Reproducibility of thalamic segmentation based on probabilistic tractography.
ABSTRACT Reliable identification of thalamic nuclei is required to improve targeting of electrodes used in Deep Brain Stimulation (DBS), and for exploring the role of thalamus in health and disease. A previously described method using probabilistic tractography to segment the thalamus based on connections to cortical target regions was implemented. Both within- and between-subject reproducibility were quantitatively assessed by the overlap of the resulting segmentations; the effect of two different numbers of target regions (6 and 31) on reproducibility of the segmentation results was also investigated. Very high reproducibility was observed when a single dataset was processed multiple times using different starting conditions. Thalamic segmentation was also very reproducible when multiple datasets from the same subject were processed using six cortical target regions. Within-subject reproducibility was reduced when the number of target regions was increased, particularly in medial and posterior regions of the thalamus. A large degree of overlap in segmentation results from different subjects was obtained, particularly in thalamic regions classified as connecting to frontal, parietal, temporal and pre-central cortical target regions.
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ABSTRACT: Stereotactic targets for thalamotomy are usually derived from population-based coordinates. Individual anatomy is used only to scale the coordinates based on the location of some internal guide points. While on conventional MR imaging the thalamic nuclei are indistinguishable, recently it has become possible to identify individual thalamic nuclei using different connectivity profiles, as defined by MR diffusion tractography. Here we investigated the inter-individual variation of the location of target nuclei for thalamotomy: the putative ventralis oralis posterior (Vop) and the ventral intermedius (Vim) nucleus as defined by probabilistic tractography. We showed that the mean inter-individual distance of the peak Vop location is 7.33 mm and 7.42 mm for Vim. The mean overlap between individual Vop nuclei was 40.2% and it was 31.8% for Vim nuclei. As a proof of concept, we also present a patient who underwent Vop thalamotomy for untreatable tremor caused by traumatic brain injury and another patient who underwent Vim thalamotomy for essential tremor. The probabilistic tractography indicated that the successful tremor control was achieved with lesions in the Vop and Vim respectively. Our data call attention to the need for a better appreciation of the individual anatomy when planning stereotactic functional neurosurgery.PLoS ONE 01/2012; 7(1):e29969. · 4.09 Impact Factor