RESULTS: The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.
CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.
Collapse
|
25
|
Kerl HU, Gerigk L, Pechlivanis I, Al-Zghloul M, Groden C, Nölte IS. The subthalamic nucleus at 7.0 Tesla: evaluation of sequence and orientation for deep-brain stimulation. Acta Neurochir (Wien) 2012; 154:2051-62. [PMID: 22930282 DOI: 10.1007/s00701-012-1476-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/05/2012] [Indexed: 02/06/2023]
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.
Collapse
Affiliation(s)
- Hans U Kerl
- Department of Neuroradiology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | | | | | | | | | | |
Collapse
|
26
|
Kerl HU, Gerigk L, Pechlivanis I, Al-Zghloul M, Groden C, Nölte I. The subthalamic nucleus at 3.0 Tesla: choice of optimal sequence and orientation for deep brain stimulation using a standard installation protocol: clinical article. J Neurosurg 2012; 117:1155-65. [PMID: 23039154 DOI: 10.3171/2012.8.jns111930] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT Reliable visualization of the subthalamic nucleus (STN) is indispensable for accurate placement of electrodes in deep brain stimulation (DBS) surgery for patients with Parkinson disease (PD). The aim of the study was to evaluate different promising new MRI methods at 3.0 T for preoperative visualization of the STN using a standard installation protocol. METHODS Magnetic resonance imaging studies (T2-FLAIR, T1-MPRAGE, T2*-FLASH2D, T2-SPACE, and susceptibility-weighted imaging sequences) obtained in 9 healthy volunteers and in 1 patient with PD were acquired. Two neuroradiologists independently analyzed image quality and visualization of the STN using a 6-point scale. Interrater reliability, contrast-to-noise ratios, and signal-to-noise ratios for the STN were calculated. For illustration of the anatomical accuracy, coronal T2*-FLASH2D images were fused with the corresponding coronal section schema of the Schaltenbrand and Wahren stereotactic atlas. RESULTS The STN was best and reliably visualized on T2*-FLASH2D imaging (in particular, the coronal view). No major artifacts in the STN were observed in any of the sequences. Susceptibility-weighted, T2-SPACE, and T2*-FLASH2D imaging provided significantly higher contrast-to-noise ratio values for the STN than standard T2-weighted imaging. Fusion of the coronal T2*-FLASH2D and the digitized coronal atlas view projected the STN clearly within the boundaries of the STN found in anatomical sections. CONCLUSIONS For 3.0-T MRI, T2*-FLASH2D (particularly the coronal view) provides optimal delineation of the STN using a standard installation protocol.
Collapse
Affiliation(s)
- Hans U Kerl
- Department of Neuroradiology, University of Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany
| | | | | | | | | | | |
Collapse
|
27
|
Deistung A, Schäfer A, Schweser F, Biedermann U, Turner R, Reichenbach JR. Toward in vivo histology: a comparison of quantitative susceptibility mapping (QSM) with magnitude-, phase-, and R2*-imaging at ultra-high magnetic field strength. Neuroimage 2012; 65:299-314. [PMID: 23036448 DOI: 10.1016/j.neuroimage.2012.09.055] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/17/2012] [Accepted: 09/17/2012] [Indexed: 01/13/2023] Open
Abstract
Quantitative magnetic susceptibility mapping (QSM) has recently been introduced to provide a novel quantitative and local MRI contrast. However, the anatomical contrast represented by in vivo susceptibility maps has not yet been compared systematically and comprehensively with gradient (recalled) echo (GRE) magnitude, frequency, and R(2)(*) images. Therefore, this study compares high-resolution quantitative susceptibility maps with conventional GRE imaging approaches (magnitude, frequency, R(2)(*)) in healthy individuals at 7 T with respect to anatomic tissue contrast. Volumes-of-interest were analyzed in deep and cortical gray matter (GM) as well as in white matter (WM) on R(2)(*) and susceptibility maps. High-resolution magnetic susceptibility maps of the human brain exhibited superb contrast that allowed the identification of substructures of the thalamus, midbrain and basal ganglia, as well as of the cerebral cortex. These were consistent with histology but not generally visible on magnitude, frequency or R(2)(*)-maps. Common target structures for deep brain stimulation, including substantia nigra pars reticulata, ventral intermediate nucleus, subthalamic nucleus, and the substructure of the internal globus pallidus, were clearly distinguishable from surrounding tissue on magnetic susceptibility maps. The laminar substructure of the cortical GM differed depending on the anatomical region, i.e., a cortical layer with increased magnetic susceptibility, corresponding to the Stria of Gennari, was found in the GM of the primary visual cortex, V1, whereas a layer with reduced magnetic susceptibility was observed in the GM of the temporal cortex. Both magnetic susceptibility and R(2)(*) values differed substantially in cortical GM depending on the anatomic regions. Regression analysis between magnetic susceptibility and R(2)(*) values of WM and GM structures suggested that variations in myelin content cause the overall contrast between gray and white matter on susceptibility maps and that both R(2)(*) and susceptibility values provide linear measures for iron content in GM. In conclusion, quantitative magnetic susceptibility mapping provides a non-invasive and spatially specific contrast that opens the door to the assessment of diseases characterized by variation in iron and/or myelin concentrations. Its ability to reflect anatomy of deep GM structures with superb delineation may be useful for neurosurgical applications.
Collapse
Affiliation(s)
- Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology I, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, 07743 Jena, Germany.
| | | | | | | | | | | |
Collapse
|
28
|
Pouratian N, Thakkar S, Kim W, Bronstein JM. Deep brain stimulation for the treatment of Parkinson's disease: efficacy and safety. Degener Neurol Neuromuscul Dis 2012; 2012. [PMID: 24298202 DOI: 10.2147/dnnd.s25750] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) surgery has become increasingly utilized in the treatment of advanced Parkinson's disease. Over the past decade, a number of studies have demonstrated that DBS is superior to best medical management in appropriately selected patients. The primary targets for DBS in Parkinson's disease include the subthalamic nucleus and the internal segment of the globus pallidus, both of which improve the cardinal motor features in Parkinson's disease. Recent randomized studies have revealed that both targets are similarly effective in treating the motor symptoms of Parkinson's disease, but emerging evidence suggests that the globus pallidus may be the preferred target in many patients, based on differences in nonmotor outcomes. Here, we review appropriate patient selection, and the efficacy and safety of DBS therapy in Parkinson's disease. Best outcomes are achieved if the problems of the individual patient are considered when evaluating surgical candidates and considering whether the subthalamic nucleus or the globus pallidus internus should be targeted.
Collapse
Affiliation(s)
- Nader Pouratian
- Departments of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles ; Bioengineering, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
| | | | | | | |
Collapse
|