Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

Sander Bus; Pepijn van den Munckhof; Maarten Bot; Gian Pal; Bichun Ouyang; Sepehr Sani; Leo Verhagen Metman

doi:10.1007/s00701-017-3432-5

Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

Sander Bus^*, Pepijn van den Munckhof, Maarten Bot, Gian Pal, Bichun Ouyang, Sepehr Sani, Leo Verhagen Metman

^*Corresponding author for this work

Neurology

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Background: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). Objective: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods: Intraoperative CT (iCT) was performed after each MER track. iCT images were merged with preoperative images using planning software. Dorsal and ventral borders of each track were determined and compared to MRI-STN borders. Differences between borders were calculated. Results: A total of 125 tracks were evaluated in 45 patients. MER-STN started and ended more dorsally than respective dorsal and ventral MRI-STN borders. For dorsal borders, differences were 1.9 ± 1.4 mm (T2) and 2.5 ± 1.8 mm (SWI). For ventral borders, differences were 1.9 ± 1.6 mm (T2) and 2.1 ± 1.8 mm (SWI). Conclusions: Discrepancies were found comparing borders on T2 and SWI to the electrophysiological STN. The largest border differences were found using SWI. Border differences were considerably larger than errors associated with iCT and fusion techniques. A cautious approach should be taken when relying solely on MR imaging for delineation of both clinically relevant STN borders.

Original language	English (US)
Pages (from-to)	373-383
Number of pages	11
Journal	Acta Neurochirurgica
Volume	160
Issue number	2
DOIs	https://doi.org/10.1007/s00701-017-3432-5
State	Published - Feb 1 2018

Funding

Conflicts of interest LVM has received fees for consulting activities, advisory boards, and educational activities from Medtronic Inc., Boston Scientific, St. Jude Medical, Cynapsus and US WorldMeds LLC. SB received financial support from The Vreedefonds Foundation; Parkinson’s Foundation the Netherlands; Amsterdam Foundation for Promoting Neurosurgical Development.

Keywords

Deep brain stimulation
Intraoperative computed tomography
Microelectrode recording
Subthalamic nucleus
Susceptibility weighted imaging
T2-weighted imaging

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1007/s00701-017-3432-5

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@article{64437a35b9bb4a7190ad3bb447c8aa97,

title = "Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT",

abstract = "Background: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). Objective: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson{\textquoteright}s disease (PD). Methods: Intraoperative CT (iCT) was performed after each MER track. iCT images were merged with preoperative images using planning software. Dorsal and ventral borders of each track were determined and compared to MRI-STN borders. Differences between borders were calculated. Results: A total of 125 tracks were evaluated in 45 patients. MER-STN started and ended more dorsally than respective dorsal and ventral MRI-STN borders. For dorsal borders, differences were 1.9 ± 1.4 mm (T2) and 2.5 ± 1.8 mm (SWI). For ventral borders, differences were 1.9 ± 1.6 mm (T2) and 2.1 ± 1.8 mm (SWI). Conclusions: Discrepancies were found comparing borders on T2 and SWI to the electrophysiological STN. The largest border differences were found using SWI. Border differences were considerably larger than errors associated with iCT and fusion techniques. A cautious approach should be taken when relying solely on MR imaging for delineation of both clinically relevant STN borders.",

keywords = "Deep brain stimulation, Intraoperative computed tomography, Microelectrode recording, Subthalamic nucleus, Susceptibility weighted imaging, T2-weighted imaging",

author = "Sander Bus and {van den Munckhof}, Pepijn and Maarten Bot and Gian Pal and Bichun Ouyang and Sepehr Sani and {Verhagen Metman}, Leo",

note = "Publisher Copyright: {\textcopyright} 2017, The Author(s).",

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doi = "10.1007/s00701-017-3432-5",

language = "English (US)",

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T1 - Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

AU - Bus, Sander

AU - van den Munckhof, Pepijn

AU - Bot, Maarten

AU - Pal, Gian

AU - Ouyang, Bichun

AU - Sani, Sepehr

AU - Verhagen Metman, Leo

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). Objective: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods: Intraoperative CT (iCT) was performed after each MER track. iCT images were merged with preoperative images using planning software. Dorsal and ventral borders of each track were determined and compared to MRI-STN borders. Differences between borders were calculated. Results: A total of 125 tracks were evaluated in 45 patients. MER-STN started and ended more dorsally than respective dorsal and ventral MRI-STN borders. For dorsal borders, differences were 1.9 ± 1.4 mm (T2) and 2.5 ± 1.8 mm (SWI). For ventral borders, differences were 1.9 ± 1.6 mm (T2) and 2.1 ± 1.8 mm (SWI). Conclusions: Discrepancies were found comparing borders on T2 and SWI to the electrophysiological STN. The largest border differences were found using SWI. Border differences were considerably larger than errors associated with iCT and fusion techniques. A cautious approach should be taken when relying solely on MR imaging for delineation of both clinically relevant STN borders.

AB - Background: It is unclear which magnetic resonance imaging (MRI) sequence most accurately corresponds with the electrophysiological subthalamic nucleus (STN) obtained during microelectrode recording (MER, MER-STN). CT/MRI fusion allows for comparison between MER-STN and the STN visualized on preoperative MRI (MRI-STN). Objective: To compare dorsal and ventral STN borders as seen on 3-Tesla T2-weighted (T2) and susceptibility weighted images (SWI) with electrophysiological STN borders in deep brain stimulation (DBS) for Parkinson’s disease (PD). Methods: Intraoperative CT (iCT) was performed after each MER track. iCT images were merged with preoperative images using planning software. Dorsal and ventral borders of each track were determined and compared to MRI-STN borders. Differences between borders were calculated. Results: A total of 125 tracks were evaluated in 45 patients. MER-STN started and ended more dorsally than respective dorsal and ventral MRI-STN borders. For dorsal borders, differences were 1.9 ± 1.4 mm (T2) and 2.5 ± 1.8 mm (SWI). For ventral borders, differences were 1.9 ± 1.6 mm (T2) and 2.1 ± 1.8 mm (SWI). Conclusions: Discrepancies were found comparing borders on T2 and SWI to the electrophysiological STN. The largest border differences were found using SWI. Border differences were considerably larger than errors associated with iCT and fusion techniques. A cautious approach should be taken when relying solely on MR imaging for delineation of both clinically relevant STN borders.

KW - Deep brain stimulation

KW - Intraoperative computed tomography

KW - Microelectrode recording

KW - Subthalamic nucleus

KW - Susceptibility weighted imaging

KW - T2-weighted imaging

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EP - 383

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

IS - 2

ER -

Borders of STN determined by MRI versus the electrophysiological STN. A comparison using intraoperative CT

Abstract

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Keywords

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