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Purpose <p>Accurate segmentation of the subthalamic nucleus (STN) is paramount for optimising outcomes under deep brain stimulation (DBS) in Parkinson’s disease (PD). Clinically available tools like Brainlab Elements (BL-E) enable automated segmentations for surgical planning, yet their spatial relationship with postoperative volumes of tissue activated (VTAs) remains insufficiently characterised. Using multi-atlas segmentation (MAS) as an external anatomical reference, we compared the spatial correspondence of STN segmentations derived from BL-E with effective VTAs following monopolar contact review.</p> Methods <p>We analysed imaging data from 40 PD patients with chronic STN-DBS. Segmentations were obtained using BL-E based on T1w and T2w scans and MAS derived from a library of 20 manually segmented midbrain nuclei atlases. Spatial correspondence was assessed using Dice Coefficients, Jaccard Indices, and Euclidean centroid distances. Distances between VTA centroids and clinically established settings for STN-DBS were calculated to evaluate targeting consistency. Statistical differences between metrics were assessed using Wilcoxon signed-rank tests.</p> Results <p>BL-E segmentations demonstrated superior spatial correspondence with VTAs compared to MAS, with smaller Euclidean distances between centroids (<i>p</i> &lt; 0.001). Dice Coefficients and Jaccard Indices showed no significant differences (<i>p</i> = 0.18). VTA centroid distances to the most efficient stimulation location were consistent across hemispheres (left: 2.54&#xa0;mm [1.92–3.25]; right: 2.87&#xa0;mm [1.85–3.82]) MAS targets were positioned more inferiorly and anteriorly compared to BL-E targets.</p> Conclusion <p>Clinically applied VTAs showed good spatial correspondence with planning segmentations, suggesting within-workflow reproducibility but not superior correspondence to anatomical ground truth per se. Future studies should incorporate connectomic information to more accurately reflect the functional relevance of stimulation and its therapeutic effects.</p>

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Subthalamic segmentations in relation to deep brain stimulation volumes in Parkinson’s disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月1日

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  • Alexander Calvano,
  • Yiming Xiao,
  • Kenan Steidel,
  • Philipp A. Loehrer,
  • Marina C. Ruppert-Junck,
  • Christopher Nimsky,
  • Lars Timmermann,
  • Miriam H. A. Bopp,
  • David J. Pedrosa

摘要

Purpose

Accurate segmentation of the subthalamic nucleus (STN) is paramount for optimising outcomes under deep brain stimulation (DBS) in Parkinson’s disease (PD). Clinically available tools like Brainlab Elements (BL-E) enable automated segmentations for surgical planning, yet their spatial relationship with postoperative volumes of tissue activated (VTAs) remains insufficiently characterised. Using multi-atlas segmentation (MAS) as an external anatomical reference, we compared the spatial correspondence of STN segmentations derived from BL-E with effective VTAs following monopolar contact review.

Methods

We analysed imaging data from 40 PD patients with chronic STN-DBS. Segmentations were obtained using BL-E based on T1w and T2w scans and MAS derived from a library of 20 manually segmented midbrain nuclei atlases. Spatial correspondence was assessed using Dice Coefficients, Jaccard Indices, and Euclidean centroid distances. Distances between VTA centroids and clinically established settings for STN-DBS were calculated to evaluate targeting consistency. Statistical differences between metrics were assessed using Wilcoxon signed-rank tests.

Results

BL-E segmentations demonstrated superior spatial correspondence with VTAs compared to MAS, with smaller Euclidean distances between centroids (p < 0.001). Dice Coefficients and Jaccard Indices showed no significant differences (p = 0.18). VTA centroid distances to the most efficient stimulation location were consistent across hemispheres (left: 2.54 mm [1.92–3.25]; right: 2.87 mm [1.85–3.82]) MAS targets were positioned more inferiorly and anteriorly compared to BL-E targets.

Conclusion

Clinically applied VTAs showed good spatial correspondence with planning segmentations, suggesting within-workflow reproducibility but not superior correspondence to anatomical ground truth per se. Future studies should incorporate connectomic information to more accurately reflect the functional relevance of stimulation and its therapeutic effects.