Validation of diffusion tensor imaging tractography to visualize the dentatorubrothalamic tract for surgical planning.

Nowacki, Andreas; Schlaier, Jürgen; Debove, Ines; Pollo, Claudio (2018). Validation of diffusion tensor imaging tractography to visualize the dentatorubrothalamic tract for surgical planning. Journal of neurosurgery, 130(1), pp. 99-108. American Association of Neurological Surgeons 10.3171/2017.9.JNS171321

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OBJECTIVE The dentatorubrothalamic tract (DRTT) has been suggested as the anatomical substrate for deep brain stimulation (DBS)-induced tremor alleviation. So far, little is known about how accurately and reliably tracking results correspond to the anatomical DRTT. The objective of this study was to systematically investigate and validate the results of different tractography approaches for surgical planning. METHODS The authors retrospectively analyzed 4 methodological approaches for diffusion tensor imaging (DTI)-based fiber tracking using different regions of interest in 6 patients with essential tremor. Tracking results were analyzed and validated with reference to MRI-based anatomical landmarks, were projected onto the stereotactic atlas of Morel at 3 predetermined levels (vertical levels -3.6, -1.8, and 0 mm below the anterior commissure-posterior commissure line), and were correlated to clinical outcome. RESULTS The 4 different methodologies for tracking the DRTT led to divergent results with respect to the MRI-based anatomical landmarks and when projected onto the stereotactic atlas of Morel. There was a statistically significant difference in the lateral and anteroposterior coordinates at the 3 vertical levels (p < 0.001, 2-way ANOVA). Different fractional anisotropy values ranging from 0.1 to 0.46 were required for anatomically plausible tracking results and led to varying degrees of success. Tracking results were not correlated to postoperative tremor reduction. CONCLUSIONS Different tracking methods can yield results with good anatomical approximation. The authors recommend using 3 regions of interest including the dentate nucleus of the cerebellum, the posterior subthalamic area, and the precentral gyrus to visualize the DRTT. Tracking results must be cautiously evaluated for anatomical plausibility and accuracy in each patient.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Nowacki, Andreas; Debove, Ines and Pollo, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

09 May 2018 15:31

Last Modified:

25 Oct 2019 11:26

Publisher DOI:

10.3171/2017.9.JNS171321

PubMed ID:

29570012

Uncontrolled Keywords:

AC = anterior commissure AP = anteroposterior DBS = deep brain stimulation DRTT = dentatorubrothalamic tract DTI = diffusion tensor imaging DTI fiber tracking ET = essential tremor FA = fractional anisotropy LAT = lateral ML = medial lemniscus PC = posterior commissure PSA = posterior subthalamic area PT = pyramidal tract RN = red nucleus ROI = region of interest STN = subthalamic nucleus TRS = Fahn-Tolosa-Marin tremor rating scale VERT = vertical VLp = ventrolateral posterior part of the thalamus Vim = ventral intermediate nucleus deep brain stimulation dentatorubrothalamic tract fct = fasciculus cerebellothalamicus functional neurosurgery ml = medial lemniscus per the Morel atlas surgical planning

BORIS DOI:

10.7892/boris.116434

URI:

https://boris.unibe.ch/id/eprint/116434

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