title: Fiducial registration with spoiled gradient-echo magnetic resonance imaging enhances the accuracy of subthalamic nucleus targeting.
abstract: BACKGROUND
  A variety of imaging strategies may be used to derive reliable stereotactic coordinates when performing deep brain stimulation lead implants. No single technique has yet proved optimal.
  
  
  OBJECTIVE
  To compare the relative accuracy of stereotactic coordinates for the subthalamic nucleus (STN) derived either from fast spin echo/inversion recovery (FSE/IR) magnetic resonance imaging MRI alone (group 1) or FSE/IR in conjunction with T1-weighted spoiled gradient-echo MRI (group 2).
  
  
  METHODS
  A retrospective analysis of 145 consecutive STN deep brain stimulation lead placements (group 1, n = 72; group 2, n = 73) was performed in 81 Parkinson disease patients by 1 surgical team. From the operative reports, we recorded the number of microelectrode recording trajectories required to localize the desired STN target and the span of STN traversed along the implantation trajectory. In addition, we calculated the 3-dimensional vector difference between the initial MRI-derived coordinates and the final physiologically refined coordinates.
  
  
  RESULTS
  The proportion of implants completed with just 1 microelectrode recording trajectory was greater (81% vs 58%; P < .001) and the 3-dimensional vector difference between the anatomically selected target and the microelectrode recording-refined target was smaller (0.6 ± 1.2 vs 0.9 ± 1.3; P = .04) in group 2 than in group 1. At the same time, the mean expanse of STN recorded along the implantation trajectory was 8% greater in group 2 (4.8 ± 0.6 vs 5.2 ± 0.6 mm; P < .001).
  
  
  CONCLUSIONS
  A combination of stereotactic FSE/IR and spoiled gradient-echo MRI yields more accurate coordinates for the STN than FSE/IR MRI alone.
authors.affiliation: Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Sharona
authors.initials: S
authors.lastname: Ben-Haim
authors.forename: Yakov
authors.initials: Y
authors.lastname: Gologorsky
authors.forename: Ann
authors.initials: A
authors.lastname: Monahan
authors.forename: Donald
authors.initials: D
authors.lastname: Weisz
authors.forename: Ron L
authors.initials: RL
authors.lastname: Alterman
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D008279:Magnetic Resonance Imaging; D008839:Microelectrodes; D010300:Parkinson Disease / Q000601:surgery*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques