Connectivity derived thalamic segmentation in deep brain stimulation for tremor
| Autor: | Enrico De Vita, Marwan Hariz, Timothy E.J. Behrens, Harith Akram, Ludvic Zrinzo, John Ashburner, Marjan Jahanshahi, Patricia Limousin, Thomas Foltynie, Viswas Dayal, Philipp Mahlknecht, Jonathan Hyam, Dejan Georgiev |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Neurologi FNIRT FMRIB's non-linear image registration tool medicine.medical_treatment FSL FMRIB's software library Deep Brain Stimulation DBS Dentate nucleus Tremor NIfTI neuroimaging informatics technology initiative UPDRS unified Parkinson's disease rating scale 0302 clinical medicine Dentato-rubro-thalamic tract DRT PFC prefrontal cortex LEDD l-DOPA equivalent daily dose GLM general linear model FLIRT FMRIB's linear image registration tool Connectivity Supplementary motor area SMA supplementary motor area SAR specific absorption rate Regular Article DF degrees of freedom SNR signal-to-noise ratio Ventrointermedialis VIM PC posterior commissure Neurology Parkinson's disease PD VP ventral posterior PD SSEPI single-shot echo planar imaging Primary motor cortex BEDPOSTX Bayesian estimation of diffusion parameters obtained using sampling techniques X VL ventral lateral CON connectivity Deep brain stimulation HFS high frequency stimulation Essential Tremor Thalamus TFCE threshold-free cluster enhancement MPTP 1-methyl-4-phenyl-1 2 3 6-tetrahydropyridine S1 primary sensory cortex IPG implantable pulse generator lcsh:Computer applications to medicine. Medical informatics DICOM digital imaging and communications in medicine 03 medical and health sciences Humans Aged Ventrolateral nucleus HARDI high angular resolution diffusion imaging M1 primary motor cortex Diffusion weighted imaging medicine.disease Diffusion weighted imaging DWI Diffusion Magnetic Resonance Imaging VTA volume of tissue activated VIM LC Levodopa challenge Neurology (clinical) Neuroscience Dentato-rubro-thalamic tract 030217 neurology & neurosurgery STN subthalamic nucleus Diffusion MRI Cerebellum Parkinson's disease Dentate nucleus cZI caudal zona incerta DWI lcsh:RC346-429 030218 nuclear medicine & medical imaging AC anterior commissure Tremor Ventrolateral nucleus VL MNI Montreal neurological institute MPRAGE magnetization-prepared rapid gradient-echo Essential tremor Parkinson Disease Middle Aged NHNN National Hospital for Neurology and Neurosurgery medicine.anatomical_structure PMC premotor cortex lcsh:R858-859.7 Female Cognitive Neuroscience Ventrointermedialis MMS mini-mental score medicine Radiology Nuclear Medicine and imaging lcsh:Neurology. Diseases of the nervous system SE standard error business.industry DWI diffusion weighted imaging TMS transcranial magnetic stimulation EV explanatory variable FMRIB Oxford centre for functional MRI of the brain FoV field of view VBM voxel based morphometry CI confidence interval Deep brain stimulation DBS BET brain extraction tool DRT VL business SD standard deviation DBS deep brain stimulation |
| Zdroj: | NeuroImage : Clinical Akram, H, Dayal, V, Mahlknecht, P, Georgiev, D, Hyam, J, Foltynie, T, Limousin, P, De Vita, E, Jahanshahi, M, Ashburner, J, Behrens, T, Hariz, M & Zrinzo, L 2018, ' Connectivity derived thalamic segmentation in deep brain stimulation for tremor ', NeuroImage: Clinical, vol. 18, pp. 130-142 . https://doi.org/10.1016/j.nicl.2018.01.008 NeuroImage: Clinical, Vol 18, Iss, Pp 130-142 (2018) |
| ISSN: | 2213-1582 |
| DOI: | 10.1016/j.nicl.2018.01.008 |
| Popis: | The ventral intermediate nucleus (VIM) of the thalamus is an established surgical target for stereotactic ablation and deep brain stimulation (DBS) in the treatment of tremor in Parkinson's disease (PD) and essential tremor (ET). It is centrally placed on a cerebello-thalamo-cortical network connecting the primary motor cortex, to the dentate nucleus of the contralateral cerebellum through the dentato-rubro-thalamic tract (DRT). The VIM is not readily visible on conventional MR imaging, so identifying the surgical target traditionally involved indirect targeting that relies on atlas-defined coordinates. Unfortunately, this approach does not fully account for individual variability and requires surgery to be performed with the patient awake to allow for intraoperative targeting confirmation. The aim of this study is to identify the VIM and the DRT using probabilistic tractography in patients that will undergo thalamic DBS for tremor. Four male patients with tremor dominant PD and five patients (three female) with ET underwent high angular resolution diffusion imaging (HARDI) (128 diffusion directions, 1.5 mm isotropic voxels and b value = 1500) preoperatively. Patients received VIM-DBS using an MR image guided and MR image verified approach with indirect targeting. Postoperatively, using parallel Graphical Processing Unit (GPU) processing, thalamic areas with the highest diffusion connectivity to the primary motor area (M1), supplementary motor area (SMA), primary sensory area (S1) and contralateral dentate nucleus were identified. Additionally, volume of tissue activation (VTA) corresponding to active DBS contacts were modelled. Response to treatment was defined as 40% reduction in the total Fahn-Tolosa-Martin Tremor Rating Score (FTMTRS) with DBS-ON, one year from surgery. Three out of nine patients had a suboptimal, long-term response to treatment. The segmented thalamic areas corresponded well to anatomically known counterparts in the ventrolateral (VL) and ventroposterior (VP) thalamus. The dentate-thalamic area, lay within the M1-thalamic area in a ventral and lateral location. Streamlines corresponding to the DRT connected M1 to the contralateral dentate nucleus via the dentate-thalamic area, clearly crossing the midline in the mesencephalon. Good response was seen when the active contact VTA was in the thalamic area with highest connectivity to the contralateral dentate nucleus. Non-responders had active contact VTAs outside the dentate-thalamic area. We conclude that probabilistic tractography techniques can be used to segment the VL and VP thalamus based on cortical and cerebellar connectivity. The thalamic area, best representing the VIM, is connected to the contralateral dentate cerebellar nucleus. Connectivity based segmentation of the VIM can be achieved in individual patients in a clinically feasible timescale, using HARDI and high performance computing with parallel GPU processing. This same technique can map out the DRT tract with clear mesencephalic crossing. Highlights • The thalamic target for surgery for tremor is not readily visible on conventional MRI. • Probabilistic tractography is used to segment the thalamus based on connectivity. • The best target area is connected to the contralateral dentate cerebellar nucleus. • GPU processing is used to segment the thalamus in a clinically feasible timescale. • This technique can map out the DRT tract with clear mesencephalic crossing. |
| Databáze: | OpenAIRE |
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