title: The subthalamic nucleus at 3.0 Tesla: choice of optimal sequence and orientation for deep brain stimulation using a standard installation protocol: clinical article.
abstract: OBJECTIVE
  Reliable visualization of the subthalamic nucleus (STN) is indispensable for accurate placement of electrodes in deep brain stimulation (DBS) surgery for patients with Parkinson disease (PD). The aim of the study was to evaluate different promising new MRI methods at 3.0 T for preoperative visualization of the STN using a standard installation protocol.
  
  
  METHODS
  Magnetic resonance imaging studies (T2-FLAIR, T1-MPRAGE, T2*-FLASH2D, T2-SPACE, and susceptibility-weighted imaging sequences) obtained in 9 healthy volunteers and in 1 patient with PD were acquired. Two neuroradiologists independently analyzed image quality and visualization of the STN using a 6-point scale. Interrater reliability, contrast-to-noise ratios, and signal-to-noise ratios for the STN were calculated. For illustration of the anatomical accuracy, coronal T2*-FLASH2D images were fused with the corresponding coronal section schema of the Schaltenbrand and Wahren stereotactic atlas.
  
  
  RESULTS
  The STN was best and reliably visualized on T2*-FLASH2D imaging (in particular, the coronal view). No major artifacts in the STN were observed in any of the sequences. Susceptibility-weighted, T2-SPACE, and T2*-FLASH2D imaging provided significantly higher contrast-to-noise ratio values for the STN than standard T2-weighted imaging. Fusion of the coronal T2*-FLASH2D and the digitized coronal atlas view projected the STN clearly within the boundaries of the STN found in anatomical sections.
  
  
  CONCLUSIONS
  For 3.0-T MRI, T2*-FLASH2D (particularly the coronal view) provides optimal delineation of the STN using a standard installation protocol.
authors.affiliation: Department of Neuroradiology, University of Heidelberg, Medical Faculty Mannheim, Heidelberg, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Kerl
authors.forename: Lars
authors.initials: L
authors.lastname: Gerigk
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pechlivanis
authors.forename: Mansour
authors.initials: M
authors.lastname: Al-Zghloul
authors.forename: Christoph
authors.initials: C
authors.lastname: Groden
authors.forename: Ingo
authors.initials: I
authors.lastname: Nölte
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D016477:Artifacts; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D015588:Observer Variation; D010300:Parkinson Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012016:Reference Values; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus; D036542:Tomography, Spiral Computed
chemical_list: D000978:Antiparkinson Agents