Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Breisacher Strasse 64, 79106, Freiburg i.Br, Germany.
Medical Faculty of Freiburg University, Freiburg, Germany.
Acta Neurochir (Wien). 2021 Oct;163(10):2809-2824. doi: 10.1007/s00701-021-04890-4. Epub 2021 Jun 28.
An increasing number of neurosurgeons use display of the dentato-rubro-thalamic tract (DRT) based on diffusion weighted imaging (dMRI) as basis for their routine planning of stimulation or lesioning approaches in stereotactic tremor surgery. An evaluation of the anatomical validity of the display of the DRT with respect to modern stereotactic planning systems and across different tracking environments has not been performed.
Distinct dMRI and anatomical magnetic resonance imaging (MRI) data of high and low quality from 9 subjects were used. Six subjects had repeated MRI scans and therefore entered the analysis twice. Standardized DICOM structure templates for volume of interest definition were applied in native space for all investigations. For tracking BrainLab Elements (BrainLab, Munich, Germany), two tensor deterministic tracking (FT2), MRtrix IFOD2 ( https://www.mrtrix.org ), and a global tracking (GT) approach were used to compare the display of the uncrossed (DRTu) and crossed (DRTx) fiber structure after transformation into MNI space. The resulting streamlines were investigated for congruence, reproducibility, anatomical validity, and penetration of anatomical way point structures.
In general, the DRTu can be depicted with good quality (as judged by waypoints). FT2 (surgical) and GT (neuroscientific) show high congruence. While GT shows partly reproducible results for DRTx, the crossed pathway cannot be reliably reconstructed with the other (iFOD2 and FT2) algorithms.
Since a direct anatomical comparison is difficult in the individual subjects, we chose a comparison with two research tracking environments as the best possible "ground truth." FT2 is useful especially because of its manual editing possibilities of cutting erroneous fibers on the single subject level. An uncertainty of 2 mm as mean displacement of DRTu is expectable and should be respected when using this approach for surgical planning. Tractographic renditions of the DRTx on the single subject level seem to be still illusive.
越来越多的神经外科医生使用基于弥散加权成像（dMRI）的齿状核红核丘脑束（DRT）显示作为立体定向震颤手术中刺激或损毁方法常规计划的基础。尚未针对现代立体定向规划系统和不同跟踪环境评估 DRT 显示的解剖学有效性。
使用 9 名受试者的高质量和低质量的不同弥散加权成像（dMRI）和解剖磁共振成像（MRI）数据。其中 6 名受试者接受了重复 MRI 扫描，因此他们分析了两次。所有研究均在原始空间中应用了用于定义感兴趣区域的标准化 DICOM 结构模板。对于 BrainLab Elements（德国慕尼黑 BrainLab）的跟踪，使用了两种张量确定性跟踪（FT2）、MRtrix IFOD2（https://www.mrtrix.org）和全局跟踪（GT）方法，将未交叉（DRTu）和交叉（DRTx）纤维结构转换为 MNI 空间后比较显示。研究了所得的流线的一致性、可重复性、解剖学有效性和解剖学途径结构的穿透性。
一般来说，DRTu 可以用高质量显示（根据途径点判断）。FT2（手术）和 GT（神经科学）显示高度一致。虽然 GT 对 DRTx 的结果具有部分可重复性，但其他（iFOD2 和 FT2）算法无法可靠重建交叉途径。
由于在个体受试者中进行直接解剖比较较为困难，我们选择与两种研究性跟踪环境进行比较作为最佳“真实情况”。FT2 特别有用，因为它具有在单个受试者水平上手动编辑错误纤维的可能性。在使用这种方法进行手术计划时，预计 DRTu 的平均位移为 2 毫米的不确定性，并且应该尊重该值。在单个受试者水平上，DRTx 的轨迹显示似乎仍然难以捉摸。
