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T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease.
Neuroimage Clin. 2016; 12:832-837.NC

Abstract

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.

Authors+Show Affiliations

University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.Movement Disorders Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.Movement Disorders Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27843765

Citation

Lönnfors-Weitzel, Tarja, et al. "T2-relaxometry Predicts Outcome of DBS in Idiopathic Parkinson's Disease." NeuroImage. Clinical, vol. 12, 2016, pp. 832-837.
Lönnfors-Weitzel T, Weitzel T, Slotboom J, et al. T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease. Neuroimage Clin. 2016;12:832-837.
Lönnfors-Weitzel, T., Weitzel, T., Slotboom, J., Kiefer, C., Pollo, C., Schüpbach, M., Oertel, M., Kaelin, A., & Wiest, R. (2016). T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease. NeuroImage. Clinical, 12, 832-837.
Lönnfors-Weitzel T, et al. T2-relaxometry Predicts Outcome of DBS in Idiopathic Parkinson's Disease. Neuroimage Clin. 2016;12:832-837. PubMed PMID: 27843765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - T2-relaxometry predicts outcome of DBS in idiopathic Parkinson's disease. AU - Lönnfors-Weitzel,Tarja, AU - Weitzel,Thilo, AU - Slotboom,Johannes, AU - Kiefer,Claus, AU - Pollo,Claudio, AU - Schüpbach,Michael, AU - Oertel,Markus, AU - Kaelin,Alain, AU - Wiest,Roland, Y1 - 2016/09/29/ PY - 2016/06/22/received PY - 2016/09/26/revised PY - 2016/09/28/accepted PY - 2016/11/16/entrez PY - 2016/11/16/pubmed PY - 2017/11/3/medline KW - Basal ganglia KW - Deep brain stimulation KW - Parkinson's disease KW - Subthalamic nucleus KW - T2 relaxometry SP - 832 EP - 837 JF - NeuroImage. Clinical JO - Neuroimage Clin VL - 12 N2 - 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. SN - 2213-1582 UR - https://www.unboundmedicine.com/medline/citation/27843765/T2_relaxometry_predicts_outcome_of_DBS_in_idiopathic_Parkinson's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-1582(16)30177-2 DB - PRIME DP - Unbound Medicine ER -