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Accurate localization of deep brain stimulation electrode contacts using extended Hounsfield unit computed tomography
Naomi I Kremer1, Arjen L J van Hulzen2, Katalin Tamasi3,4
1Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. n.i.kremer@umcg.nl.
European Radiology
|December 20, 2025
Summary
Extended Hounsfield unit (EHU) CT imaging improves visualization of deep brain stimulation (DBS) electrode contacts compared to conventional CT. This advanced imaging technique offers superior clarity for better surgical planning and patient outcomes.
Area of Science:
- Neurosurgery
- Medical Imaging
- Biomedical Engineering
Background:
- Accurate localization of deep brain stimulation (DBS) electrodes is crucial for effective therapeutic outcomes.
- Conventional computed tomography (CT) imaging is limited by metallic artifacts, hindering the visualization of individual DBS electrode contacts.
- Extended Hounsfield unit (EHU) CT utilizes an expanded scale (up to 40,000 HU) to potentially overcome these limitations.
Purpose of the Study:
- To evaluate the efficacy of EHU-CT for accurate localization of individual DBS electrode contacts.
- To compare the visualization capabilities of EHU-CT against conventional CT for DBS electrodes.
- To assess the impact of EHU-CT on DBS workflow and decision-making.
Main Methods:
- Retrospective analysis of 29 patients (58 DBS electrodes) with postoperative conventional CT and EHU-CT scans.
- Two independent raters localized electrode contacts using a standardized protocol.
- Quantitative (intraclass correlation coefficients, Euclidean distances) and qualitative assessments of contact visibility were performed.
Main Results:
- Quantitative analysis demonstrated near-perfect agreement between EHU-CT and conventional CT (ICC ≈ 1) with high inter-rater consistency.
- Qualitative evaluation revealed superior contact visualization with EHU-CT, with 100% of contacts clearly identifiable.
- Conventional CT failed to distinguish individual contacts due to blooming artifacts and was sensitive to window-level adjustments.
Conclusions:
- EHU-CT provides consistent and direct visualization of individual DBS contacts, offering a robust alternative to conventional CT.
- The improved interpretability and reduced sensitivity to display settings of EHU-CT can enhance intra-operative decision-making and postoperative programming.
- EHU-CT supports more reliable DBS workflows, potentially improving patient outcomes.
