Original Article
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World J Radiol. Jan 28, 2013; 5(1): 5-16
Published online Jan 28, 2013. doi: 10.4329/wjr.v5.i1.5
Imaging for deep brain stimulation: The zona incerta at 7 Tesla
Hans U Kerl, Lars Gerigk, Marc A Brockmann, Sonia Huck, Mansour Al-Zghloul, Christoph Groden, Thomas Hauser, Armin M Nagel, Ingo S Nölte
Hans U Kerl, Marc A Brockmann, Sonia Huck, Mansour Al-Zghloul, Christoph Groden, Ingo S Nölte, Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
Lars Gerigk, Thomas Hauser, Division of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
Armin M Nagel, Department of Medical Physics and Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
Author contributions: Kerl HU and Gerigk L contributed equally to this work; Kerl HU, Gerigk L and Nölte IS designed the study; Gerigk L, Hauser T and Nagel AM were responsible for the acquisition of the scans; Brockmann MA, Huck S, Al-Zghoul M and Groden C edited the manuscript; Kerl HU and Nölte IS wrote the paper; all authors contributed to supportive work.
Correspondence to: Dr. Ingo S Nölte, MED, Department of Neuroradiology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. ingo.noelte@umm.de
Telephone: +49-621-3832443 Fax: +49-621-3832165
Received: September 20, 2012
Revised: October 24, 2012
Accepted: January 17, 2013
Published online: January 28, 2013
Abstract

AIM: To evaluate different promising magnetic resonance imaging (MRI) methods at 7.0 Tesla (T) for the pre-stereotactic visualization of the zona incerta (ZI).

METHODS: Two neuroradiologists qualitatively and quantitatively examined T2-turbo spin-echo (T2-TSE), T1-weighted gradient-echo, as well as FLASH2D-T2Star and susceptibility-weighted imaging (SWI) for the visualization of the ZI at 7.0 T MRI. Delineation and image quality for the ZI were independently examined using a 6-scale grading system. Inter-rater reliability using Cohen’s kappa coefficient (κ) were assessed. Contrast-to-noise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were calculated for all sequences. Differences in delineation, SNR, and CNR between the sequences were statistically assessed using a paired t-test. For the anatomic validation the coronal FLASH2D-T2Star images were co-registered with a stereotactic atlas (Schaltenbrand-Wahren).

RESULTS: The rostral part of the ZI (rZI) could easily be identified and was best and reliably visualized in the coronal FLASH2D-T2Star images. The caudal part was not definable in any of the sequences. No major artifacts in the rZI were observed in any of the scans. FLASH2D-T2Star and SWI imaging offered significant higher CNR values for the rZI compared to T2-TSE images (P > 0.05). The co-registration of the coronal FLASH2D-T2Star images with the stereotactic atlas schema (Schaltenbrand-Wahren) confirmed the correct localization of the ZI in all cases.

CONCLUSION: FLASH2D-T2Star imaging (particularly coronal view) provides the reliable and currently optimal visualization of the rZI at 7.0 T. These results can facilitate a better and more precise targeting of the caudal part of the ZI than ever before.

Keywords: Deep brain stimulation, Essential tremor, Magnetic resonance imaging, Parkinson’s disease, Zona incerta, 7 Tesla