Abstract
OBJECTIVES:The pedunculopontine nucleus (PPN) is considered a promising new target for neurostimulation in Parkinson's disease (PD) patients with postural instability and gait disturbance that is refractory to other treatment modalities. However, the PPN is typically difficult to visualize with magnetic resonance imaging (MRI) at clinical field strengths, which greatly limits the PPN as a viable surgical target for deep brain stimulation (DBS). Thus, the aim of this study is to directly visualize the PPN based on 7.0T ultrahigh-field MRI.METHODS:Five PD patients were enrolled and scanned using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI scanner. Then, the MP2RAGE sequences were imported into a commercially available navigation system. The coordinates of the directly localized PPN poles were recorded in the navigation system relative to the anterior commissure-posterior commissure plane.RESULTS:Our results indicated that the PPN presented intermediate signal intensity in the 7.0T ultrahigh-field MR images in comparison with the surrounding structure, such as the hypo-intensity of the periaqueductal gray and the hyperintensity of the neighboring white matter tracts, in PD patients. The mean coordinates for the rostral and caudal poles of PPN were 6.50 mm and 7.20 mm lateral, 1.58 mm and 2.21 mm posterior, and 8.89 mm and 13.83 mm relative to the posterior commissure.CONCLUSION:Our findings provide, for the first time, direct visualization of the PPN using the MP2RAGE sequence on a 7.0T ultrahigh-field MRI, which may improve the accuracy of stereotactic targeting of the PPN and improve the outcomes in patients undergoing DBS.
Highlights
As a leading cause of morbidity and death in advanced Parkinson’s disease (PD) patients, postural instability and gait disturbance (PIGD) has been a great challenge in the clinic because it is commonly refractory to currently available medications [1]
The pedunculopontine nucleus (PPN) was delineated as a region of intermediate signal intensity when compared to the surrounding structure, such as the hypo-intensity of the periaqueductal gray (PAG) and the hyperintensity of the neighboring triad of white matter tracts
Our findings provide, for the first time, direct visualization of the PPN in PD patients with the use of 7.0T ultrahigh-field magnetic resonance imaging (MRI)
Summary
As a leading cause of morbidity and death in advanced PD patients, postural instability and gait disturbance (PIGD) has been a great challenge in the clinic because it is commonly refractory to currently available medications [1]. Previous studies have demonstrated that the pedunculopontine nucleus (PPN) is an important component of the locomotor region in the brain stem and a key structure in the control of posture and gait [1,2,3]. To date, there are several completed or ongoing studies on the topic of PPN-DBS for addressing PIGD in PD. Received for publication on February 8, 2018. Accepted for publication on December 21, 2018
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