Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Oper Neurosurg (Hagerstown). 2023 Nov 1;25(5):441-448. doi: 10.1227/ons.0000000000000849. Epub 2023 Aug 16.
Commercially available lead localization software for deep brain stimulation (DBS) often relies on postoperative computed tomography (CT) scans to define electrode positions. When cases are performed with intraoperative MRI, another imaging set exists with which to perform these localizations. To compare DBS localization error between postoperative CT scans and intraoperative MRI.
A retrospective cohort of patients who underwent MRI-guided placement of DBS electrodes using the ClearPoint platform was identified. Using Brainlab Elements, postoperative CT scans were coregistered to intraoperative magnetic resonance images visualizing the ClearPoint guidance sheaths and ceramic stylets. DBS electrodes were identified in CT scans using Brainlab's lead localization tool. Trajectory and vector errors were quantified between scans for each lead in each patient.
Eighty patients with a total of 157 implanted DBS electrodes were included. We observed mean trajectory and vector errors of 0.78 ± 0.44 mm (range 0.1-2.0 mm) and 1.57 ± 0.79 mm (range 0.2-4.2 mm), respectively, between postoperative CT and intraoperative MRI. There were 7 patients with CT scans collected at multiple time points. Trajectory error increased by 0.15 ± 0.42 mm ( P = .31), and vector error increased by 0.22 ± 0.53 mm ( P = .13) in the later scans. Across all scans, there was no significant association between trajectory ( P = .053) or vector ( P = .98) error and the date of CT acquisition. DBS electrodes targeting the subthalamic nucleus had significantly greater trajectory errors ( P = .02) than those targeting the globus pallidus pars internus nucleus.
Commercially available software produced largely concordant lead localizations when comparing intraoperative MRIs with postoperative CT scans, with trajectory errors on average <1 mm. CT scans tend to be more comparable with intraoperative MRI in the immediate postoperative period, with increased time intervals associated with a greater magnitude of error between modalities.
商用的深部脑刺激（DBS）定位软件通常依赖于术后 CT 扫描来定义电极位置。当使用术中 MRI 进行手术时，存在另一种成像套件可用于进行这些定位。比较术后 CT 扫描与术中 MRI 之间的 DBS 定位误差。
回顾性分析了使用 ClearPoint 平台进行 MRI 引导 DBS 电极植入的患者队列。使用 Brainlab Elements，将术后 CT 扫描与术中磁共振图像配准，可视化 ClearPoint 引导鞘和陶瓷导向针。在 CT 扫描中使用 Brainlab 的导联定位工具识别 DBS 电极。对每位患者的每个导联在两次扫描之间进行轨迹和向量误差的量化。
共纳入 80 例患者，共植入 157 个 DBS 电极。我们观察到术后 CT 与术中 MRI 之间的平均轨迹和向量误差分别为 0.78 ± 0.44 mm（范围 0.1-2.0 mm）和 1.57 ± 0.79 mm（范围 0.2-4.2 mm）。有 7 例患者进行了多次 CT 扫描。在后续的扫描中，轨迹误差增加了 0.15 ± 0.42 mm（P =.31），向量误差增加了 0.22 ± 0.53 mm（P =.13）。在所有扫描中，轨迹（P =.053）或向量（P =.98）误差与 CT 采集日期之间均无显著相关性。与靶向苍白球 internus 核的 DBS 电极相比，靶向丘脑底核的 DBS 电极的轨迹误差显著更大（P =.02）。
在比较术中 MRI 和术后 CT 扫描时，商用软件产生了大致一致的导联定位，平均轨迹误差<1 mm。在术后即刻，CT 扫描往往更能与术中 MRI 相匹配，随着时间间隔的延长，两种模态之间的误差幅度更大。
