Precise targeting of the globus pallidus internus with quantitative susceptibility mapping for deep brain stimulation surgery

Hongjiang Wei; Chencheng Zhang; Tao Wang; Naying He; Dianyou Li; Yuyao Zhang; Chunlei Liu; Fuhua Yan; Bomin Sun

doi:10.3171/2019.7.JNS191254

Precise targeting of the globus pallidus internus with quantitative susceptibility mapping for deep brain stimulation surgery

J Neurosurg. 2019 Oct 11;133(5):1605-1611. doi: 10.3171/2019.7.JNS191254.

Authors

Hongjiang Wei¹, Chencheng Zhang², Tao Wang², Naying He³, Dianyou Li², Yuyao Zhang⁴, Chunlei Liu^{5

6}, Fuhua Yan³, Bomin Sun²

Affiliations

¹ 1Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University.
² 2Department of Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University.
³ 3Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University.
⁴ 4School of Information and Science and Technology, Shanghai Tech University, Shanghai, China.
⁵ 5Department of Electrical Engineering and Computer Sciences, University of California, Berkeley; and.
⁶ 6Helen Wills Neuroscience Institute, University of California, Berkeley, California.

PMID: 31604332
DOI: 10.3171/2019.7.JNS191254

Abstract

Objective: The goal of this study was to demonstrate the use of quantitative susceptibility mapping (QSM)-based images to precisely localize the globus pallidus internus (GPi) for deep brain stimulation (DBS) planning and to enhance postsurgical visualization of the DBS lead positions.

Methods: Presurgical T1-weighted (T1w), T2-weighted (T2w), and QSM images as well as postsurgical CT images were obtained in 29 patients with Parkinson's disease. To enhance the contrast within the GP, a hybrid contrast was created by linearly combining T1w and QSM images. Contrast-to-noise ratios (CNRs) of the GPi on T1w, T2w, QSM, and hybrid images were compared. The CNR differences were tested using the 1-way ANOVA method. The visualization of the DBS lead position was demonstrated by merging the postsurgical CT with presurgical MR images.

Results: The hybrid images yield the best CNRs for GPi depiction and the visualization of the postsurgical DBS lead position was significantly improved.

Conclusions: QSM-based images allow for confident localization of borders of the GPi that is superior to T1w and T2w images. High-contrast hybrid images can be used for precisely directed DBS targeting, e.g., GPi DBS for the treatment of advanced Parkinson's disease.

Keywords: Parkinson’s disease; deep brain stimulation; diagnostic technique; electrode placement; functional neurosurgery; globus pallidus internus; quantitative susceptibility mapping.