AI Article Synopsis
- Deep brain stimulation (DBS) trajectory planning primarily relies on standard 3-D T1-weighted gadolinium-enhanced MRI (T1-Gd), but this study explored the potential of susceptibility-weighted MRI (SWI) for better visualization of neurovascular structures.
- In a comparison involving 10 patients, SWI identified significantly more vascular conflicts (53) in DBS trajectories than T1-Gd (13), while all vessels seen in T1-Gd were also visible in SWI.
- The findings suggest that SWI offers a greater sensitivity for detecting neurovascular structures, making it a promising alternative for DBS planning, which may lead to a reconsideration of the frequency of vascular interactions in DBS trajectories that cause symptomatic bleeding.
Article Abstract
Background: Deep brain stimulation (DBS) trajectory planning is mostly based on standard 3-D T1-weighted gadolinium-enhanced MRI sequences (T1-Gd). Susceptibility-weighted MRI sequences (SWI) show neurovascular structures without the use of contrast agents. The aim of this study was to investigate whether SWI might be useful in DBS trajectory planning.
Methods: We performed bilateral DBS planning using conventional T1-Gd images of 10 patients with different kinds of movement disorders. Afterwards, we matched SWI sequences and compared the visibility of vascular structures in both imaging modalities.
Results: By analyzing 100 possible trajectories, we found a potential vascular conflict in 13 trajectories based on T1-Gd in contrast to 53 in SWI. Remarkably, all vessels visible in T1-Gd were also depicted in SWI, whereas SWI showed many additional vascular structures which could not be identified in T1-Gd.
Conclusion/discussion: The sensitivity for detecting neurovascular structures for DBS planning seems to be significantly higher in SWI. As SWI does not require a contrast agent, we suggest that SWI may be a valuable alternative to T1-Gd MRI for DBS trajectory planning. Furthermore, the data analysis suggests that vascular interactions of DBS trajectories might be more frequent than expected from the very low incidence of symptomatic bleedings. The explanation for this is currently the subject of debate and merits further studies.
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