Hellerbach Alexandra, Dembek Till A, Hoevels Mauritius, Holz Jasmin A, Gierich Andreas, Luyken Klaus, Barbe Michael T, Wirths Jochen, Visser-Vandewalle Veerle, Treuer Harald
Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany.
Department of Neurology, University Hospital of Cologne, Cologne, Germany.
Stereotact Funct Neurosurg. 2018;96(5):335-341. doi: 10.1159/000494738. Epub 2018 Nov 27.
Directional deep brain stimulation (DBS) allows steering the stimulation in an axial direction which offers greater flexibility in programming. However, accurate anatomical visualization of the lead orientation is required for interpreting the observed stimulation effects and to guide programming.
In this study we aimed to develop and test an accurate and robust algorithm for determining the orientation of segmented electrodes based on standard postoperative CT imaging used in DBS.
Orientation angles of directional leads (CartesiaTM; Boston Scientific, Marlborough, MA, USA) were determined using CT imaging. Therefore, a sequential algorithm was developed that quantitatively compares the similarity of the observed CT artifacts with calculated artifact patterns based on the lead's orientation marker and a geometric model of the segmented electrodes. Measurements of seven ground truth phantoms and three leads with 60 different configurations of lead implantation and orientation angles were analyzed for validation.
The accuracy of the determined electrode orientation angles was -0.6 ± 1.5° (range: -5.4 to 4.2°). This accuracy proved to be sufficiently high to resolve even subtle differences between individual leads.
The presented algorithm is user independent and provides highly accurate results for the orientation of the segmented electrodes for all angular constellations that typically occur in clinical cases.
定向深部脑刺激（DBS）可在轴向引导刺激，这在编程方面提供了更大的灵活性。然而，为了解释观察到的刺激效果并指导编程，需要对电极方向进行准确的解剖学可视化。
在本研究中，我们旨在开发并测试一种基于DBS术后标准CT成像确定分段电极方向的准确且稳健的算法。
使用CT成像确定定向电极（CartesiaTM；美国波士顿科学公司，马尔伯勒，马萨诸塞州）的方向角。因此，开发了一种顺序算法，该算法基于电极的方向标记和分段电极的几何模型，定量比较观察到的CT伪影与计算出的伪影模式的相似性。分析了七个真实模型以及三根具有60种不同电极植入配置和方向角的电极的测量结果以进行验证。
确定的电极方向角的准确度为-0.6±1.5°（范围：-5.4至4.2°）。事实证明，这种准确度足够高，甚至可以分辨出各个电极之间的细微差异。
所提出的算法独立于用户，对于临床病例中通常出现的所有角度组合的分段电极方向，都能提供高度准确的结果。
