T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease.

Lönnfors-Weitzel, Tarja; Weitzel, Thilo; Slotboom, Johannes; Kiefer, Claus; Pollo, Claudio; Schüpbach, Michael; Oertel, Markus Florian; Kaelin, Alain; Wiest, Roland (2016). T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease. NeuroImage: Clinical, 12, pp. 832-837. Elsevier 10.1016/j.nicl.2016.09.019

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INTRODUCTION Deep brain stimulation (DBS) nowadays is a well-established treatment of motor symptoms in Parkinson's disease. The subthalamic nucleus (STN) is a common target for DBS, because motor improvements have been shown to be superior to best medical therapy, if DBS electrodes have been appropriately positioned. DBS target identification can be assisted by MRI beyond structural imaging by spatially resolved measurement of T2-relaxation times (T2r). AIM We pose the question, whether T2r of the STN is linked to the severity of the disease and whether outcome of DBS may be correlated to an asymmetric manifestation of the disease. Further, we investigated if abnormal T2r in the STN may be predictive for outcome of DBS. METHODS Twelve patients underwent preoperative MR imaging including a multi echo relaxometry sequence (3 Tesla, Siemens Medical Systems, Erlangen, Germany) ahead of DBS. T2r were determined for STN, substantia nigra (SN), red nucleus (RN) and centrum semiovale (CSO). Unified Parkinson's disease Rating Scale (UPDRS) scores were tested before and after DBS. Patients' T2r and deduced values representing left-right asymmetry of measurements were correlated with UPDRS scores and measures for outcome of DBS. Furthermore, patients' T2r were compared with T2r measurements in 12 healthy controls (HC). RESULTS Patients' T2r for SN (mean 45.4 ms ± 4.4 ms) and STN (mean 56.4 ms ± 3.8 ms) were significantly shorter than T2r in HCs for SN (mean 60.7 ± 4.6) and STN (mean 66.1 ms ± 4.0 ms). While no mean T2r asymmetry was found in the SN, patients' mean T2r for STN showed a weakened left-right correlation (Pearson correlation coefficient 0.19 versus 0.72 in HC) indicating asymmetric degeneration. T2r asymmetry was not linked to the more severely affected hemisphere. The respective lower T2r within the left or right target region was significantly correlated to the outcome in terms of UPDRS III improvement in "off" state (Pearson correlation 0.82 corresponding to p ≪ 0.01). Patients with T2r of STN lower than 50 ms showed no response to DBS in the UPDRS. The maximum T2r for SN correlated to the improvement between UPDRS "off" minus and "on" (Dopamine response) but failed to predict DBS outcome. CONCLUSIONS The lower boundaries of T2r in the STN predict motor outcome in DBS. T2r asymmetry in the STN is not associated with increased clinical symptoms, but with response to therapy. Thus, patients with very low T2r may be inappropriate candidates for DBS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine

UniBE Contributor:

Lönnfors-Weitzel, Tarja; Weitzel, Thilo; Slotboom, Johannes; Kiefer, Claus; Pollo, Claudio; Schüpbach, Michael; Oertel, Markus Florian; Kaelin, Alain and Wiest, Roland

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2213-1582

Publisher:

Elsevier

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

16 Jan 2017 09:31

Last Modified:

16 Jan 2017 09:31

Publisher DOI:

10.1016/j.nicl.2016.09.019

PubMed ID:

27843765

Uncontrolled Keywords:

Basal ganglia; Deep brain stimulation; Parkinson's disease; Subthalamic nucleus; T2 relaxometry

BORIS DOI:

10.7892/boris.91575

URI:

https://boris.unibe.ch/id/eprint/91575

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