Medical Faculty Mannheim, Department of Neuroradiology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
Clin Neuroradiol. 2012 Mar;22(1):55-68. doi: 10.1007/s00062-012-0136-3. Epub 2012 Feb 17.
Deep-brain stimulation (DBS) of the zona incerta (ZI) has shown promising results for medication-refractory neurological disorders including Parkinson's disease (PD) and essential tremor (ET). The success of the intervention is indispensably dependent on the reliable visualisation of the ZI. The aim of the study was to evaluate different promising new magnetic resonance imaging (MRI) methods at 3.0 Tesla for pre-stereotactic visualisation of the ZI using a standard installation the protocol.
MRI of nine healthy volunteers was acquired (T1-MPRAGE, T2-FLAIR, T2*-FLASH2D, T2-SPACE and susceptibility-weighted imaging (SWI). Image quality and visualisation of the ZI for each sequence were analysed independently by two neuroradiologists using a 6-point scale. For T2*-FLASH2D the axial, coronal and sagittal planes were compared. The delineation of the ZI versus the internal capsule, the subthalamic nucleus and the pallidofugal fibres was evaluated in all sequences and compared to T2-FLAIR using a paired t-test. Inter-rater reliability, contrast-to-noise ratios (CNR), and signal-to-noise ratios (SNR) for the ZI were computed. For illustration, coronal T2*-FLASH2D images were co-registered with the corresponding section schema of the Schaltenbrand-Wahren stereotactic atlas.
Only the rostral part of the ZI (rZI) could be identified. The rZI was best and reliably visualised in T2*-FLASH2D (particularly coronal orientation; p < 0.05). No major artifacts in the rZI were observed in any of the sequences. SWI, T2-SPACE, and T2*-FLASH imaging offered significant higher CNR values for the rZI compared to T2-FLAIR imaging using standard parameters. The co-registration of the coronal T2*-FLASH2D images projected the ZI clearly into the boundaries of the anatomical sections.
The delineation of the rZI is best possible in T2*-FLASH2D (particularly coronal view) using a standard installation protocol at 3.0 T. The caudal ZI could not be discerned in any of the sequences.
深部脑刺激（DBS）于神经调节治疗中展现出令人期待的成果，尤其在药物难治性神经疾病方面，例如帕金森病（PD）和原发性震颤（ET）。干预的成功与否在很大程度上取决于准确的间脑下核可视化。本研究旨在评估不同有前景的新磁共振成像（MRI）方法在 3.0 特斯拉下，通过标准安装协议，对间脑下核进行术前可视化的效果。
对 9 名健康志愿者进行 MRI 扫描（T1-MPRAGE、T2-FLAIR、T2*-FLASH2D、T2-SPACE 和磁敏感加权成像（SWI）。两位神经放射科医生使用 6 分制对每种序列的图像质量和间脑下核的可视化程度进行独立分析。对于 T2*-FLASH2D，比较了轴位、冠状位和矢状位。在所有序列中评估了间脑下核与内囊、底丘脑核和苍白球传出纤维的分界，并与 T2-FLAIR 进行配对 t 检验。计算了间脑下核的对比噪声比（CNR）和信噪比（SNR），并评估了其组内信度。为了说明问题，我们将冠状位 T2*-FLASH2D 图像与 Schaltenbrand-Wahren 立体定向图谱的相应截面图进行了配准。
仅能识别间脑下核的前段（rZI）。T2*-FLASH2D 能最好且可靠地显示 rZI（特别是冠状面方向；p<0.05）。在任何序列中均未观察到 rZI 有明显的伪影。SWI、T2-SPACE 和 T2*-FLASH 成像在使用标准参数时，提供了比 T2-FLAIR 成像更高的 rZI 的 CNR 值。冠状位 T2*-FLASH2D 图像的配准清晰地将间脑下核投影到解剖学截面的边界内。
在 3.0T 下，使用标准安装协议，T2*-FLASH2D（特别是冠状视图）能最好地显示 rZI。在任何序列中均无法识别间脑下核的后段。
