| Background:Parkinson’s disease(PD)is a common neurodegenerative disease in middle-aged and elderly people at present.Its treatment methods mainly include drug therapy and surgical treatment.Deep Brain Stimulation(DBS)is considered to be an effective method for the treatment of advanced Parkinson’s disease.The key of the operation is to accurately implant intracranial electrodes into the designated target nucleus.In the past,disruptive surgery or electrode implantation in Parkinson’s disease was mainly performed by ventriculography and the coordinates of the nucleus provided by the human brain atlas,but the coordinates provided by the brain atlas are not applicable to each patient,However,because ventriculography cannot clearly show the brain tissue and nucleus structure,and the differences in individual development lead to large implantation error,the coordinates provided by the brain atlas are not applicable to every patient.With the progress of Medical Imaging,Magnetic Resonance Imaging(MRI)has gradually replaced ventriculography and brain atlas coordinates by virtue of good tissue contrast and direct vision of the target nucleus.However,due to the different magnetic resonance field intensities,the imaging sequence is numerous and the scaning time is long,the imaging effect of the target nucleus group is also different.For DBS surgery,there is no optimal sequence for guidance,and there are relative imaging errors among different sequences.Therefore,the imaging sequence commonly used in magnetic resonance and able to look directly at the target nucleus group was chosen as the research direction in this study to compare the imaging effect,accuracy,and error of the T2 sequence and SWI sequence.Objective:To explore the visualization effect and imaging clarity of magnetic resonance T2 sequence and SWI sequence in the Subthalamic Nucleus(STN),to study the error between the surgical target located by different sequences and the actual target,and to calculate the error amount,to guide the preoperative surgical planning and imaging selection.Research methods:A total of 11 patients,including 8 males(72.7%)and 3 females(27.3%),who received DBS surgery for Parkinson’s disease in the Department of Neurosurgery of the First Affiliated Hospital of Henan University from December 2018 to December 2020 and who met the inclusion criteria of this study were collected and analyzed.The average age is(58.55±6.78)from 45 to 67.The course of disease ranges from 5to 10,with a median course of 8 years.Hoehn-Yahr scores(Appendix 1)are mostly at grades 3-5,including1 person at grade 3,7 people at grade 4,and 3 people at grade 5.After rigorous preoperative evaluation,all patients received preoperative 3.0T magnetic resonance Imaging,and 3DT1 Bravo,T2,and Susceptibility Weighted Imaging(SWI)sequences were scanned.T2 sequence and SWI sequence were used to formulate the surgical plan and generate the corresponding surgical coordinates,and T2 sequence planning coordinates were selected for the operation,and intraoperative Microelectrode Recording(MER)was performed to assist in the verification of the core depth of the target.All patients received bilateral subthalamic nucleus deep brain electrode implantation,a total of 22 sides.High-resolution thin-layer craniocerebral CT was reexamined postoperatively and fused with preoperative MRI.The location coordinates of the electrode tip were reconstructed after surgery and compared with the coordinates of the T2 plan and the coordinates of the SWI plan respectively to analyze the error values.Results:By comparison of image sequences,the same sequence of the same patient was graded and scored by two non-surgical surgeons.the results show that the SWI sequence is higher than the T2 sequence in terms of nucleus imaging clarity and nucleus boundary recognition.The pairwise comparison of the two sequence planning coordinates and the actual coordinates show that the P-values of the left and right sides of the T2 planned coordinates and the actual coordinates on the X-axis are 0.077 and 0.119 respectively,both > 0.05,and the difference is not statistically significant,indicating that the preoperative planning and the actual coordinates after surgery are in high agreement on the X-axis.On the Y-axis,the P-values on the left and right sides are 0.000 and 0.003 respectively,both <0.05,and the difference is statistically significant.It shows that the actual Y-axis coordinate is behind the planned coordinate.The P-values on the left and right sides of the Z-axis are 0.01 and 0.003,respectively,both < 0.05,and the difference is statistically significant.It shows that the actual Z-axis coordinate is deeper than the Z-axis planned coordinate.SWI planned coordinates are compared with the actual coordinates.The p-values are 0.072 and 0.251 both > 0.05 for the left and right sides on the X-axis,0.398 and 0.181 for the left and right sides on the Y-axis,and 0.369 and 0.809 both > 0.05 for the left and right sides on the Z-axis,with no statistical difference,indicating a high degree of conformity between the SWI planned and actual coordinates.Comparison of T2 planning coordinates and SWI planning coordinates shows that P values on the left and right sides of the X-axis are 0.633 and 0.489 respectively,both greater than 0.05,and the difference is not statistically significant.P-values of 0.058 and 0.163 on the left and right sides of the Y-axis are > 0.05,respectively,and the difference is not statistically significant.It indicates that the coordinate of the T2 plan in the X-axis and Y-axis is in high conformity with the coordinate of the SWI plan.The P values on the left and right sides of the Z-axis are 0.000 and 0.001 respectively,both < 0.05,and the difference is statistically significant.This indicates that the planned coordinates on the Z-axis of SWI are deeper than those on the Z-axis of T2.The Z-axis difference between T2 and SWI coordinates on both sides is calculated and compared.The result is that the left SWI is 2.16±1.02 mm deeper than T2.The right SWI is 2.13±1.62 mm deeper than T2.Conclusions:1.SWI sequences show superiority over T2 sequences in terms of imaging effect and boundary display of target nucleus.2.The depth of STN in the SWI sequence is about 2mm deeper than that in the T2 sequence,and it is more consistent with the electrophysiological depth.3.The actual implanted electrode coordinates are backward compared to the T2 planned coordinates,However,there is no significant difference between the actual coordinates and the SWI sequence planning coordinates. |
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