Artikel
Susceptibility-weighted phase MR-imaging for targeting the subthalamic nucleus in Parkinson's disease?
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Autoren
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Naureen Uzma
- Department of Neurosurgery, Georg-August-University of Goettingen, Germany
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Friederike Sixel-Döring
- Paracelsus Elena Klinik Kassel, Germany
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Joseph Cohnen
- Department of Neuroradiology, Georg-August-University of Goettingen, Germany
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Ali Abaci
- Department of Neurosurgery, Georg-August-University of Goettingen, Germany
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Martin Sommer
- Department of Neurophysiology, Georg-August-University of Goettingen, Germany
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Veit Rohde
- Department of Neurosurgery, Georg-August-University of Goettingen, Germany
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has reached a major role in the treatment of therapy-refractory Parkinson's disease (PD). For targeting the STN a combination of brain atlas derived coordinates and visualization of the STN on T2-weightd images is used by many. Susceptibility-weighted phase MR images (SWI) likewise allows STN visualisation but substantial clinical experiences addressing the accuracy of STN targeting with SWI are lacking so far.
Methods: Eighteen PD patients undergoing bilateral STN-DBS were preoperatively investigated using T1-weighted contrast enhanced, T2-weighted and SW images. The targeting was done using stereotactic atlas-derived coordinates, which were confirmed by STN visualisation on T2-weigthed images. After surgery the postoperative CT scans with the visible DBS electrode in place were fused with the preoperative SW images, compared with the T2-weighted images and correlated to the clinical outcome. Assuming that good clinical results are achieved with the DBS in the STN, the fusion of postoperative CT with the preoperative SWI allows deciding if SWI could be useful for STN targeting.
Results: In the 36 examined STN electrodes, 1 (2,8%) was not within the STN as seen on SWI, but clinical effect was good, indicating that at least in this case SWI did not show the correct anatomical STN localisation. There were 2 (5,6%) electrodes with one contact, 16 (44,4%) electrodes with 2 contacts and 17 (47,2%) electrodes with 3 contacts in the STN. The clinical effects of all patients with either 2 or 3 contacts in the STN had been good indicating that preoperative SWI visualised the anatomical STN site. The visualization of STN in SWI had a higher definition compared to T2-weighted images.
Conclusions: We confirm recent reports that the STN can be well identified on SWI. Our data suggest that SWI is superior to T2-weighted MR images and could be supplementary used for STN targeting during DBS surgery. Taking the 2.8% inaccuracy we still propose that targeting should not rely only on MR imaging of the STN, but be augmented by atlas-derived coordinates.
