On the (Non-)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients
On the (Non-)equivalency of monopolar and bipolar settings for deep brain stimulation fMRI studies of Parkinson's disease patients
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DOI：
10.1002/jmri.26321
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发表时间：
2019-06-01
影响因子：
4.4
通讯作者：
Madhavan, Radhika
中科院分区：
文献类型：
--
作者：
Hancu, Ileana;Boutet, Alexandre;Madhavan, Radhika
背景 大多数接受深部脑刺激 (DBS) 的帕金森病患者使用单极配置，这对脑电图和 MRI 研究提出了挑战。文献报道了将单极设置转换为双极设置的算法。目的/假设 在功能磁共振成像研究期间，使用已发表的转换方案，使用临床和假定的等效设置来评估植入 DBS 的帕金森病患者的大脑反应。研究类型前瞻性。受试者 13 名 DBS 患者。场强/序列 1.5T 和 3T，使用梯度回波平面成像的 fMRI。评估 患者使用单极和双极设置接受 30/30 秒开/关 DBS fMRI 扫描。为了转换为双极设置，用于单极配置的负极接触保持不变，相邻的背侧接触变为正极，同时将电压增加 30%。对两种配置下的患者进行了功能磁共振成像激活/失活图和运动统一帕金森病评定量表 (UPDRS-III) 评分的比较。统计检验 T 检验用于比较单极和双极配置中的 UPDRS 评分和组织激活 (VTA) 直径体积。结果单极和双极配置中的 fMRI 激活模式通常不同。使用患者的临床设置，丘脑、苍白球和视觉皮层表现出比假定的等效设置更高的激活。双极配置的 VTA 直径较小（7 毫米 vs. 6.3 毫米，P = 0.047），UPDRS 评分通常高于单极配置（28.3 +/- 17.4）（33.2 +/- 16），但未达到统计学显着性（P > 0.05）。数据结论 使用先前发布的单极-双极转换算法时，单极和双极配置会导致不同的大脑激活模式。通过不同的大脑反应模式可以实现临床益处。为了理解 DBS 的机制，应避免从一种到另一种的盲目转换。
Background The majority of Parkinson's disease patients with deep brain stimulation (DBS) use a monopolar configuration, which presents challenges for EEG and MRI studies. The literature reports algorithms to convert monopolar to bipolar settings. Purpose/Hypothesis To assess brain responses of Parkinson's disease patients implanted with DBS during fMRI studies using their clinical and presumed equivalent settings using a published conversion recipe. Study Type Prospective. Subjects Thirteen DBS patients. Field Strength/Sequence 1.5T and 3T, fMRI using gradient echo-planar imaging. Assessment Patients underwent 30/30sec ON/OFF DBS fMRI scans using monopolar and bipolar settings. To convert to a bipolar setting, the negative contact used for the monopolar configuration remained constant and the adjacent dorsal contact was rendered positive, while increasing the voltage by 30%. fMRI activation/deactivation maps and motor Unified Parkinson's Disease Rating Scale (UPDRS-III) scores were compared for patients in both configurations. Statistical Tests T-tests were used to compare UPDRS scores and volumes of tissue activated (VTA) diameters in monopolar and bipolar configurations. Results The patterns of fMRI activation in the monopolar and bipolar configurations were generally different. The thalamus, pallidum, and visual cortices exhibited higher activation using the patient's clinical settings than the presumed equivalent settings. VTA diameters were lower (7 mm vs. 6.3 mm, P = 0.047) and UPDRS scores were generally higher in the bipolar (33.2 +/- 16) than in the monopolar configuration (28.3 +/- 17.4), without reaching statistical significance (P > 0.05). Data Conclusion Monopolar and bipolar configurations result in different patterns of brain activation while using a previously published monopolar-bipolar conversion algorithm. Clinical benefits may be achieved with varying patterns of brain responses. Blind conversion from one to the other should be avoided for purposes of understanding the mechanisms of DBS.