Atlas-based identification of targets for functional radiosurgery

Joseph Stancanello, Pantaleo Romanelli, Nicola Modugno, Pietro Cerveri, Giancarlo Ferrigno, Fulvio Uggeri, Giampaolo Cantore

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Functional disorders of the brain, such as Parkinson's disease, dystonia, epilepsy, and neuropathic pain, may exhibit poor response to medical therapy. In such cases, surgical intervention may become necessary. Modern surgical approaches to such disorders include radio-frequency lesioning and deep brain stimulation (DBS). The subthalamic nucleus (STN) is one of the most useful stereotactic targets available: STN DBS is known to induce substantial improvement in patients with end-stage Parkinson's disease. Other targets include the Globus Pallidus pars interna (GPi) for dystonia and Parkinson's disease, and the centromedian nucleus of the thalamus (CMN) for neuropathic pain. Radiosurgery is an attractive noninvasive alternative to treat some functional brain disorders. The main technical limitation to radiosurgery is that the target can be selected only on the basis of magnetic resonance anatomy without electrophysiological confirmation. The aim of this work is to provide a method for the correct atlas-based identification of the target to be used in functional neurosurgery treatment planning. The coordinates of STN, CMN, and GPi were identified in the Talairach and Tournoux atlas and transformed to the corresponding regions of the Montreal Neurological Institute (MNI) electronic atlas. Binary masks describing the target nuclei were created. The MNI electronic atlas was deformed onto the patient magnetic resonance imaging-T1 scan by applying an affine transformation followed by a local nonrigid registration. The first transformation was based on normalized cross correlation and the second on optimization of a two-part objective function consisting of similarity criteria and weighted regularization. The obtained deformation field was then applied to the target masks. The minimum distance between the surface of an implanted electrode and the surface of the deformed mask was calculated. The validation of the method consisted of comparing the electrode-mask distance to the clinical outcome of the treatments in ten cases of bilateral DBS implants. Electrode placement may have an effect within a radius of stimulation equal to 2 mm, therefore the registration process is considered successful if error is less than 2 mm. The registrations of the MNI atlas onto the patient space succeeded in all cases. The comparison of the distance to the clinical outcome revealed good agreement: where the distance was high (at least in one implant), the clinical outcome was poor; where there was a close correlation between the structures, clinical outcome revealed an improvement of the pathological condition. In conclusion, the proposed method seems to provide a useful tool for the identification of the target nuclei for functional radiosurgery. Also, the method is applicable to other types of functional treatment.

Original languageEnglish
Pages (from-to)1603-1611
Number of pages9
JournalMedical Physics
Volume33
Issue number6
DOIs
Publication statusPublished - Jun 2006

Fingerprint

Radiosurgery
Atlases
Masks
Subthalamic Nucleus
Deep Brain Stimulation
Intralaminar Thalamic Nuclei
Parkinson Disease
Globus Pallidus
Dystonia
Brain Diseases
Neuralgia
Thalamus
Electrodes
Implanted Electrodes
Neurosurgery
Radio
Epilepsy
Anatomy
Magnetic Resonance Spectroscopy
Therapeutics

Keywords

  • Atlas-based identification
  • Centromedian nucleus
  • Functional radiosurgery
  • Globus pallidus pars interna
  • Non-rigid registration
  • Subthalamic nucleus

ASJC Scopus subject areas

  • Biophysics

Cite this

Stancanello, J., Romanelli, P., Modugno, N., Cerveri, P., Ferrigno, G., Uggeri, F., & Cantore, G. (2006). Atlas-based identification of targets for functional radiosurgery. Medical Physics, 33(6), 1603-1611. https://doi.org/10.1118/1.2198588

Atlas-based identification of targets for functional radiosurgery. / Stancanello, Joseph; Romanelli, Pantaleo; Modugno, Nicola; Cerveri, Pietro; Ferrigno, Giancarlo; Uggeri, Fulvio; Cantore, Giampaolo.

In: Medical Physics, Vol. 33, No. 6, 06.2006, p. 1603-1611.

Research output: Contribution to journalArticle

Stancanello, J, Romanelli, P, Modugno, N, Cerveri, P, Ferrigno, G, Uggeri, F & Cantore, G 2006, 'Atlas-based identification of targets for functional radiosurgery', Medical Physics, vol. 33, no. 6, pp. 1603-1611. https://doi.org/10.1118/1.2198588
Stancanello J, Romanelli P, Modugno N, Cerveri P, Ferrigno G, Uggeri F et al. Atlas-based identification of targets for functional radiosurgery. Medical Physics. 2006 Jun;33(6):1603-1611. https://doi.org/10.1118/1.2198588
Stancanello, Joseph ; Romanelli, Pantaleo ; Modugno, Nicola ; Cerveri, Pietro ; Ferrigno, Giancarlo ; Uggeri, Fulvio ; Cantore, Giampaolo. / Atlas-based identification of targets for functional radiosurgery. In: Medical Physics. 2006 ; Vol. 33, No. 6. pp. 1603-1611.
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