Proton Density MR Imaging: A Simple and Powerful Sequence to Visualise Anatomical Structures in Functional...

Area of Science:

• Neurosurgery
• Medical Imaging
• Radiology

Background:

• Direct visualization of subcortical structures is crucial for functional neurosurgery accuracy.
• Proton density-weighted (PDW) MRI provides excellent grey-white matter contrast and is widely accessible.
• The utility of PDW imaging for functional neurosurgical targeting requires comprehensive review.

Purpose of the Study:

• To summarize evidence on PDW imaging for functional neurosurgery.
• To illustrate PDW imaging's use in identifying targets for deep brain stimulation (DBS), radiofrequency ablation (RFA), and focused ultrasound (FUS).

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Inclusion of in-vivo studies visualizing basal ganglia, thalamic, white-matter, and brainstem targets.
• Analysis of clinical PDW images correlated with human anatomy for radiological demonstration.

Main Results:

• Thirteen studies (326 subjects) met inclusion criteria.
• PDW imaging visualized key targets like Vim, globus pallidus, habenula, and PPN.
• Additional visualized structures include pallidothalamic tract, internal capsule, fornix, and nucleus accumbens.

Conclusions:

• PDW MRI is a powerful, underutilized tool for direct, anatomy-based functional neurosurgery targeting.
• Its robustness and contrast aid stereotactic planning and postoperative verification.
• Wider adoption can improve surgical precision and expand image-guided intervention options.