Bionics Institute, East Melbourne, Victoria, Australia.
School of Engineering, RMIT University, Melbourne, Victoria, Australia.
J Neuroimaging. 2023 Sep-Oct;33(5):792-801. doi: 10.1111/jon.13133. Epub 2023 Jun 8.
In deep brain stimulation (DBS), accurate electrode placement is essential for optimizing patient outcomes. Localizing electrodes enables insight into therapeutic outcomes and development of metrics for use in clinical trials. Methods of defining anatomical targets have been described with varying accuracy and objectivity. To assess variability in anatomical targeting, we compare four methods of defining an appropriate target for DBS of the subthalamic nucleus for Parkinson's disease.
The methods compared are direct visualization, red nucleus-based indirect targeting, mid-commissural point-based indirect targeting, and automated template-based targeting. This study assessed 226 hemispheres in 113 DBS recipients (39 females, 73 males, 62.2 ± 7.7 years). We utilized the electrode placement error (the Euclidean distance between the defined target and closest DBS electrode) as a metric for comparative analysis. Pairwise differences in electrode placement error across the four methods were compared using the Kruskal-Wallis H-test and Wilcoxon signed-rank tests.
Interquartile ranges of the differences in electrode placement error spanned 1.18-1.56 mm. A Kruskal-Wallis H-test reported a statistically significant difference in the median of at least two groups (H(5) = 41.052, p < .001). Wilcoxon signed-rank tests reported statistically significant difference in two comparisons: direct visualization versus red nucleus-based indirect, and direct visualization versus automated template-based methods (T < 9215, p < .001).
All methods were similarly discordant in their relative accuracy, despite having significant technical differences in their application. The differing protocols and technical aspects of each method, however, have the implication that one may be more practical depending on the clinical or research application at hand.
在脑深部刺激（DBS）中，准确的电极放置对于优化患者的治疗效果至关重要。对电极进行定位有助于深入了解治疗效果，并开发用于临床试验的指标。目前已经描述了多种定义解剖学目标的方法，其准确性和客观性各有不同。为了评估解剖学定位的变异性，我们比较了 4 种用于帕金森病患者丘脑底核 DBS 的合适目标定义方法。
比较的方法包括直接可视化、基于红核的间接靶向、中脑连合点基于间接靶向和自动模板基于靶向。本研究评估了 113 名 DBS 接受者的 226 个半球（39 名女性，73 名男性，62.2±7.7 岁）。我们使用电极放置误差（定义的目标与最近的 DBS 电极之间的欧几里得距离）作为比较分析的指标。使用 Kruskal-Wallis H 检验和 Wilcoxon 符号秩检验比较了 4 种方法之间电极放置误差的差异。
电极放置误差的四分位间距跨度为 1.18-1.56mm。Kruskal-Wallis H 检验报告称，至少有两组的中位数存在统计学差异（H(5) = 41.052，p <.001）。Wilcoxon 符号秩检验报告了两项比较存在统计学差异：直接可视化与基于红核的间接靶向，以及直接可视化与自动模板基于方法（T < 9215，p <.001）。
尽管在应用上存在显著的技术差异，但所有方法的相对准确性都存在差异。然而，每种方法的不同方案和技术方面意味着，根据手头的临床或研究应用，一种方法可能更实用。
