Toward a standard preoperative MRI protocol for functional neurosurgery.

Area of Science:

• Neurosurgery
• Medical Imaging
• Neurology

Background:

• Deep Brain Stimulation (DBS) is crucial for movement disorders, but requires precise electrode placement.
• Current preoperative MRI protocols for DBS vary significantly, hindering data comparison and research.
• Accurate targeting relies on high signal-to-noise ratio in preoperative MRI scans.

Purpose of the Study:

• To evaluate various MRI sequences for their suitability in DBS targeting.
• To suggest a standardized MRI protocol for preoperative DBS procedures.
• To improve the accuracy and consistency of DBS electrode placement.

Main Methods:

• Two healthy subjects underwent scanning with multiple MRI sequences (T2w, PDw, T2FLAIRw, T2*w, SWI, FGATIR, T1TIR, QSM).
• Twelve experienced DBS surgeons rated sequence suitability for targeting the subthalamic nucleus (STN), globus pallidus internus (GPi), and ventrointermediate (VIM) thalamus.
• Contrast-to-noise ratios (CNR) were calculated and correlated with targeting accuracy.

Main Results:

• T2w, SWI, QSM, and T2FLAIRw sequences were highly rated for STN-DBS targeting.
• FGATIR, PDw, and SWI were preferred for GPi-DBS, while FGATIR was best for VIM-DBS.
• Higher CNR correlated with improved targeting accuracy (R²=0.29 for z-scores, R²=0.18 for coordinates).

Conclusions:

• A suggested MRI protocol can standardize preoperative imaging for DBS.
• Optimizing MRI sequences enhances the precision of electrode placement in DBS surgery.
• Openly sharing imaging data and protocols facilitates research and clinical practice standardization.