Toward a standard preoperative MRI protocol for functional neurosurgery

Christopher Güttler, Institute of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
Johannes Achtzehn, Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
Patric Blomstedt, Dept of Clinical Neuroscience / Unit for Deep Brain Stimulation, University Hospital of Northern Sweden, Umeå, Sweden.
Stéphan Charbardès, Department of Neurosurgery, Université Joseph Fourier, Grenoble, France.
Katharina Faust, Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Stefan Hetzer, Berlin Center for Advanced Neuroimaging, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Brian H. Kopell, Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Joachim K. Krauss, Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Andres Lozano, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Joseph Neimat, Department of Neurosurgery, University of Louisville, School of Medicine, Louisville, KY, United States.
Francisco A. Ponce, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Pratik Rohatgi, Department of Neurosurgery, Boston University, Boston, MA, United States.
John Rolston, Department of Neurosurgery, University of Utah, Salt Lake City, UT, United States.
Mathieu Santin, Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.
Philip A. Starr, Weill Institute for Neurosciences, University of California, San Francsico, CA, United States.
Veerle Visser-Vandewalle, Network Stimulation Institute, Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Germany.
Andrea A. Kühn, Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.
Andreas Horn, Network Stimulation Institute, Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Germany.
Anna Tietze, Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.

Document Type

Article

Abstract

Deep Brain Stimulation (DBS) is a well-established approach to treat movement disorders such as Parkinson's Disease, dystonia or essential tremor. For optimal therapy response, accurate electrode placement is critical requiring high signal-to-noise of target areas in preoperative MRI. Currently, imaging protocols vary considerably between DBS centers, making it difficult to compare results or pool data for research purposes. Here, various currently employed MRI sequences from several DBS centers are evaluated regarding their suitability for DBS targeting and a protocol is suggested taking image quality and practical considerations into account. Two healthy subjects (52-year-old female and a 37-year-old male) were each scanned with various sequences (5 T2w, 1 PDw, 4 T2FLAIRw, 2 T2*w, 5 SWI, 2 FGATIR, 1 T1TIR, and 2 QSM techniques) that then were rated by 12 experienced DBS surgeons for their suitability for targeting the subthalamic nucleus (STN), the internal globus pallidus internus (GPi), and the ventrointermediate (VIM) thalamic nucleus. For a subset of sequences, surgeons were asked to identify the optimal DBS target in the STN and GPi. Contrast-to-noise ratios (CNR) were calculated and correlated to intra-rater z-scores and distances of target coordinates. For STN-DBS, surgeons rated T2w, most SWI, QSM, and T2FLAIRw the highest. For GPi-DBS, FGATIR, PDw, and SWI and for VIM-DBS, FGATIR were deemed the most suitable. Higher CNR correlated with higher intra-rater z-scores (R= 0.29, p < .005) which improved targeting (R= 0.18, p < .05). Our MRI protocol suggestion is a first step toward standardizing preoperative imaging. All imaging data, MRI sequence parameters, and protocol files are made openly available.

Publication Date

1-1-2025

Publication Title

Imaging neuroscience (Cambridge, Mass.)

E-ISSN

2837-6056

Volume

3

PubMed ID

40800933

Digital Object Identifier (DOI)

10.1162/IMAG.a.52

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