Li Yan, He Naying, Zhang Chencheng, Liu Yu, Li Jun, Sun Bomin, Lai Yijie, Li Hongyang, Wang Chengyan, Haacke Ewart Mark, Yan Fuhua, Li Dianyou
Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Huangpu District, Shanghai, 200025, China.
Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Huangpu District, Shanghai, 200025, China.
Neurol Ther. 2022 Jun;11(2):659-677. doi: 10.1007/s40120-022-00331-1. Epub 2022 Feb 14.
This study assessed the safety of postoperative diffusion tensor imaging (DTI) with on-state deep brain stimulation (DBS) and the feasibility of reconstruction of the white matter tracts in the vicinity of the stimulation site of the subthalamic nucleus (STN). The association between the impact of DBS on the nigrostriatal pathway (NSP) and the treatment effect on motor symptoms in Parkinson's disease (PD) was then evaluated.
Thirty-one PD patients implanted with STN-DBS (mean age: 66 years; 25 male) were scanned on a 1.5-T magnetic resonance imaging (MRI) scanner using the DTI sequence with DBS on. Twenty-three of them were scanned a second time with DBS off. The NSP, dentato-rubro-thalamic tract (DRTT), and hyperdirect pathway (HDP) were generated using both deterministic and probabilistic tractography methods. The DBS-on-state and off-state tractography results were validated and compared. Afterward, the relationships between the characteristics of the reconstructed white matter tracts and the clinical assessment of PD symptoms and the DBS effect were further examined.
No adverse events related to DTI were identified in either the DBS-on-state or off-state. Overall, the NSP was best reconstructed, followed by the DRTT and HDP, using the probabilistic tractography method. The connection probability of the left NSP was significantly lower than that of the right side (p < 0.05), and a negative correlation (r = -0.39, p = 0.042) was identified between the preoperative symptom severity in the medication-on state and the connection probability of the left NSP in the DBS-on-state images. Furthermore, the distance from the estimated left-side volume of tissue activated (VTA) by STN-DBS to the ipsilateral NSP was significantly shorter in the DBS-responsive group compared to the DBS-non-responsive group (p = 0.046).
DTI scanning is safe and delineation of white matter pathway is feasible for PD patients implanted with the DBS device. Postoperative DTI is a useful technique to strengthen our current understanding of the therapeutic effect of DBS for PD and has the potential to refine target selection strategies for brain stimulation.
本研究评估了帕金森病患者在开启状态下进行深部脑刺激（DBS）时术后弥散张量成像（DTI）的安全性，以及丘脑底核（STN）刺激部位附近白质束重建的可行性。随后评估了DBS对黑质纹状体通路（NSP）的影响与帕金森病（PD）运动症状治疗效果之间的关联。
31例植入STN-DBS的PD患者（平均年龄：66岁；25例男性）在1.5-T磁共振成像（MRI）扫描仪上使用开启DBS的DTI序列进行扫描。其中23例在关闭DBS时再次进行扫描。使用确定性和概率性纤维束成像方法生成NSP、齿状核-红核-丘脑束（DRTT）和超直接通路（HDP）。对开启DBS状态和关闭DBS状态下的纤维束成像结果进行验证和比较。之后，进一步研究重建白质束的特征与PD症状的临床评估及DBS效果之间的关系。
在开启DBS状态或关闭DBS状态下均未发现与DTI相关的不良事件。总体而言，使用概率性纤维束成像方法时，NSP重建效果最佳，其次是DRTT和HDP。左侧NSP的连接概率显著低于右侧（p<0.05），并且在开启DBS状态图像中，术前服药状态下的症状严重程度与左侧NSP的连接概率之间存在负相关（r=-0.39，p=0.042）。此外，与DBS无反应组相比，DBS有反应组中STN-DBS估计的左侧组织激活体积（VTA）到同侧NSP的距离显著更短（p=0.046）。
对于植入DBS装置的PD患者，DTI扫描是安全的，白质通路的描绘是可行的。术后DTI是一种有用的技术，可增强我们目前对DBS治疗PD效果的理解，并有可能优化脑刺激的靶点选择策略。
