title: Susceptibility-Weighted MRI for Deep Brain Stimulation: Potentials in Trajectory Planning.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
authors.forename: Frank
authors.initials: F
authors.lastname: Hertel
authors.forename: Andreas
authors.initials: A
authors.lastname: Husch
authors.forename: Georges
authors.initials: G
authors.lastname: Dooms
authors.forename: Florian
authors.initials: F
authors.lastname: Bernard
authors.forename: Peter
authors.initials: P
authors.lastname: Gemmar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D046690:Deep Brain Stimulation / Q000379:methods*; D020821:Dystonic Disorders / Q000473:pathology / Q000628:therapy; D020329:Essential Tremor / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology / Q000628:therapy; D059906:Neuroimaging / Q000379:methods*; D010300:Parkinson Disease / Q000473:pathology / Q000628:therapy