Elsevier

NeuroImage

Volume 47, Supplement 2, August 2009, Pages T44-T52
NeuroImage

A high resolution and high contrast MRI for differentiation of subcortical structures for DBS targeting: The Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR)

https://doi.org/10.1016/j.neuroimage.2009.04.018Get rights and content

Abstract

DBS depends on precise placement of the stimulating electrode into an appropriate target region. Image-based (direct) targeting has been limited by the ability of current technology to visualize DBS targets. We have recently developed and employed a Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR) 3T MRI sequence to more reliably visualize these structures. The FGATIR provides significantly better high resolution thin (1 mm) slice visualization of DBS targets than does either standard 3T T1 or T2-weighted imaging. The T1 subcortical image revealed relatively poor contrast among the targets for DBS, though the sequence did allow localization of striatum and thalamus. T2 FLAIR scans demonstrated better contrast between the STN, SNr, red nucleus (RN), and pallidum (GPe/GPi). The FGATIR scans allowed for localization of the thalamus, striatum, GPe/GPi, RN, and SNr and displayed sharper delineation of these structures. The FGATIR also revealed features not visible on other scan types: the internal lamina of the GPi, fiber bundles from the internal capsule piercing the striatum, and the boundaries of the STN. We hope that use of the FGATIR to aid initial targeting will translate in future studies to faster and more accurate procedures with consequent improvements in clinical outcomes.

Section snippets

Background

Deep brain stimulation (DBS) has become an accepted treatment for medication refractory movement disorders (DBSPDSG, 2001, Hung et al., 2007, Wider et al., 2008, Zorzi et al., 2005) and has also been employed for neuropsychiatric indications in several recent trials (Cosyns et al., 2003, Greenberg et al., 2006, Lozano et al., 2008, Temel and Visser-Vandewalle, 2004). The procedure consists of placing a stimulating electrode into a specific brain structure with the intent of locally modulating a

Subjects

For this pilot study we examined the preoperative scans of three patients with advanced and medication refractory Parkinson's disease (n = 2) or essential tremor (n = 1) who were to undergo DBS. These patients underwent formal evaluations by a fellowship-trained Movement Disorders Neurologist, a Neurosurgeon, a Psychiatrist, and a Neuropsychologist in order to ensure accuracy of diagnosis by clinical criteria (Okun et al., 2004) as well as absence of significant cognitive or psychiatric

Qualitative analysis

The T1-w MP-RAGE subcortical image revealed relatively poor contrast among the targets for DBS, however the sequence did allow reasonable localization of striatum and thalamus. T2-w FLAIR scans demonstrated better contrast and were better able to localize the STN, SNr, red nucleus (RN), and pallidum (GPe/GPi). The FGATIR scans allowed for localization of the thalamus, striatum, GPe/GPi, RN, and SNr and displayed sharper delineation of these structures (Fig. 1). The FGATIR revealed features not

Discussion

The DBS surgical procedure is focused primarily on obtaining accurate electrode placement. Imaging has played a central role in making this a reality. Progress in imaging – the stereotome, CT scans, and MRI – have all advanced DBS by making target localization more precise. Both T1 and T2 weighted scans have been employed in this regard. T1 weighted imaging has been a widely used scanning procedure for stereotactic surgery and radiosurgery due to its ability to produce thin slice, high

Conflict of interest

The authors declare that there is no conflict of interest.

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