Correlation of diffusion tensor tractography and intraoperative macrostimulation during deep brain stimulation for Parkinson disease

Clinical article

Nicholas Said M.D., M.B.A.1, W. Jeff Elias M.D.2, Prashant Raghavan M.B.B.S.1, Alan Cupino M.P.H.1, Nicholas Tustison D.Sc.1, Robert Frysinger Ph.D.2, James Patrie M.S.3, Wenjun Xin M.S.3, and Max Wintermark M.D., M.A.S.1,4
View More View Less
  • 1 Departments of Radiology, Neuroradiology Division;
  • | 2 Neurological Surgery; and
  • | 3 Public Health Sciences, University of Virginia, Charlottesville, Virginia; and
  • | 4 Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

The purpose of this study was to investigate whether diffusion tensor imaging (DTI) of the corticospinal tract (CST) is a reliable surrogate for intraoperative macrostimulation through the deep brain stimulation (DBS) leads. The authors hypothesized that the distance on MRI from the DBS lead to the CST as determined by DTI would correlate with intraoperative motor thresholds from macrostimulations through the same DBS lead.

Methods

The authors retrospectively reviewed pre- and postoperative MRI studies and intraoperative macrostimulation recordings in 17 patients with Parkinson disease (PD) treated by DBS stimulation. Preoperative DTI tractography of the CST was coregistered with postoperative MRI studies showing the position of the DBS leads. The shortest distance and the angle from each contact of each DBS lead to the CST was automatically calculated using software-based analysis. The distance measurements calculated for each contact were evaluated with respect to the intraoperative voltage thresholds that elicited a motor response at each contact.

Results

There was a nonsignificant trend for voltage thresholds to increase when the distances between the DBS leads and the CST increased. There was a significant correlation between the angle and the voltage, but the correlation was weak (coefficient of correlation [R] = 0.36).

Conclusions

Caution needs to be exercised when using DTI tractography information to guide DBS lead placement in patients with PD. Further studies are needed to compare DTI tractography measurements with other approaches such as microelectrode recordings and conventional intraoperative MRI–guided placement of DBS leads.

Abbreviations used in this paper:

CST = corticospinal tract; DBS = deep brain stimulation; DTI = diffusion tensor imaging; GEE = generalized estimating equation; GPi = globus pallidus internus; MPRAGE = magnetization-prepared rapid acquisition gradient echo; NEX = number of excitations; PD = Parkinson disease; STN = subthalamic nucleus; Vim = ventral intermediate nucleus.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Avants BB, , Tustison NJ, , Song G, , Cook PA, , Klein A, & Gee JC: A reproducible evaluation of ANTs similarity metric performance in brain image registration. Neuroimage 54:20332044, 2011

    • Search Google Scholar
    • Export Citation
  • 2

    Benabid AL, , Pollak P, , Gao D, , Hoffmann D, , Limousin P, & Gay E, et al.: Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 84:203214, 1996

    • Search Google Scholar
    • Export Citation
  • 3

    Blond S, , Caparros-Lefebvre D, , Parker F, , Assaker R, , Petit H, & Guieu JD, et al.: Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus. J Neurosurg 77:6268, 1992

    • Search Google Scholar
    • Export Citation
  • 4

    Coenen VA, , Allert N, & Mädler B: A role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (drt) for the treatment of therapy-refractory tremor. Acta Neurochir (Wien) 153:15791585, 2011

    • Search Google Scholar
    • Export Citation
  • 5

    Cook PA, , Bai Y, , Nedjati-Gilani SK, , Seunarine KK, , Hall MG, & Parker GJ, et al.: Camino: open-source diffusion-MRI reconstruction and processing. Centre for Medical Image Computing. (http://www0.cs.ucl.ac.uk/research/medic/camino/files/camino_2006_abstract.pdf) [Accessed June 22, 2014] (Abstract)

    • Search Google Scholar
    • Export Citation
  • 6

    Deep-Brain Stimulation for Parkinson's Disease Study Group: Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 345:956963, 2001

    • Search Google Scholar
    • Export Citation
  • 7

    Jankovic J: Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 79:368376, 2008

  • 8

    Jones DK: Tractography gone wild: probabilistic fibre tracking using the wild bootstrap with diffusion tensor MRI. IEEE Trans Med Imaging 27:12681274, 2008

    • Search Google Scholar
    • Export Citation
  • 9

    Kumar K, , Kelly M, & Toth C: Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson's disease and essential tremor. Stereotact Funct Neurosurg 72:4761, 1999

    • Search Google Scholar
    • Export Citation
  • 10

    Maurer CR Jr, , Qi R, & Raghavan V: A linear time algorithm for computing exact Euclidean distance transforms of binary images in arbitrary dimensions. IEEE Trans Pattern Anal Mach Intell 25:265270, 2003

    • Search Google Scholar
    • Export Citation
  • 11

    McIntyre CC, , Mori S, , Sherman DL, , Thakor NV, & Vitek JL: Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus. Clin Neurophysiol 115:589595, 2004

    • Search Google Scholar
    • Export Citation
  • 12

    Morishita T, , Foote KD, , Wu SS, , Jacobson CE IV, , Rodriguez RL, & Haq IU, et al.: Brain penetration effects of microelectrodes and deep brain stimulation leads in ventral intermediate nucleus stimulation for essential tremor. Clinical article. J Neurosurg 112:491496, 2010. (Erratum in J Neurosurg 112: 689, 2010)

    • Search Google Scholar
    • Export Citation
  • 13

    Starr PA, , Martin AJ, , Ostrem JL, , Talke P, , Levesque N, & Larson PS: Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. Clinical article. J Neurosurg 112:479490, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Starr PA, , Turner RS, , Rau G, , Lindsey N, , Heath S, & Volz M, et al.: Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 104:488501, 2006

    • Search Google Scholar
    • Export Citation
  • 15

    Whitcher B, , Tuch DS, , Wisco JJ, , Sorensen AG, & Wang L: Using the wild bootstrap to quantify uncertainty in diffusion tensor imaging. Hum Brain Mapp 29:346362, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Yelnik J, , Damier P, , Demeret S, , Gervais D, , Bardinet E, & Bejjani BP, et al.: Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas-magnetic resonance imaging coregistration method. J Neurosurg 99:8999, 2003

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 344 162 14
Full Text Views 709 14 0
PDF Downloads 341 9 0
EPUB Downloads 0 0 0