An Application of Advanced Imaging and Visualization to Clinical Deep Brain Stimulation

PROJECT SUMMARY Subthalamic deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) can be highly effective at improving motor symptoms and enhancing the patient’s quality of life. However, DBS surgical targeting technology and post-operative programming practices have been relatively stagnant over the ~20 year history of the therapy. Nonetheless, substantial scientific advances have been made in MRI acquisition protocols, patient-specific DBS modeling methods, and 3D visualization technologies. Therefore, the goal of this Bioengineering Research Grant (PAR-19-159) is to apply the latest advances in MR imaging, DBS modeling, and holographic visualization to the clinical practice of subthalamic DBS for PD. The first step of this project is to apply the scientific advances of quantitative MRI to the clinical problem of subthalamic nucleus (STN) identification in patients with PD. Magnetic Resonance Fingerprinting (MRF) is a completely new approach to MR acquisition, reconstruction, and post processing. Our group has used MRF to simultaneously acquire quantitative maps of T1, T2, and T2* in a single, inherently co-registered, whole-brain 3D acquisition, with 0.6 mm3 image resolution, lasting only ~15 min. The key advantage of multi-dimensional MRF data is that provides the best possible information for performing volumetric segmentation of the STN. The second step of this project is to take the patient-specific MRF data, with our STN segmentations, and integrate them with the coordinate system of the stereotactic frame via holographic visualization for the neurosurgeon. Our group developed the first fully functional neurosurgical navigation system within the Microsoft HoloLens visualization platform and this system is directly compatible with the Leksell stereotactic frame. This study will apply that tool we call HoloDBS to the creation of the pre-operative surgical plan for our research subjects. The third step of this project is to take the patient-specific holographic model of DBS and put it into the hands of the programming neurologist. Modern DBS devices consist of electrodes with 8 contacts and a nearly infinite parameter space of stimulus amplitudes, pulse durations, and frequencies. This study will provide our patient-specific DBS models, which also run within the HoloLens platform, to the neurologist who can then use holographic visualization to help customize the treatment to patient.