High-resolution QSM for functional and structural depiction of subthalamic nuclei in DBS presurgical mapping

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OBJECTIVE

Faithful depiction of the subthalamic nucleus (STN) is critical for planning deep brain stimulation (DBS) surgery in patients with Parkinson’s disease (PD). Quantitative susceptibility mapping (QSM) has been shown to be superior to traditional T2-weighted spin echo imaging (T2w). The aim of the study was to describe submillimeter QSM for preoperative imaging of the STN in planning of DBS.

METHODS

Seven healthy volunteers were included in this study. T2w and QSM were obtained for all healthy volunteers, and images of different resolutions were reconstructed. Image quality and visibility of STN anatomical features were analyzed by a radiologist using a 5-point scale, and contrast properties of the STN and surrounding tissue were calculated. Additionally, data from 10 retrospectively and randomly selected PD patients who underwent 3-T MRI for DBS were analyzed for STN size and susceptibility gradient measurements.

RESULTS

Higher contrast-to-noise ratio (CNR) values were observed in both high-resolution and low-resolution QSM images. Inter-resolution comparison demonstrated improvement in CNR for QSM, but not for T2w images. QSM provided higher inter-quadrant contrast ratios (CR) within the STN, and depicted a gradient in the distribution of susceptibility sources not visible in T2w images.

CONCLUSIONS

For 3-T MRI, submillimeter QSM provides accurate delineation of the functional and anatomical STN features for DBS targeting.

ABBREVIATIONS AC = anterior commissure; AL = anterolateral; AM = anteromedial; CNR = contrast-to-noise ratio; CR = contrast ratio; DBS = deep brain stimulation; GPi = globus pallidus internus; GRE = gradient echo; MER = microelectrode recording; PC = posterior commissure; PD = Parkinson’s disease; PL = posterolateral; PM = posteromedial; QSM = quantitative susceptibility mapping; SN = substantia nigra; STN = subthalamic nucleus; T2w = spin-echo T2-weighted; WM (or wm) = white matter.

Article Information

Correspondence Yi Wang: Cornell University, New York, NY. yiwang@med.cornell.edu.

INCLUDE WHEN CITING Published online August 10, 2018; DOI: 10.3171/2018.3.JNS172145.

Disclosures Dr. Wang owns equity in Medimagemetric LLC, a Cornell spinoff company. Dr. Kopell is a consultant for Medtronic and Abbott Neuromodulation.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Axial and coronal views of the STN in T2w (A and C) and QSM (B and D) images from a healthy 25-year-old man showing the subthalamic nucleus (STN), substantia nigra (SN), and red nucleus (RN). Border points indicated by “x” were used to create bilateral masks of the nuclei (A) and to define the 4 STN quadrants: anterolateral (AL), anteromedial (AM), posterolateral (PL), and posteromedial (PM) (B). STN susceptibility gradient (shown with arrows) is clearly visible in the QSM images.

  • View in gallery

    Effects of slice thickness on STN-vs-tissue contrast in T2w and QSM images in a healthy 33-year-old man. A and C: T2w (A) and QSM (C) images with slice thickness of 0.5 mm. B and D: T2w (B) and QSM images (D) with slice thickness of 2 mm. Visibility of STN in T2w is relatively insensitive to slice thickness, as indicated by CNR measurements and the T2w image scores given by the radiologist. However, low resolution causes susceptibility underestimation in QSM, which led to significantly reduced contrast in the posterolateral quadrant (dashed arrows). Unlike T2w, QSM demonstrates a clearly visible gradient toward the caudal STN pole (−0.024 ppm/mm) in both hemispheres.

  • View in gallery

    Comparison of intensity profiles extracted from submillimeter-resolution QSM (A and B) and T2w (C and D) images of STN along the rostro-caudal axis. A and C: Left STN. B and D: Right STN. QSM consistently indicates a linear decrease in iron concentration (red dashed line), with an average susceptibility gradient of −0.022 ppm/mm. a.u. = arbitrary units. Figure is available in color online only.

  • View in gallery

    QSM of STN (arrows) in axial (A) and coronal (B) planes in a 58-year-old man with PD. QSM provided good spatial definition of STN geometry; provided the ability to differentiate between STN, SN, and surrounding white matter; and visualized a decrease in iron toward the dorsolateral portion of the nucleus.

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