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Optimal MRI methods for direct stereotactic targeting of the subthalamic nucleus and globus pallidus

  • Magnetic Resonance
  • Published:
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Abstract

Objective

Reliable identification of the subthalamic nucleus (STN) and globus pallidus interna (GPi) is critical for deep brain stimulation (DBS) of these structures. The purpose of this study was to compare the visibility of the STN and GPi with various MRI techniques and to assess the suitability of each technique for direct stereotactic targeting.

Methods

MR images were acquired from nine volunteers with T2- and proton density-weighted (PD-W) fast spin echo, susceptibility-weighted imaging (SWI), phase-sensitive inversion recovery and quantitative T1, T2 and T2* mapping sequences. Contrast-to-noise ratios (CNR) for the STN and GPi were calculated for all sequences. Targeting errors on SWI were evaluated on magnetic susceptibility maps. The sequences demonstrating the best conspicuity of DBS target structures (SWI and T2*) were then applied to ten patients with movement disorders, and the CNRs for these techniques were assessed.

Results

SWI offers the highest CNR for the STN, but standard PD-W images provide the best CNR for the pallidum. Susceptibility maps indicated that the GPi margins may be shifted slightly on SWI, although no shifts were seen for the STN.

Conclusion

SWI may improve the visibility of the STN on pre-operative MRI, potentially improving the accuracy of direct stereotactic targeting.

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Abbreviations

CNR:

contrast-to-noise ratio(s)

DBS:

deep brain stimulation

DESPOT1 :

driven equilibrium single-pulse observation of T1

FSE:

fast spin echo

GPi:

globus pallidus interna

GRE:

gradient echo

IR:

inversion recovery

IR-FSPGR:

inversion recovery prepared fast spoiled gradient echo volume

PSIR:

phase sensitive inversion recovery

PD:

Parkinson’s disease

PD-W:

proton density-weighted

STN:

subthalamic nucleus

SWI:

susceptibility-weighted imaging

TE:

echo time

TI:

inversion time

TR:

repetition time

T2-W:

T2-weighted

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Acknowledgements

The authors would like to thank Sean Deoni for supplying the DESPOT sequence.

Author information

Authors and Affiliations

  1. Department of Neuroradiology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Ruth L. O’Gorman & Jozef Jarosz

  2. MR Zentrum, University Children’s Hospital (Kinderspital), Steinwiesstrasse 75, 8032, Zurich, Switzerland

    Ruth L. O’Gorman

  3. Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Bldg 10, Rm B1D-728, Bethesda, MD, 20892-1065, USA

    Karin Shmueli

  4. Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Keyoumars Ashkan & Richard P. Selway

  5. Department of Neurology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Michael Samuel

  6. Department of Clinical Neuroscience, Institute of Psychiatry, London, SE5 8AF, UK

    David J. Lythgoe, Asal Shahidiani & Stephen J. Wastling

  7. Department of Medical Engineering and Physics, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK

    Stephen J. Wastling & Michelle Footman

Authors
  1. Ruth L. O’Gorman
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  2. Karin Shmueli
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  3. Keyoumars Ashkan
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  4. Michael Samuel
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  7. Stephen J. Wastling
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  8. Michelle Footman
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  9. Richard P. Selway
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  10. Jozef Jarosz
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Corresponding author

Correspondence to Ruth L. O’Gorman.

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O’Gorman, R.L., Shmueli, K., Ashkan, K. et al. Optimal MRI methods for direct stereotactic targeting of the subthalamic nucleus and globus pallidus. Eur Radiol 21, 130–136 (2011). https://doi.org/10.1007/s00330-010-1885-5

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  • DOI: https://doi.org/10.1007/s00330-010-1885-5

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