Validation of diffusion tensor imaging tractography to visualize the dentatorubrothalamic tract for surgical planning.
J Neurosurg
; 130(1): 99-108, 2018 03 23.
Article
em En
| MEDLINE
| ID: mdl-29570012
ABSTRACT
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.
Palavras-chave
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
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Tálamo
/
Núcleos Cerebelares
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Tremor Essencial
/
Imagem de Tensor de Difusão
Tipo de estudo:
Observational_studies
Idioma:
En
Revista:
J Neurosurg
Ano de publicação:
2018
Tipo de documento:
Article