Succop Benjamin S, Zamora Carlos, Roque Daniel Alberto, Hadar Eldad, Kessler Brice, Quinsey Carolyn
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Department of Neuroradiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Neurol. 2023 Dec 19;14:1253241. doi: 10.3389/fneur.2023.1253241. eCollection 2023.
This study sought to characterize postoperative day one MRI findings in deep brain stimulation (DBS) patients.
DBS patients were identified by CPT and had their reviewed by a trained neuroradiologist and neurosurgeon blinded to MR sequence and patient information. The radiographic abnormalities of interest were track microhemorrhage, pneumocephalus, hematomas, and edema, and the occurrence of these findings in compare the detection of these complications between T1/T2 gradient-echo (GRE) and T1/T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) sequences was compared. The presence, size, and association of susceptibility artifact with other radiographic abnormalities was also described. Lastly, the association of multiple microelectrode cannula passes with each radiographic finding was evaluated. investigation evaluated hemisphere-specific associations. Multiple logistic regression with Bonferroni correction (corrected = 0.006) was used for all analysis.
Out of 198 DBS patients reviewed, 115 (58%) patients showed entry microhemorrhage; 77 (39%) track microhemorrhage; 44 (22%) edema; 69 (35%) pneumocephalus; and 12 (6%) intracranial hematoma. T2 GRE was better for detecting microhemorrhage (OR = 14.82, < 0.0001 for entry site and OR = 4.03, < 0.0001 for track) and pneumocephalus (OR = 11.86, < 0.0001), while T2 FLAIR was better at detecting edema (OR = 123.6, < 0.0001). The relatively common findings of microhemorrhage and edema were best visualized by T2 GRE and T2 FLAIR sequences, respectively. More passes intraoperatively was associated with detection of ipsilateral track microhemorrhage (OR = 7.151, < 0.0001 left; OR = 8.953, < 0.0001 right). Susceptibility artifact surrounding electrodes possibly interfered with further detection of ipsilateral edema (OR = 4.323, = 0.0025 left hemisphere only).
Day one postoperative magnetic resonance imaging (MRI) for DBS patients can be used to detect numerous radiographic abnormalities not identifiable on a computed tomographic (CT) scan. For this cohort, multiple stimulating cannula passes intraoperatively was associated with increased microhemorrhage along the electrode track. Further studies should be performed to evaluate the clinical relevance of these observations.
本研究旨在描述脑深部电刺激（DBS）患者术后第一天的MRI表现。
通过CPT识别DBS患者，并由一位对MR序列和患者信息不知情的训练有素的神经放射科医生和神经外科医生进行复查。感兴趣的影像学异常包括轨迹微出血、气颅、血肿和水肿，并比较了T1/T2梯度回波（GRE）和T1/T2液体衰减反转恢复（FLAIR）磁共振（MR）序列中这些发现的发生率，以比较这些并发症的检测情况。还描述了敏感性伪影与其他影像学异常的存在、大小及相关性。最后，评估了多个微电极套管穿刺与每个影像学发现的相关性。该研究评估了半球特异性关联。所有分析均使用经Bonferroni校正（校正后 = 0.006）的多元逻辑回归。
在复查的198例DBS患者中，115例（58%）患者出现入口微出血；77例（39%）轨迹微出血；44例（22%）水肿；69例（35%）气颅；12例（6%）颅内血肿。T2 GRE在检测微出血（入口处OR = 14.82，< 0.0001；轨迹处OR = 4.03，< 0.0001）和气颅（OR = 11.86，< 0.0001）方面更好，而T2 FLAIR在检测水肿方面更好（OR = 123.6，< 0.0001）。微出血和水肿这两个相对常见的发现分别通过T2 GRE和T2 FLAIR序列能得到最佳显示。术中穿刺次数更多与同侧轨迹微出血的检测相关（左侧OR = 7.151，< 0.0001；右侧OR = 8.953，< 0.0001）。电极周围的敏感性伪影可能会干扰同侧水肿的进一步检测（仅左半球OR = 4.323，= 0.0025）。
DBS患者术后第一天的磁共振成像（MRI）可用于检测计算机断层扫描（CT）上无法识别的众多影像学异常。对于该队列，术中多个刺激套管穿刺与沿电极轨迹的微出血增加相关。应进行进一步研究以评估这些观察结果的临床相关性。
