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. 2017 Apr 19;12(4):e0176130.
doi: 10.1371/journal.pone.0176130. eCollection 2017.

Comparison of T2*-weighted and QSM contrasts in Parkinson's disease to visualize the STN with MRI

Anneke Alkemade  1 , Gilles de Hollander  1 , Max C Keuken  1   2 , Andreas Schäfer  2 , Derek V M Ott  2   3 , Johannes Schwarz  4 , David Weise  5 , Sonja A Kotz  2   6 , Birte U Forstmann  1   7
Affiliations

Comparison of T2*-weighted and QSM contrasts in Parkinson's disease to visualize the STN with MRI

Anneke Alkemade et al. PLoS One. .

Abstract

The subthalamic nucleus (STN) plays a crucial role in the surgical treatment of Parkinson's disease (PD). Studies investigating optimal protocols for STN visualization using state of the art magnetic resonance imaging (MRI) techniques have shown that susceptibility weighted images, which display the magnetic susceptibility distribution, yield better results than T1-weighted, T2-weighted, and T2*-weighted contrasts. However, these findings are based on young healthy individuals, and require validation in elderly individuals and persons suffering from PD. Using 7T MRI, the present study set out to investigate which MRI contrasts yielded the best results for STN visualization in 12 PD patients and age-matched healthy controls (HC). We found that STNs were more difficult to delineate in PD as reflected by a lower inter-rater agreement when compared to HCs. No STN size differences were observed between the groups. Analyses of quantitative susceptibility mapping (QSM) images showed a higher inter-rater agreement reflected by increased Dice-coefficients. The location of the center of mass of the STN was not affected by contrast. Overall, contrast-to-noise ratios (CNR) were higher in QSM than in T2*-weighted images. This can at least partially, explain the higher inter-rater agreement in QSM. The current results indicate that the calculation of QSM contrasts contributes to an improved visualization of the entire STN. We conclude that QSM contrast is the preferred choice for the visualization of the STN in persons with PD as well as in aging HC.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. STN outlines.
Representative views of the STN (coronal and axial views) of the T2*-weighted and QSM contrasts. Note the overlapping outlines of the STN masks made by two different raters in red and blue.
Fig 2
Fig 2. Quantitative results.
A) Mean dice-coefficients. PD participants are compared to healthy controls. Error bars indicate 95% bootstrapped confidence intervals. Note the significant increase in Dice-coefficient in QSM contrasts. B) Mean distances between the center of mass. Error bars indicate 95% bootstrapped confidence interval. Note the smaller distances in the QSM corresponding to higher agreement between raters. C) Average contrast-to-noise ratios (CNRs). Error bars indicate 95% bootstrapped confidence interval. Note that higher CNR-values in QSM contrasts reflect improved visibility.
Fig 3
Fig 3. Probabilistic STN atlas in standard MNI space.
The probability maps for the controls are in red-yellow. Superimposed in blue are the probability maps for Parkinson’s disease patients. Color intensity reflects the percentage overlap between individuals.
See this image and copyright information in PMC

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