title: Accuracy of subthalamic nucleus targeting by T2, FLAIR and SWI-3-Tesla MRI confirmed by microelectrode recordings.
abstract: BACKGROUND
  Successful deep brain stimulation is mostly dependent on accurate positioning of the leads at the optimal target points. We investigated whether the identification of the subthalamic nucleus in T2-weighted 3-T MRI, fluid-attenuated inversion recovery 3-T MRI and susceptibility-weighted 3-T MRI is confirmed by intraoperative neurological microelectrode recording.
  
  
  METHODS
  We evaluated 182 microelectrode recording leads in 21 patients with bilateral deep brain stimulation, retrospectively. Consequently, 728 electrode contact positions in T2-weighted 3-T MRI, 552 electrode contact positions in fluid-attenuated inversion recovery 3-T MRI and 490 electrode contact positions in susceptibility-weighted 3-T MRI were evaluated for a positive nucleus subthalamicus signal.
  
  
  RESULTS
  The highest sensitivity was measured for fluid-attenuated inversion recovery 3-T MRI with 82.5 %, while the highest specificity was observed for susceptibility-weighted 3-T MRI with 90.6 %. The negative predictive value was nearly equal for susceptibility-weighted MRI and fluid-attenuated inversion recovery MRI with 87.5 % vs. 87.1 %, but the positive predictive value was higher in susceptibility-weighted 3-T MRI (86.0 %) than in the other MRI sequences.
  
  
  CONCLUSIONS
  The susceptibility-weighted 3-T MRI-based subthalamic nucleus localization shows the best accuracy compared with T2-weighted and fluid-attenuated inversion recovery 3-T MRI. Therefore, the susceptibility-weighted 3-T MRI should be preferred for surgical planning when the operation procedure is performed under general anesthesia without microelectrode recordings.
authors.affiliation: Department of Neurosurgery, Medical school 'Carl Gustav Carus' of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany, witold.polanski@uniklinikum-dresden.de.
authors.forename: Witold H
authors.initials: WH
authors.lastname: Polanski
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Martin
authors.forename: Kay
authors.initials: K
authors.lastname: Engellandt
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kummer
authors.forename: Lisa
authors.initials: L
authors.lastname: Klingelhoefer
authors.forename: Mareike
authors.initials: M
authors.lastname: Fauser
authors.forename: Alexander
authors.initials: A
authors.lastname: Storch
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Sobottka
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020531:Subthalamic Nucleus / Q000503:physiopathology*