Related Experiment Video
Updated: Jun 25, 2026
A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery
Published on: May 20, 2016
The accuracy and reliability of 3D CT/MRI co-registration in planning epilepsy surgery
James X Tao1, Susan Hawes-Ebersole, Maria Baldwin
1Department of Neurology and Neurosurgery, Adult Epilepsy Center, The University of Chicago, 5841 South Maryland Ave., MC2030, Chicago, IL 60637, USA. jtao@neurology.bsd.uchicago.edu
Objective:
To investigate the accuracy and reliability of 3D CT/MRI co-registration technique for the localization of implanted subdural electrodes in the routine epilepsy presurgical evaluation, in so doing assess its usefulness in planning the tailored resection of epileptic focus.
Methods:
Four external anatomic fiducial makers were used for co-registration of volumetric pre-implant brain MRI and post-implant head CT using Curry 5.0 software in 19 epilepsy presurgical candidates. The location of subdural electrodes derived from the co-registration was compared to that obtained by intra-operative digital photographs by using gyral/sulcal patterns and cortical vasculature as anatomic markers.
Results:
The mean localization error was 4.3+/-2.5 mm in all 19 patients. However, the mean localization error was 3.1+/- 1.3 mm in 13 patients with all four reliable fiducial markers; whereas the mean localization error was 6.8+/-2.4 mm in 6 patients with two or three reliable fiducial markers.
Conclusion:
Visualization of subdural electrode positions on a patient's cortex can be accurately performed in the routine clinical setting by 3D CT/MRI co-registration. However, the accuracy of co-registration is dependent upon having reliable surface fiducial markers. In practice, confirmation of location accuracy, such as with intra-operative digital photographs, is necessary for planning of tailored resective surgery.
Significance:
The combination of 3D CT/MRI co-registration and intra-operative digital photography techniques provides a practical and effective algorithm for the localization and validation of implanted subdural electrodes.
