A 3D multimodal approach to precisely locate DBS electrodes in the basal ganglia brain region

Deep Brain Stimulation (DBS) is the effective surgical treatment for drug-refractory movement disorders. In order to improve the therapeutic outcome precise anatomic location of electrodes must be achieved. Thus, neurologists can achieve better clinical decisions and take a more careful selection of the best stimulation parameters for DBS. In this paper, we present a system that accurately obtains the 3D positions of DBS electrodes relative to anatomical structures. The latter is based on the segmentation of deep brain structures and on a multimodal imaging approach. In this study, we examined 16 patients undergoing DBS (8 with Parkinson's disease and 8 with dystonia). A “neuroscientist friendly” graphic user interface (GUI) was designed to support the processing pipeline to precisely detect the electrodes from the DBS lead. Using this system, we obtained the electrodes position and compared them with the ones manually calculated by an experienced physician. The differences observed were less than a voxel size for 89.9% of the cases and the automated procedure takes less 97.5% time than the manual procedure (1min vs 40min). The resulting masks were congruent in shape and position with the corresponding areas in the individuals' space. Using our automatic segmentation pipeline, clinicians save 77% of their time when compared with a manual segmentation (1.20min vs 5.26min). Both structures and electrodes masks were warped to the MNI space in order to provide a common reference space, for the clinical interpretations.